Wisdom from Wisot Wednesdays, Round 19!

Reprint from Redbook’s Fertility Diaries

Hello, hello, and welcome back to our weekly Q&A with tippy-top fertility expert Dr. Arthur Wisot. If you've got a question for Dr. Wisot, just leave it in the Comments section. And now, for the 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 have hypothalmic annovulation and my doctor has started me on high doses of Repronex on my last two cycles (both which ended in negative pregnancy test). I responded great, but my doses were like 250units for the first 5-6 days, then 150units for the last 3 days. Followed by IUI. Do you think too high of doses can cause poor egg quality? Should we start at a lower dose?

Answer: The dose needed is dependent on the exact cause of the lack of ovulation. If it's really hypothalamic (the hormones from the hypothalamus are dysfunctional), lower doses of pure FSH will usually work. Pure FSH drugs have no LH; the body manufactures it itself so you don't need extra LH. Repronex has both FSH and LH and the higher doses of LH can affect egg quality. If the problem is hypogondotropic (the body does not produce FSH or LH) then both are needed and in fairly high doses. But based on two cycles you can not assume that this is an egg quality issue. Even at a young age, all this can do is restore you to normal fertility for your age and that would give you a monthly fecundity rate (the rate at which women conceive per cycle at a given age) that would probably give you less than a 50% chance of conceiving in two cycles. It may need more time.

Question #2: Hi, Dr. Wisot. I am writing in reference to this week's #2 question about a husband taking Clomid that increased his sperm count "from 1.5 to 3 million in 12 weeks." Is Clomid often used to increase sperm count? I had asked you a question via this site a few months ago. I am 32, DH 38 diagnosed with male factor: low count. Of 3 sperm analyses his counts were: 2.92, 4.7, 7.1. We are currently in the middle of our 2WW with IVF/ICSI #1 (I'm a nervous wreck!), but in the meantime...would this be an option for us? For him to try the Clomid thing to increase his count? This would be so much more affordable for us. Again, thank you so much...for all that you do! Your shared knowledge and expertise is so greatly appreciated!

Answer: I am not an expert in male fertility so I turned to Dr. Jacob Rajfer, Professor of Urology at the UCLA School of Medicine, who is a male fertility expert extraordinaire. He says that Clomid may be used primarily in men who have both low counts and low testosterone levels. "Clomid is used to increase the testosterone levels within the testicle. This supposedly is "beneficial" for speramatogenesis (making sperm). Since each sperm takes about 70 days to form and then it takes about 12 or so days for it to transit from the testicle to the outside, Clomid should be used for a minimum of 3 months and preferably for 6 months, which includes two full spermatogenic cycles." But let's hope the IVF worked so you will not be confronted with this issue. If it doesn't, ask your doctor if this would be an appropriate course of treatment for your husband.