Fertility Q & A - Redbook's Fertility Diaries

Wisdom from Wisot Wednesdays, Reprint from Redbook's Fertility Diaries
January 7, 2009 at 10:00 AM by Cheryl | 6 comments

It's the post you've been waiting for, dear readers: the weekly Q&A with top fertility expert Dr. Arthur Wisot (who's featured in this week's Life & Style, talking about Lance Armstrong's super sperm. Pick up a copy when you buy your Redbook!) Before the questions, the doctor's disclaimer: "My answers to questions on this blog do not constitute medical advice, but are merely meant to create an educational forum for consumers. It is always best to discuss these issues with your health care provider." The good doctor's answers are below, in bold:

Question #1: Dr. Wisot, I am 30 and my husband is 28. We have been trying to conceive for 4 years. We have both been through all the testing except the post coital test. I was diagnosed with PCOS but have since lost 50 lbs and taken Clomid numerous times. We have been through 3 rounds of IUI with Clomid that my RE felt progressed perfectly but still no pregnancy. My insurance does not cover IVF so we have put that idea on hold. Since our last IUI my husband has lost 60 lbs (and still going) under a doctor's care and I have been working on getting in better shape. We are considering trying IUI again before working on the financials for IVF since we are both much healthier. Is this a good idea or should we just move on? Thank you for your input.

Answer: You are doing great things for both your fertility and your general health. One of the best things a PCOSer (Polycystic Ovarian Syndrome) can do is lose even 5% of their body weight. You have done much more. Another measure to enhance your chances with Clomid would be to ask your doctor to put you on metformin to combat the insulin resistance associated with PCOS. Also ask your doctor to monitor your cycles with ultrasound to make sure the Clomid is being effective (if he/she is not already doing that). With the weight loss, metformin, and monitoring, I would be inclined to try a few more cycles of Clomid with IUI while you get your bodies and finances in shape for IVF.

Question #2: What are your thoughts on the use of alternative medicines or treatments such as acupuncture to assist with fertility treatments? My friend mentioned that she sees an acupunturist and that he told her he can do acupuncture that can assist with infertility treatment.

Answer: Acupuncture has been shown to improve the success rates of IVF. You will see all sorts of claims for acupuncture and herbs. I think it is fine as an adjunct to your fertility treatment, but not a substitute. When I wrote my last book I did a lot of research on acupuncture and herbs and found out that you need to be very careful with herbs because of a great variation in purity. You need to get a good prescription from a doctor of Chinese medicine and obtain them from reliable sources. Mind-Body Connection programs have also been shown to enhance the effects of fertility treatments. Especially if you are feeling stressed (and who going through this isn't?), stress may be playing a role and stress reduction techniques like these may help.

Question #3: My husband and I are both 32 years old. I have PCOS. My RE has me on Clomid (100 mg) to help me ovulate (I wasn't ovulating before) and now for the first time in my life I'm getting a period every month. My husband's first semen analysis came up normal. I've been on the Clomid for six months now, though, and no babies. I'm scheduled for an HSG next month - I've heard that an HSG sometimes raises the chances of conception. Is this true? If so, do you have any percentages? Also, my GP says that I am probably not conceiving because I'm overweight. She first suggested Metformin to help me with that, but then looked at my chart, told me that she couldn't prescribe Metformin because my "liver numbers are elevated" because of being overweight. So should I even be TTC if I have something wrong with my liver? My RE knows about it and isn't advising against it.

Answer: Overweight leading to liver problems? If that isn't a signal to get serious about your weight I don't know what is. That's where I would start. The HSG (tubal dye test) can improve pregnancy rates over the next six months, especially if they inject an oil-based dye after they show your tubes are open. One of my partners (David Meldrum, M.D.) showed that back in the 1980's. I can not tell you how much that will affect your chances because of all the other problems. By the time one gets to six months of Clomid, one can start to experience some of its negative effects like thinning of the lining of the uterus and reduction in cervical mucus. I would ask your doctor if you should take some time off from Clomid, lose the weight, get your liver in good shape and then restart trying the the HSG, metformin and Clomid.

Question #4: I will be 38 and my husband will be 33 soon. I was diagnosed with PCOS and had HSG, laparascopy. Everything was ok. I am taking metformin 500 mg daily. We have been trying to conceive since 2005. First we tried clomid and it didn't work. I have gone through three IUI's with injectables.(not consecutive, cannot afford it) First was unsuccessful as was the last one this past month. The second IUI succeeded, yet ended in miscarriage at 8 weeks. We can't afford to try again until in abouth three months. Is that to long to wait considering my age? Should we do more tests? My husband had a semen analysis in 2005 and everything was fine.I also want to mention that I am about 100 pounds overweight. I want to try and get healthier during the time we raise the money for the IUI, but i know i wont't lose all the weight in a few months and i don't want to lose more time. What do you reccomend?

Answer: Is there a PCOS epidemic this week? It sounds like you have three months to lose as much weight as you can. You've got to get serious about this. It may mean the difference between success and another failed cycle. If you have been trying since 2005, I would be looking at going beyond IUI and consider IVF after you get yourself in better shape. Unless you can't tolerate more, 500 mg is a fairly low dose of metformin. If IVF is out of the question for you, set a goal to lose 30 pounds in the next three months, ask your doctor if it might help to increase the metformin dose and then do another cycle of injectables with IUI. Like the women above, you can do a lot to help yourself.