Dr. Wisot Discusses Clomid

As a consultant on fertility issues for the Choice Mom community, choicemoms.org, I am frequently asked questions about treatment options for single women who are attempting to achieve pregnancy without a partner.

Q. What to do if my lining is thin on clomiphene (Clomid)?

One recent query sent to me by Choice Moms liaison Mikki Morrissette was about a woman whose RE clinic reported that her uterine lining was affected by taking Clomid, which had barely reached 6mm for her previous IUI. He recommended that she take injections [one option: Follistim]. She wasn't sure if the RE was erring on the side of too much intervention. She was concerned about the greater likelihood of having twins. And she was afraid that she would miss her next cycle while she waited to take the "training" required for the injections.

A. Success rates are not reported for this type of treatment so except for the doctor's pride this would not be recommended for the reason of increased success rates. I think most REs will actually try the most conservative treatments first. Of course there will always be someone who rushes patients into the highest level of treatment right away. But, as I point out in my book, Conceptions & Misconceptions," the treatment has to make sense and even a lay person can get a sense of what's appropriate. If there is a question, one can always get a second opinion.

The risk of multiples is increased over Clomid. That is true, but if the injectables are used judiciously the risk can be reduced, especially the risk of the higher order multiple pregnancies like triplets and above.

The injection training can be done in a few minutes and not really a reason for delaying a cycle.

But there is another alternative that you can ask for and do it in this cycle. If you use estrogen for five days after the last Clomid it may adequately thicken the endometrium and if it doesn't you can go to injectables next cycle.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group, Inc.
A Southern California Fertility Center

Credits –

This information is provided by Arthur L. Wisot, M.D., F.A.C.O.G., one of the team of outstanding fertility doctors at the Southern California fertility center, Reproductive Partners Medical Group. For more information on IVF and the many available infertility treatments please visit www.reproductivepartners.com.

Brad and Angelina: Meet Louise Brown

In an exclusive article just released in Us Weekly magazine it was disclosed that two of the world’s biggest celebrities and movie stars conceived their recently-delivered twins by in vitro fertilization (IVF). Coincidentally, this article was published 30 years to the week of the very first IVF birth (Louise Brown on July 25, 1978).

I am pleased that Us Weekly chose Reproductive Partners Medical Group, Inc. to be their source of background information on this important story. Here is an excerpt from the story as released on their website. For the full story, please see the August 4, 2008 issue of Us Weekly.

Forget Mother Nature – Us Weekly reports in its new issue, on newsstands now, that Angelina Jolie and Brad Pitt turned to fertility treatments to quickly conceive twins Knox and Vivienne. “They conceived through in vitro fertilization," a well-placed source within their camp tells Us. "They both desperately wanted more babies soon."

The chance of having fraternal twins at Angelina's age (33) naturally is under 1 percent; with in vitro, the chances are 25 percent. Says Dr. Arthur Wisot of L.A.'s Reproductive Medical Group (who did not treat the couple), "We live in an era of reproductive freedom, so anybody can do anything they want within legal limits."

The actress chose the procedure (which can cost around $12,000 a pop) so "she wouldn't have to deal with the stress of trying to get pregnant," the source tells Us. "She could just knock it out."

Indeed, Jolie has spoken about her goal to do just that. "If we're going to have 10 kids, we'd like to raise them while we're young," she told Elle U.K. last year. Brad Pitt turns 45 on December 18.

A source adds: "They were too impatient."

Knox and Vivienne – born in Nice, France on July 12 – join the couple's adopted brood of Maddox, 6, Pax, 4, Zahara, 3.

Credits –

This information is provided by Arthur L. Wisot, M.D., F.A.C.O.G., one of the team of outstanding fertility doctors at the Southern California fertility center, Reproductive Partners Medical Group. For more information on IVF and the many available fertility treatments please visit www.reproductivepartners.com.

Excerpts from the ReproductivePartners.com Infertility Bulletin Board

Ask Dr. Wisot -

When to perform an insemination?

Q. Could you please give your opinion on what is the best time to perform an insemination (IUI) without any drugs in relation to the detection of the LH surge? Is it before or after detection of surge and please be specific with hours. There seems to be a lot of differing info on best times.

A. I usually recommend that a single insemination be done in a natural cycle the day after an LH surge is detected by an ovulation predictor kit. That’s because the surge usually precedes ovulation by 36 or more hours. You are detecting the surge sometime after it happened. Most women test once a day in the afternoon or evening, so they should be close to ovulation by the next morning. The egg has about 12-24 hours to be fertilized and the most sperm specimens can maintain good motility for 48 hours in the wash media, so the IUI does not have to be done at the exact time of ovulation. All the averages coincide the morning after the surge is detected, making it the most logical time to perform the IUI. Alternatives to using the urinary ovulation predictor kit to time intercourse or insemination are ultrasound or a variety of fertility monitors. At the time of the insemination an ultrasound can be performed and if ovulation has not occurred, the insemination can be repeated, insuring that it will be done as close to ovulation as possible.

With eight previous miscarriages what tests should I DEMAND?

Q. I have just lost my 8th baby due to early pregnancy loss. All losses have been at 11wks or earlier. The hardest part was there was a great heartbeat and a perfect looking baby. My OB/GYN said I was having a textbook perfect pregnancy. Of course I let my guard down, got excited and lost the baby almost 2 weeks later. The OB who did the D&C said she would have testing done on the placenta. What tests is she talking about? And more importantly we want to have a baby and are ready emotionally to try again, so what tests should I have done before we try again?

A. I am so sorry to hear about your repeated losses. You can be sure that your enthusiasm had nothing to do with the loss. The test the doctor wanted to do on the placental tissue was probably to examine the chromosomes to see if the baby was normal or abnormal. That could provide clues on what is causing the problem and how to deal with it.

Once you recover from this miscarriage you might want to see an Ob/Gyn who treats recurrent miscarriage or a reproductive endocrinologist to review your history and see what tests are appropriate. Yours does not sound like the typical case and I really can't tell specifically which tests should be done from this information. Generally the tests will check the following issues:

· The chromosomes of both partners

· The quality of the woman’s eggs with hormone tests

· Abnormalities of the uterus

· Infection with an organism-ureaplasma

· Progesterone levels/development of the uterine lining

· Abnormal antibodies in the woman’s blood

· Heredity blood clotting problems in the woman

By the way, when anyone approaches a doctor I would recommend that one not start the interaction by “demanding” that something be done. Start by listening to the doctor’s advice and then add any “request” you may have with the reason you want something done. The best doctor-patient relationship is one of mutual concern, cooperation and trust. If one does not feel that their doctor is concerned about their problem, not willing to reasonably cooperate or they do not trust the doctor, it is best to find another doctor.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group, Inc.
Southern California Fertility Center

Credits –

This information is provided by Arthur L. Wisot, M.D., F.A.C.O.G., one of the team of outstanding fertility doctors at the Southern California fertility center, Reproductive Partners Medical Group. For more information on IVF and the many available infertility treatments please visit www.reproductivepartners.com.