Infertility/Fertility/pregnancy issues

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Question
QUESTION: Hello sir,
I am having a problem in infertility.its almost 4 nd half years of my marraige i m not able to conceive.infact i have done an operation "laproscopy" then IUI for 2years, but still there is no signs of my pregnancy.i am having irregular period after my marraige.infact i would say not having monthly.i have to take medicine to get my monthly.when i was doing my IUI monthly was regular.when i stop after 2years doing iui its again started irregular.i am having an vaginal infection too ( yeast infection).which irritates me a lot.i have inserted dresin v tab and cadid cl tab but the problem is still unsolved.
Doing my laps operation havnt solve my problem of irregularity and infertility..
What should i do now i m unable to decide.still i m looking for ivf.but should i go for donar or trust my own eggs,is a question mark for me.and where should i go for ivf in kolkata because there arelot of doctor for ivf but which doctor should i choose.or should i go for any other treatment...
Please help me fir this i m from kolkata.
Thank you

ANSWER: Hello Archana from India,

When I advise my patients, I usually advise to do no more than four IUI cycles.  This is because studies have shown that the chances of pregnancy go down drastically after four attempts.  The thinking is that the IUI's failed because there is something else preventing pregnancy that IUI is not treating.  I would NEVER do IUI's for two years.  That is a waste of time and money.

The fact that you don't have regular periods shows that you have an ovulatory dysfunction whereby the ovaries are not ovulating.  The most common cause of this is a disorder called PCOD, but without knowing test results, there is no way for me to know for sure.  The treatment is to correct the underlying problem.  You mention that you had regular periods when you were doing your IUI's so that implies that you were ovulating with those cycles.  That is why you have to conclude that there is something else going on.

You've not given me enough information or your full history to know what direction I would advise for you, but in general, the plan I make with my patients is if they fail four IUI cycles, then they should move to IVF.  It is the only remaining infertility treatment available after IUI.

I cannot advise a specific doctor or clinic in India as I have no knowledge of the clinics or doctors there.  I know there are a lot of them, and I know that the quality varies greatly.  In choosing a clinic, I would ask for their pregnancy rates for your age group and make sure that these are high rates.  You can look up the pregnancy rates via the internet in the U.S. to use as a comparison.  Look at cdc.gov/ART to see what the U.S. results are overall and by age group.

Good Luck,

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

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.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at ejrmd@montereybayivf.com if you are interested in continuous access to me.



---------- FOLLOW-UP ----------

QUESTION: Hello Dr Edward
First of all thanks a lot for your reply. You are absolutely right i have a PCOD problem. I gave consulted multiple doctors for the same reason in Kolkata. I was told that IUI could be  used as a solution prior to IVF. I underwent laproscopic surgery for endometrosis and post that had multiple IUI cycles. My menstural cycles were regular during the IUI during my iui i was having cyst problem too. I have not had any success for the same and have had at least 7/8 attempts. For the last 3 months i am not undergoing any treatment and my periods have been irregular again. Also the flow has been very less..
Please suggest:
1) IVF treatment is very costly so what is the best way to improve the chances of getting pregnant.... how many attempts should i try of IVF.. the doctors in Kolkata suggest that it maybtake 4/5 attempts at times
2) i have heavy infection (probably candidiasis) resulting in white curd like discharge and a pungent smell so what is the solution for that (i have already tried dresin v(vaginal insert) and candid cl)
Would request a response

Thanks  
Archana Modi

Answer
Hello Again,

I think that IVF is the next step.  I cannot tell you how many it will take because there are too many variables.  Pregnancy rates are very dependent on your age, your clinic, your laboratory and your doctor.  In my clinic, 50% get pregnant on their first attempt but the remainder will take 2-3 attempts.  Some do go to 4-6 attempts but they tend to be the older (>37 year old) patients.

Candidiasis is treated with anti-fungal medication.  I don't know what is available in India.  In the most resistant cases, you may have to use the medication for at least 14 days.  In the U.S. there is an oral medication and vaginal medications to use.  Boric acid douches also work for chronic cases.

Good Luck,

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

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.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at ejrmd@montereybayivf.com if you are interested in continuous access to me.  

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Edward 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 19 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, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

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

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