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QUESTION: Dear Doctor

We went with your advice and had the uterine septum of my wife resected yesterday. It was the second session to completely divide a broad based septum of 3.3 cm thickness at the base. The surgeon advised a combined estrogen and progesterone therapy for 2 cycles before attempting ICSI for poor sperm motility.

The problem is that my wife had AMH level of 0.07 last April(less than 0.1)and it is hard to wait for 2 more months with this extremely low AMH. After stimulation with letrozole and 225 mg menogon early in june, she had 5 eggs. When menogone dose was up to 300 mg in her next cycle, she had only 3 eggs. she is on DHEA 75 mg, coenzyme q10 and vitamin D since mid of May.

Her reproductive endocrinologist says he can wait for 2 months.He said she ovulated in june and it is unlikely, although possible, to stop ovulating in 2 months period.

Donor ggs are not allowed here for religious and social reasons.

Any suggestion to solve this dilemma is greatly appreciated.

ANSWER: Hello,

I'm sorry but you will have to wait at least 6 weeks after the surgery for the inflammation resulting from the surgery to resolve.  Putting embryos into an inflamed uterus is like throwing them into a fire.  It will fail.  Also, your doctor is correct in giving the endometrium time to heal with estrogen and progesterone.

You have no choice but to wait.  Granted your wife's fertility is limited, and that is unfortunate, but there is no other choice.

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: Thank you Dr. For your answer. I understand that a 6 weeks waiting period is mandatory. However; She will be on combined estrogen and progesterone for 27 days followed by 7 days rest interval. This totals 34 days. If embryos are to be transferred, this will be after more 7-10 day. This exceeds 6 weeks...am I correct?..Please advise.

Answer
Hello,

I think you have misinterpreted my reply.  The body needs a "minimum" of 6 weeks for the inflammatory response to resolve.  That is not an exact number.  As long as 6 weeks has passed, then it is safe to do the transfer.  Put your calculator away because this is not mathematics.

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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