AboutScott Roseff, MD, FACOG Expertise I can answer questions relating to ALL aspects of female infertility.
Experience I am Board Certified in Reproductive Endocrinology/Infertility.
Organizations Medical Advisory Board, Serono Labs, Inc.
Speaker's Bureau, TAP Pharmaceuticals, Inc.
The American Society for Reproductive Medicine
American Association of Gynecologic Laparoscopists
The International Society for Gynecologic Endoscopy
The Society of Laparoendoscopic Surgeons
The International Federation of Gynaecologic Endoscopists
U.S. International Foundation for Studies in Human Reproduction, Inc.
The Endometriosis Association
Fellow, The American College of Obstetricians & Gynecologists
American Medical Association
The Academy of Medicine of NJ
NJ Obstetrical & Gynecological Society
The NY Reproductive Medicine Society (Steering Committee)
The Society of Reproductive Endocrinologists
Resolve - National Chapter
Resolve - New Jersey - Executive Board
Publications Kettel LM, Roseff SJ, Berga SL, Mortola JF, Yen SSC. Hypothalamic-pituitary-ovarian response to clomiphene citrate in women with polycystic ovary syndrome. Fertil Steril. 1993;59:532-8.
Fischer UG, Wood SH, Bruhn J, Roseff SJ, Mortola JF, Rivier JE, Yen SSC. Effect of human corticotropin-releasing hormone on gonadotropin secretion in cycling and postmenopausal women. Fertil Steril. 1992;58:1108-12.
Kettel LM, Roseff SJ, Bangah M, Burger HG, Yen SSC. Circulating levels of inhibin in pregnant women at term: simultaneous disappearance with oestradiol and progesterone after delivery. Clin Endocrinol. 1991;34:19-23.
Kettel LM, Roseff SJ, Chiu TC, Bangah ML, Vale W, Rivier J, Burger HG, Yen SSC. Follicular arrest during the midfollicular phase of the menstrual cycle: a gonadotropin-releasing hormone antagonist imposed follicular-follicular transition. J Clin Endocrinol Metab. 1991;73:644-9.
Roseff SJ, Kettel LM, Ulmann A, Bangah ML, Rivier J, Burger HG, Baulieu E, Vale W, Yen SSC. Accelerated dissolution of luteal-endometrial integrity by the administration of antagonists of gonadotropin-releasing hormone and progesterone to late-luteal phase women. Fertil Steril. 1990;54:805-10.
Roseff SJ, Murphy AA. Laparoscopy in the diagnosis and therapy of chronic pelvic pain. In Clinical Obstetrics and Gynecology. JB Lippincott Co., Philadelphia. 1990.
Roseff SJ, Murphy AA. Pelviscopy. In Manual of Endoscopy, by the American Association of Gynecologic Laparoscopists, Edited by DC Martin, GL Holtz, M Wenof. Santa Fe Springs. 1989.
Roseff SJ, Bangah M, Kettel LM, Vale W, Rivier J, Burger HG, Yen SSC. Dynamic changes in circulating inhibin levels during the luteal-follicular transition of the human menstrual cycle. J Clin Endocrinol Metab. 1989;69:1033-9.
Roseff SJ, Bernard JM. Seasonal changes in carbohydrate levels in tissues of Carex lacustris. Can. J. Bot. 1979; 57:2140-44.
Education/Credentials Postgraduate Fellowship training in Reproductive Endocrinology & Infertility was done at The University of California, San Diego, School of Medicine.
Awards and Honors Mellon Fellow in Reproductive Endocrinology and Infertility, 1988, awarded for academic excellence in the Reproductive Sciences, for research efforts aimed at development of novel contraceptives.
Wyeth Service Award for Physician Education and Training in Norplant Contraceptive Implants.
Certificates of Service and Appreciation from Our Lady of Mercy Medical Clinic, Guadalajara, Jalisco, México, 1978-1982.
Question Hi. I have a quite a long history of infertility and trying to conceive. In short, here is my history:
5 1/2 years of consistently trying to conceive
Six (6) IUI's, using gonadatropins, clomid and/or metformin
Three (3) IVF's (two with extra PGD testing)
Miscarriage #1 (naturally conceived using metformin for 4 weeks - chemical pregnancy ending at 5 weeks- no baby/ no heartbeat)
Miscarriage #2 (conceived through IVF - chemical pregnancy ending at 5 weeks - no baby/no heartbeat)
Miscarriage #3 (conceived through IVF - saw strong heartbeat at 6 1/2 weeks - heartbeat ceased at 7 1/2 weeks - D%26C performed with results of a chromosomally normal male)
* FSH 5 1/2 years ago was 5.6
* FSH now is 6.1
The following tests have been run multiples times, all with normal results: estrodiol, FSH, Lupus Anticoagulant, Natural Killer Cells, Leiden 5 Factor, progesterone. A sperm analysis on my husband has been done multiple times - all within normal ranges, except low morphology (5% for the first 2 IVF's and 2% for the 3rd IVF)
The following procedures have been done, all with normal results: (3) hysteroscopies, (1) laparoscopy, (1) hystosalpinogram
With out 1st IVF, we had 8 fertilized eggs. Eight eggs fertilized Two made it to 8 cell (highest grade) embryos and were implanted on Day 3. chemical pregnancy almost immediately.
