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.
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 http://womenshealthandfertility.blogspot.com
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.