COMMONLY ASKED QUESTIONS

Q. When should we see a specialist?

A. There is no correct answer to this question.  A gynecologist who emphasizes fertility will do many of the tests and basic treatments outlined in the Infertility Brochure.  However, consultation with a Reproductive Endocrinologist may speed diagnosis and treatment as well as possibly avoid surgery.

Q. When should we have sex and should we use those ovulation test kits?

A. In general, intercourse (sex) about every other day in the middle of the cycle will provide sperm to the oocyte (egg) at ovulation.  Timing intercourse is often counterproductive and frustrating.  Save the money and don't buy the kits.

Q. Can stress cause infertility?  I heard if you adopt you are more likely to conceive.

A. Stress can cause infertility by causing ovulation to stop.  I have had 2-3 patients stop ovulating due to the stress of infertility.  But, in general, stress itself does not cause infertility.  There is no evidence adoption improves pregnancy rates.  A recent study found no difference in couples who adopt and those who do not.  There are many good reasons to adopt but don't do it for this reason. 

Q. Will I get pregnant from IVF?

A. Maybe.  If you are under 35 years old, have a good hormonal pattern, and good oocyte number and quality then your chances of conceiving are very good. (see IVF success rates 1997-2003).  However, older women, especially those with fewer oocytes will have a lower success rate.  Unfortunately, women with poor hormonal patterns have poor quality oocytes and are less likely to conceive. (see IVF results and research)  These patterns can not be predicted before the cycle starts and only become apparent at the end of the induction just before retrieval. We will recommend not proceeding with the retrieval in these situations, but it is left up to the patient to decide whether or not to follow our recommendations.

Q. Will a tubal reversal or IVF give me a better chance for pregnancy?

A. This depends on many factors. All of the following need to be evaluated.

• The type of tubal ligation
• Partner's sperm quality
• Women's age and oocyte supply
• Other structural abnormalities
• Previous tubal infections
• Women's ovulation quality

Q. I had a vas ligation 7 years ago. Should I have vas reversal done or is there another way that my wife can have pregnancy and still use my sperm?

A. While vas reversal is an option there is another way to achieve pregnancy. Frequently a male who has had a vas ligation will produce antibodies to his own sperm that will prevent pregnancy even after a successful reversal.  For this and other reasons many couples will have a better chance of success by having a testicular biopsy done to obtain a small number of sperm. These sperm are then used in an In Vitro Fertilization cycle to obtain embryos. individual sperm are injected directly into the oocyte to obtain embryos (ICSI)

Many factors go into the decision as to which option is best for a particular couple. I feel that part of the decision making process should be a full evaluation of the wife/partner and her potential fertility. Testing the husband for antisperm antibodies (by inidirect immunobeads) can also be helpful in making the appropriate decision.

Q. What can be done to improve my (husbands) sperm count?

A. While many treatments have been proposed, there is no consensus that any of them are effective (see reference below). My own feelings are that the only proven therapy is the termination of known sperm toxins such as cigarettes, marijuana, excessive alcohol and poor diets. Certain medications such as Calcium channel blockers used for high blood pressure (check with your doctor before stopping any medication) and Cox 2 inhibitors (Celebrax - Vioxx) may also have a negative impact.

           "Among the many treatments strongly advocated over the past 40 years are clomiphene citrate; testosterone; human menopausal gonadotropin; human chorionic gonadotropin; corticosteroids (for sperm antibodies); cold, wet athletic supporters; and worthless nutritional supplements - but there's no evidence that any of these are effective. We've even begun to seriously question the efficacy of varico-celectomy. The bottom line: Most spermatogenic defects are actually genetic in origin and clearly impervious to improvement with any therapy."
                                                                                           Sherman Solver, MD
                                                                                                                         Contemporary OB-GYN
                                                                                                                         October, 2004

Most often the only effective treatment for poor sperm quality is to make the most of what is available. This will mean treatments ranging from Intra Uterine Insemination (IUI) to In Vitro Fertilization (IVF with ICSI (intracytoplasmic sperm injection).

Ask the Doctor a Question

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This site is NOT a patient care site. It does not have encryption or other secure technology.  Asking the Doctor a question does NOT establish a patient-physician relationship. Patients of Dr. Daly should NOT use this site to communicate with the Dr.

Responses to questions are NOT posted on the web site.

Dr. Daly would be happy to answer questions you might have about infertility in general.  Detailed questions about what to do about your specific problem or questions about other physicians or infertility programs will not be answered.

An example of an appropriate question might be:

Q. I've had 3 laser laparoscopies for pelvic pain and stage I endometriosis.  Will another laparoscopic procedure help me conceive?

A. No.  More surgery is unlikely to improve fertility.  Please see Endometriosis discussion.

An example of an inappropriate question might be:

Q. Dr XYZ wants to do a laser videolaparoscopy for my stage I endometriosis.  Is he competent to to do this procedure?

This type of question will not be answered.

Dr. Daly will try to respond to questions within 10 business days. You will receive a response via email.  Due to time constraints, only one question per email address will be accepted through the web site.  Please be assured that your email address will remain confidential and will be used for no other purpose than to provide an answer to your question.
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