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Please click here to view Dr. Daly's "Ask the Expert"
segment on Wood 8 TV
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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Responses to questions are NOT posted on the web site.
Dr. Daly would be happy to
answer general questions you might have about infertility.
Detailed questions about what to do about your specific problem or
questions about other physicians or infertility programs will not be
answered. If your question falls into these categories you should make a
consultation appointment by calling 800-695-5941.
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
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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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