I have not answered questions since October, so here we go.

Because it’s been a while, sorry if my answers are a little late for those asking, but I hope other readers will have the same questions and learn from the dialogue.

A woman wrote in frantically about her new experiences using Clomid. In fact she was do distraught, she was really concerned about getting pregnant with her second child even though she was not yet pregnant with her first. Yes Clomid can make you extremely emotional, but no one should really be over the edge. If you feel like this woman, get counseling (which more people really should do) or get off Clomid, or both.

Antral follicle counts are only a guide. If you have a total of 11, you don’t really know how the cycle will work out. 11 is a very adequate number; you will probably have a nice enough response for pregnancy.

Cost efficiency of IUI vs. IVF. If you have PCOS, your injection iui cycles may be more expensive than other women’s cycles because you need to be watched more closely. But, you are more fertile that the average woman. Go over the costs of each with you doctor in the beginning. And of course you need a little luck. If you get pregnant quickly with iui, you look like a genius.

Zero Sperm Morphology. I don’t think sperm morphology is much of an issue unless it’s zero, but usually that translates to a fertilization problem. If miscarriage is the problem we don’t know. The dilemma is no one can tell you will never become pregnant with his sperm.

From to Clomid to IVF with PCOS. Women with PCO can safely be given injectables. The key is starting on a very low dose. It is sometimes a pain because the cycle becomes long, but if you don’t want to go to IVF right away, ask your doctor about a low dose protocol.

MTHFR: I like your doctor’s response. No one has shown that blood thinners are appropriate or even help. Be sure your homocystine levels are normal.

Hypothalamic Amenorrhea. Most women with this do not bleed after Provera or other progesterones, and most do not respond to Clomid. Usually the injections are necessary.

What are normal progesterone levels? We don’t know. All doctors have their own ideas. I don’t think they need to be very high.

BMI cutoffs for IVF. This depends on a few things. Can you be safely administered anesthesia? Are you at risk for having a very complicated pregnancy? Can the doctor find the cervix? Large BMI may have a negative effect on stimulation and pregnancy rates, but not to a great degree.

How many follicles are too many for IUI? IT depends on your age. Once I see more than 5-6 I talk more seriously about the odds of multiples and talk about cancellation. If there are more, I may just cancel the cycle. It’s hard to give you an exact cut-off number; it depends on age and other fertility factors. Making extra eggs is the goal of the injection cycle because extra eggs increase your odds of becoming pregnant.

AMH is a new tool. We have done some research, and are planning more. I’ll write about it in a separate blog.

Poor egg quality. I hate this term because more often than not the doctor throws it out there with little evidence, other than his own frustration. Embryo quality means 2 different things: it’s about how the embryos looks (morphology) and the embryo’s chromosomes (genetics). If you have done IVF, and your embryos barely develop or are very fragmented, you have poor egg quality. This is a morphology issue. If you have done IVF a few times and your embryos look OK, yes you may have poor embryo genetic quality. But it is also possible that you just have not yet become pregnant and your time will come. My problem is with the doctor who tells a 39 year old with 11 eggs and 6 decent looking embryos, 3 to put back, that she did not become pregnant because she had poor embryo quality.

Pumps for Hypothalamic Amenorrhea: Sure. Sounds a bit cumbersome to me, but if you want to give it a go, especially if nothing else is working, go ahead.

More answers next time. Please read disclaimer 5/17/06.

Dr. Licciardi