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Hello doctor..What can you advise as a plan of treatment for my situation? I have norm 28 day cycles no issues.  Myself age42, CD3 blood: FSH 7.5 AMH 0.17 and other levels norm. Normal weight 130lbs. 1st cycle of Femara 5mg cd 3-7. CD 14 Follies  17, 20 and 21mm. CD15 Ovidrel shot. CD 16 iui(post wash 18mil), CD 17 progest, 200 mg 2x daily. CD 21 progesterone 41.  Hubby age 35, semen analysis: vol-3.0, total count: 161.1, total motility: 116.0, progression: 2+, NORMAL FORMS: 3.5% with 90.5% having Amorphous heads. IVF is not an option. Should continue this course along with IUI?  If not, what do you recommend?

Hello Lauren from the U.S.(New Jersey),

The treatment of choice for you is IVF because of your age and your husband's decreased morphology (ICSI is recommended#.  Since that is not an option for you, the only option is to continue trying with IUI.  Keep in mind, however, that you are near the probable end of your reproductive or fertile life #pregnancies are rare after 42 years old even with IVF).  So, you chances of pregnancy with IUI is less than 1% per month attempt, whereas with IVF it is 30% per month attempt.  But ultimately it is your decision as to how badly you want to have a child, which then determines to what extent you will go through to have one.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate


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Edward Joseph Ramirez, MD, FACOG


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.


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 19 years.

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

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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