With our 2nd IVF, we had PGD done. Six eggs fertilized and were biopsied at the 6 to 8 cell stage. Results from PGD: Four were chromosomally abnormal and two were chromosomally normal. We implanted those two, one took - saw a heartbeat and then had a D %26 C.
With our 3rd IVF, we also did PGD. Had to have ICSI done this time, due to a 2% morphology of my husband. Seven eggs fertilized. Results from PGD: All seven embryos were highly chromosomally abnormal, so we could not implant any. Of the 9 chromosomal pairs they test for in PGD, almost every "pair" was not a pair, but had only 1 chromosome, 3 or even 4.
The doctor said that with our infertility history, multiple miscarriages and PGD results, his clinical suggestion was for us to use donor eggs with an IVF cycle.
My questions to you are:
1. Do you feel that this is the correct move...to move to donor eggs?
2. If my eggs are truly 'bad,' why would my FSH be so normal?
3. Our recent PGD results showed all chromosomally abnormal and basically 'diseased' embryos. Is this always the EGG that causes this? Or is it possible that the sperm could be the problem?
4. If it IS the egg, then why would I have had a chromosomally normal embryo implant with a strong heartbeat that just arrested? There is a VERY small chance that BOTH the D %26 C chromosomal analysis AND PGD was incorrect.
* The idea the doctors had for #4 was that even though all my anticoagulant tests were normal, I still may have clotted around the embryo, causing it to arrest. Their solution for the next IVF is to use heparin injections (along with the standard low-dose aspirin) *
What are your thoughts on our chances using my own eggs again? Or using donor eggs?
Sorry for the long message, but I have a long history that you had to be informed of to answer my questions.
Thank you!
Heidi
Answer Hi,
Sorry to hear you haven't been successful to date. I'll do my best to answer your questions, but you have to realize that it's impossible (and illegal) to answer your questions directly since I don't have you entire medical history, haven't examined you, and certainly don't have all test results to date. There's a LOT of important information missing (such as, and not limited to, your husband's sperm DNA function test results, your blood chromosome tests, your phosphatidylserine and phosphatidylcholine antibody test results, your AMH level, your endometrial biopsy result, etc. etc. etc.).
1. I would not recommend moving to donor egg without having everything reviewed by a board certified reproductive endocrinologist as a "second opinion". As I mentioned above, there's a ton of information missing, and it would be folly to move on to donor egg without having that information examined in detail.
Also, PGD has NOT been shown to be of any benefit for women with IVF failures or recurrent pregnancy loss, so I'm having a hard time understanding why this was recommended to you and done. This is in accordance with the guidelines set forth by the American Society for Reproductive Medicine (ASRM) in collaboration with the Society for Assisted Reproductive Technologies (SART). See: "Fertility and Sterility", Vol 90, Supplement 3, November 2008.
2. I'm not convinced from the data you've given that your eggs are truly "bad". If you're saying that because of the high number of abnormal embryos seen with PGD, that may not be the case - it would take me too long to explain why herein, but I would be glad to do so in a consultation with you, if you so desire.
3. No, it's not. Sperm can be a problem.
4. There are MANY possible reasons for a failed pregnancy, and I am not convinced they have all been evaluated in you and your husband.
If you're interested in coming here for a second opinion consultation, I can intensively review all of your data to date and give you my expert thoughts on "where you've been, and where you need to go from here". If you don't want to come here, again, I strongly suggest you seek a second opinion prior to forging ahead with another potential disaster.
All my best, always,
Dr. Roseff - Director
Palm Beach Center for Reproductive Medicine
Wellington, FL
Visit us on the web at www.reproendo.com
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Since Dr. Roseff doesn't know your entire history and hasn't examined you, any medical information given to you may be incomplete or inaccurate. Dr. Roseff and his staff are not responsible for any actions taken or not taken due to the educational information contained within these communications. All communications are for educational and informational purposes only, and should never be used to replace the information and care rendered by your own doctor. No part of any message may be reproduced, printed, or posted anywhere else without the express written authorization of Dr. Roseff.
