I was hoping you can tell me or guide me in the right direction. My husband is military and we are stationed in Georgia in 2012 I got pregnant through Fertility treatment (follistim) we were successful and were able to get pregnant with twins. Unfortunately my cervix was too short so I had to have a cerclage done at 18 weeks and after that surgery I contracted an infection from the surgery that eventually broke my water at 24 weeks. I was told nothing could be done and that my twins were not going to make it. I ended up having a cervical cerclage done in Feb of 2013 to have the issue corrected, which caused us to loose our twins. I have done 2 cycles with follistim after that with no success, My doctor is now telling me that he will only do this one more time and then my last choice would be IVF, as you know IVF is expensive and is not covered by military or other insurances. Is it possible that the cervical cerclage has caused me to not be able to get pregnant? I know my age might be a factor I just turned 40 my husband is 38 but we desperately want to have a family and would like someone to tell us what other options or what else we could do to be able to conceive again?

Thank you for your help

Hello Adriana from the U.S. (Georgia),

Taking Follistim and having intercourse is a "natural" treatment method and requires all of the natural steps (10) to occur in order to get pregnant.  Giving Follistim only increases your chances by increasing the number of eggs you ovulate (hence twins previously), but it does nothing for the other 8 steps.  Your natural chance of pregnancy is 1% per months or 10% per year so you have to factor that in.  Two Follistim cycles are obviously not enough to get pregnant by natural means.  It takes the average 20 year old, with a 20% chance of pregnancy per month, 8-12 months to achieve pregnancy (range of course is 1-12 months).  So please keep things in perspective.

The cerclage should not have an effect on your ability to get pregnant unless it was done abdominally rather than vaginally.  If so, scar tissue could form in the pelvis that can prevent the egg from getting to the tube and therefore prevent natural pregnancy from occurring.

So, you have two alternatives at this point: (1) Follistim with IUI using an aggressive protocol (ultrasound surveillance etc.) or (2) IVF.  IUI will give you about a 2% chance of pregnancy per month and by four attempts you have paid for an IVF cycle.  IVF will give you a 50-60% chance of pregnancy, depending on the clinic you go to, but will cost at least $15,000 unless you go to a military facility.  There is a military facility, near you that does IVF.  It is the program at the Walter Reed/Bethesda Medical Center.  You might want to look into going there and getting on their list.

I hope that gives you the information that you need.

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, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

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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