Frequently Asked Fertility Questions

The mission of our bulletin board is to educate consumers on fertility-related issues. The information provided is general and as such it is not meant to provide medical advice or substitute for a formal consultation. We are not able to provide specific advice or opinions regarding one's diagnosis, treatment, or specific protocols or prescribing information.

You should always consult your physician regarding the specifics of your case.

Please try to keep the questions brief. In general we do not need all the information about your case to give a general answer. The format is very informal, and a little tasteful humor is welcome. Spelling and grammar do not count. Consult the glossary for terms with which you may not be familiar.

As examples, here are some of the most common questions we have answered:

IUI - Diana

Posted by Diana

I had my first IUI (intrauterine insemination) done 7 days ago and am now in that awful waiting stage. How long do I have to wait before I can take an HPT (home pregnancy test)? I did have a shot of Profasi (hCG to trigger ovulation) 36 hours before the IUI and am now on progesterone suppositories, which I've heard can lengthen your cycle. I appreciate your time.

Posted by Dr. Wisot

If you take a pregnancy test too early it could be positive from the hCG shot. To prevent an erroneous result, we suggest waiting 16 days from the last IUI. An early negative result could cause you to miss a tubal pregnancy or stop progesterone when you actually are pregnant.

An HPT is of little value. If it is positive, most people do three more because they do not believe it. If it is negative, it could be wrong for many reasons.

A well-timed blood quantitative beta-hCG will give you an indication of the well being of that pregnancy. The HPT is for the casual reproducer-which you aren't if you're reading this board. :-)

Yet another blasted e2 ?

Posted by sam:

But you have to know I just can't help myself. On E2 (estradiol, the most important estrogen in women) levels, can you explain what exactly that number is supposed to indicate? I don't think I've ever felt like I understood it and I realize that they just need to be in a certain ballpark. I'm on my 2nd IVF and my #'s are differing by a lot. Last time it was 1426 with 11 follicles, only 6 measurable from 16-12, ended up with 6 fertilized.

This time cd (cycle day) 9 E2 is 311 with the same # of follicles. Do different RE's use different measurements?

Posted by Dr. Wisot

The E2 level just has to be consistent with the number and maturity of the follicles, but that can be a wide range. In addition, it should not drop more than 20% before hCG.

The E2 levels are somewhat lower when one uses only the pure FSH products like Gonal-F or Follistim.

HCG Doubling

Posted by David

I know you are probably getting tired of answering the same hCG (quantitative blood pregnancy test) questions over and over. In my first post I said our beta hCG at 12 dpt (days post transfer) was 14dpt it was 239...I was concerned and you replied with "You can't really read the hCGs like a Ouija board and predict the future. If only one was done you would be happy". Well, our hCG test yesterday at 16dpt was 379...every 2 days it has increased only 58%. This isn't even a pace for 3 day doubling (However progesterone level is still very good they said). My question is WHY do doctors say the level should double every 2 days if it doesn't matter? I am concerned...and other people in similar situations are concerned because we were told that one thing should happen (doubling), then we are told not to be concerned when it doesn't. Do you understand the frustration here? Thanks again,

Posted by Dr. Wisot

I understand the frustration. But, you have to understand that this is biology and does not follow exact rules like physics or engineering. In general, we look at one hCG level 16 days after retrieval and want it to be at least 100. We don't do more hCGs in that case.

If the level is below 100, we repeat it in 4 days and if it does not double or go up at least 66.7% every two days, we feel that the prognosis is guarded. That's where it ends.

All of these other situations where people try to gauge success by using this rule really do not apply. People write questions that talk about doubling at 7 1/2 weeks. The rule simply does not strictly apply at that time.

Now let's see what happens, and I hope everything will be all right.

Minidose of Lupron/GanirelixProtocol

Posted by Brenda

Can you explain the minidose of Lupron and Ganirelix protocol? Please tell me how long you would take the shots (days) and at how much (i.e. .10 per day). Do you normally take these drugs with fertility drugs with LH in them?

Another question, my RE actually said the Lupron could stimulate the eggs or follicles? Can you explain, please?

