AboutEdward Joseph Ramirez, MD, FACOG Expertise I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.
Experience I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 15 years.
Organizations American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society
Publications American Journal of Obstetrics and Gynecology
Education/Credentials Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco
Question Hello!
I am 40 years of age and now trying to concieve with my husband. I have had an HCG, and blood work done as well. the results were good. My husband was also tested and results were also good.
After 7 months of trying my doctor started me on Clomid, and I am going in for an IUI today. My cycle has been very regular for years now. 28 - 29 days. And I seem to consistantly ovulate on day 14. On clomid, the ovulation tester shows a spike in my hormone level on day 8. So, today is day 9 and we are going in for the procedure. Should I even be on clomid if my blood work shows I am ovulating? And if the ovulation testers pick up on the hormone also?? Some added history... we are late bloomers in my family, and my mother had me when she was 42, and my sister also was pregnant in her 40's.
Answer Dear Diana,
I presume that you are not seeing an infertility specialist but your general OB/GYN. My first piece of advice would be to see an infertility specialist. That way you will be doing the most effective treatments, in the proper way, which will give you the highest chances for pregnancy. This recommendation is mainly in consideration of your age.
I am glad to hear that your family has a history of getting pregnant in their 40's. By any chance was that the age of their first child or a subsequent child? That makes a huge difference. I have had many 40+ year olds get pregnant over the years but they all had been pregnant before and were working on a subsequent pregnancy. Most have been pregnant for most of their 30's. I think that preserved their ovaries and allowed then to remain fertile into their 40's. I don't want to be discouraging but you need to be efficient with your time so that you don't lose the opportunity to have a genetic child.
I think that IUI is okay. We also use some form of fertility medication to enhance the ovulation in order to increase your chances. The problem with age is that the majority of eggs have become debilitated and are no longer good. So by enhancing/increasing the number of eggs that you ovulate per cycle, you increase the chances of finding one egg that is good. It may take up to four cycles. If you don't get pregnant by four IUI cycles, then you need to move to IVF because statistically, the chances for pregnancy are dismal after four cycles.
What concerns me with your cycle is that you are using a fertility predictor kit to time your IUI's. That is what makes me think that you are seeing a general OB/GYN. These cycles need to be well timed and accurate. Ovulation predictor kits is NOT the way to do it. Your doctor should be doing pelvic ultrasounds to look at the ovaries. That allows him/her to see directly, how you are responding, whether or not the dose of Clomid is adequate or too low, how many follicles you have and when they reach the appropriate size for ovulation. You should then get an HCG shot to trigger ovulation and the insemination should be done the next two days (24 and 48 hours). Some fertility specialists will only do one insemination at 33-36 hours but I think the two insemination method is better (eventhough studies have not shown a difference). Then you should go on progesterone vaginal suppositories to help with implantation and support the early pregnancy.
In terms of the Clomid, I think this is a good medication for IUI, but use injectable medications for the higher level treatments. In your case, I would try to get at least 5 eggs to ovulate so I would use 150 -250 mg (3-5 tables per day).
A good resource for you to look up regarding the impact of aging on fertility is the ASRM.com website. They have a good patient booklet that you can print out.
I hope this gives you the information that you wanted.
Sincerely,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
