QuestionI have children from a previous marriage, no fertility issues there. My spouse also has children from a previous marriage. I was pregnant with his child 1 1/2 years ago and lost that child to a cord accident @ 28 weeks. I wasn't even trying to conceive. We have been TTC for 11 months. My FSH level was 6 and my LH was 4. I was put on clomid 50mg. They have suggested I move to IUI after 3 cycles of clomid and I have no problem with that but what would cause infertility when I have had no problems and my levels and my husbands are okay? I had an ultrasound on CD 10 and I had 7 follicles ranging from 10mm-14mm and I believe that is high? I just don't get it. Any insight would be appreciated .
Cindy
AnswerHello,
You mention in the "Subject" category that you are 38. (I presume that is what the number means). If that is the case, then your age is the current impediment. The natural chances of pregnancy at 38 years old is 12% per year or 1% per month of trying. That is the biggest change. The decrease in fertility is because the majority of your eggs are not viable (poor quality). This viability decreases with age from the time a woman is born. The fertility lifetime is only about 42 years.
If you want to approach your attempts in the most conservative manner, then IUI would be a good point to start. I would not recommend more than 4 attempts with IUI, however, and your doctor's recommendation of two attempts is reasonable. Ideally, however, I would recommend that you move to the most aggressive plan, which is IVF. The reason is that this will give you the highest chances for success, in the shortest period of time, in your age group. We are seeing a 50-60% chance of pregnancy per attempt in our program, in your age group. Rather than waste time on IUI (3-5% chance of pregnancy per attempt at 38 years old), IVF would be the treatment of choice. Your ovaries are still working well and stimulate well so you would be a good candidate. Considering that you have been pregnant before, your chances might be even higher than quoted as it has been shown in previous studies that women who have been pregnant previously have higher pregnancy rates than women who have not been pregnant before within the same age group.
Good luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