Posted by Dr. Wisot

In general, they are used to suppress one's own pituitary gland so that we may have complete control over the reproductive hormones during an IVF cycle.

For standard IVF cycles, Lupron has been the tried and true drug we have used for years. It is an agonist and first stimulates, then suppresses, and has to be given at least 10 days prior to the stimulation medications. Ganirelix is an antagonist and can be given a short time after the stimulation medications take effect. Thus, it shortens the cycle and the number of days a woman has to take shots.

There are 2 different types of poor responder protocols:

Minidose Lupron flare takes advantage of the initial stimulation properties of the Lupron (flare effect) so the gonadotropins are started shortly after the Lupron to continue the stimulation. Later in the cycle the Lupron suppresses the gonadotropins and helps to prevent ovulation.

Since Ganirelix is an antagonist, high doses of gonadotropins are started, and then only after follicles have begun to develop is the Ganirelix started so it does not suppress the development of follicles, only LH and ovulation.

We advise using only pure FSH with the minidose flare regimen since LH is stimulated early on and later in the stimulation LH is not excessively suppressed. With Ganirelix, we advise adding LH, since LH can be very low in some women on Ganirelix.

As yet there are no head-to-head studies, to my knowledge, that show one is better than the other in specific groups of poor responders.

What day does implantation take place?

Posted by sd

After a frozen embryo transfer, when does implantation usually take place? On day of transfer and day after I did not have any cramping. Now, days 3 and 4 post transfer I am experiencing some mild cramping but no implantation spotting. Just wondering what this could mean? Does one usually feel the implantation?

Posted by Dr. Wisot

Implantation usually is thought to start 6 days after ovulation/retrieval. (In an FET there is no ovulation/retrieval, so it could start 3 days after a 3 day transfer, or the day after a 5 day transfer) You can have menstrual-like cramping and bleeding during implantation, but often it is a silent process.

Baby aspirin and pcos (polycystic ovarian syndrome)

Posted by stefanie

Hi there. I am in the Lupron stage of my first IVF cycle. I have polycystic ovaries (not insulin resistant) and have heard that baby aspirin can be of some value. Is that true? If so, when would I start taking them? Thanks.

Posted by Dr. Wisot

We have our patients take baby aspirin because it has been shown to increase blood flow to both the ovaries and uterus, leading to better stimulation and implantation.

Not all REs agree. Ask your doctor. Here is an excerpt from an article from our newsletter that might help:

Now, one of the oldest treatments in medicine has been shown (Fertil Steril 1999;71: 825-829) to be useful in improving the results of IVF, one of the newest treatments available.

In a randomized, double-blind placebo-controlled study, 149 patients went through IVF cycles, with the only difference being the use of a single 100 mg aspirin (not available in the U. S.) a day in one group and placebo in the other. Patients in the aspirin group did much better than those on the placebo. Statistically, they had better numbers of eggs, higher estrogen levels, more uterine and ovarian blood flow, and almost double the implantation and pregnancy rates of the placebo group.

The authors concluded that one baby aspirin a day seems to be a useful and safe treatment for women who undergo assisted reproductive procedures. At Reproductive Partners, on the basis of early reports, we began recommending in early 1998 that all of our IVF patients routinely take baby (81 mg.) aspirin. At present there is no evidence to suggest that this recommendation should be extended to women trying to conceive without assistance, or using conventional fertility treatments.

Question on ovulation predictor tests

Posted by Stephanie

I've heard that by the time an ovulation predictor kit turns positive that it is too late to have sex (for reproductive purposes!). Is this right?

Posted by Dr. Wisot

Wrong! That's why it's called a "predictor" test. We recommend the Ovukit as the most reliable. We recommend it be done in the afternoon or evening; ovulation will usually occur the next day. So, we recommend that a couple have relations that evening or the next morning. In some instances, the following evening may be too late.

With timed intercourse it is not necessary to have relations at the moment of ovulation. In a recent study they found that 35% of women became pregnant with relations the day of, 33% the day before, 10% 5 days before and 0% the day after ovulation.

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