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" Hello, hello! We&amp;#039;re back with six new questions for Dr. Popular, fertility expert Dr. Arthur Wisot. I love that you&amp;#039;re all beginning to rely on him as much as I do! With all the questions that come up during the baby-making process, it&amp;#039;s so nice to have one of the best doctors in the country just an email away. Keep those questions coming! Just post yours in the Comments section on any post of this blog. And now, the disclaimer: &amp;quot;My answers to questions on this blog do not constitute medical advice, but are merely meant to create an educational forum for consumers. It is always best to discuss these issues with your health care provider.&amp;quot; The good doctor&amp;#039;s answers are in bold, below. Question #1: What should one expect on their first visit to an RE and how might it differ from having been on a series of Clomid metformin cycles monitored by my OB/GYN? Does a consultation with an RE automatically mean you are headed down the IVF road? We&amp;#039;ve been at this for over a year now and I would just like to go into a consultation with my eyes open. Thank you Dr. Wisot! Answer: If your OB/GYN monitored your cycles on Clomid and metformin you have some special OB/GYN. Most don&amp;#039;t. A consultation with an RE should not mean anything automatic, but is a higher level look at what it may take to help you become pregnant. That could include any number of recommendations like injectable drugs with IUI, IVF, laparoscopy. Bring all your previous records and expect to walk out with a plan based on his/her evaluation of your issues and in the context of what&amp;#039;s been done so far. Question #2: I am 32, DH (dear husband) is 37, and we have been trying for over two years for baby #1. His sperm analyses (SA) are anything but stellar: all three times, his concentration was less than 6M/ml. My RE gave us only 5% chance of naturally conceiving. Do you agree? Also, should we bother wasting time and money on IUI&amp;#039;s? Or just go straight for the gold w/ IVF? Thanks!!!! Answer: I do agree. It is rare that I see a sperm count that low work naturally or with IUI. I usually get some genetic tests when the count is that low including a karyotype and a test for a Y-chromosome deletion. Then it&amp;#039;s usually IVF with ICSI. Question #3: This is a pretty low-tech question compared to the other ones I read, but I thought you could offer some good perspective. I will turn 38 in March. I have a 13-month-old son. We would love to have another baby and know that we need to do that as soon as possible. It took me almost a year and a half to get pregnant with our son. It was unexplained infertility, and I finally conceived after my HSG (which showed no problems). I was also getting acupuncture. I got my period back when my son was seven months old and we started trying right away. No luck so far. He&amp;#039;s still nursing, and I&amp;#039;m wondering how much that might be hurting our chances. I&amp;#039;m torn, because nursing means so much to him and I know it would be really hard for him to give it up. I have an appointment with a new OB (we&amp;#039;ve moved) at the end of this month. Do you have any advice for what I might ask about when I see her? Thanks so much! Answer: Ask your son which he prefers, to continue nursing or a baby brother or sister? If he does not answer it means he wants to go for the sibling and give up the nursing. Seriously, trying while nursing may hamper your efforts so to get the best chance you may need to stop. (I don&amp;#039;t need to hear from those of you who got pregnant while nursing\u2014I know it happens.) I would probably ask to have your husband&amp;#039;s semen analysis rechecked and get a prolactin level to check for elevated breast milk hormone, and a progesterone level a week after you think you ovulated to make sure you are and the levels are adequate. I am a believer in sticking with success. I would probably repeat the HSG and inject an oil-based dye if your tubes are open and see if history repeats itself. Question #4: Okay, fact or fiction? Do either of these have any merit? 1) eating pineapple after the transfer makes the lining more &amp;quot;sticky&amp;quot; and helps with implantation? 2) using accupunture through the retrieval and transfer process to help chances of pregnancy? Answer: Eating pineapple can make your hands sticky but I am not aware that it has the same effect on the endometrium. (If it did IVF success rates should be higher in Hawaii and I don&amp;#039;t think that&amp;#039;s true. :-)) There have been studies showing better success rates in women who had acupuncture but the level of evidence is not strong. I certainly do not think there would be any harm doing acupuncture and you may want to try that. Eat pineapple only if you like it. Question #5: I just recently completed my first cycle of Clomid with an hcg trigger shot and timed intercourse. We were not successful. My question, though, is in regards to my response to the Clomid. I was put on 100mg of Clomid for cycle days (cd) 3 to 7. At cd14 we did a mid-cycle ultrasound to see how many follicles had developed. I only had one follicle at 23mm and the next two largest were at 13mm each. Is this a typical response? I am concerned b/c I am seeing a lot of people posting that they got four or five follicles. I am waiting to hear back from my doctor to see if they are going to up the dosage or change the protocol. We are planning on doing the same process of clomid, trigger shot, and timed intercourse. My husband&amp;#039;s SA came back as concentration 58.6mil, motility 54%, with a 9% morphology. I&amp;#039;m 28 and he is 31. My other question is, should we be even doing the timed intercourse or should we just move on to IUI? Answer: Most cycles of Clomid produce one egg; some two, and more than that is less frequent. Even one Clomid follicle can improve your chances by making your timing more accurate and improving your progesterone level. In another Clomid cycle, I would be either doing a post coital test to make sure the sperm can get through the cervical mucus or going to IUI based on the length of time you have been trying and your age. Question #6, a follow-up: Hello again. Just a follow-up question as my husband had the appointment with the urologist last week and I don&amp;#039;t think we thought to ask this question. The results of the test were that the prolactin went down from 35 to 25 and motility went up from 4% to 30% on the Clomid. Count decreased from 14 million to 8 million. Since the prolactin is still above normal he has been taken off of the Clomid and put onto the Parlodel. He will have to go back in March for the next round of tests. My question that we didn&amp;#039;t even think to ask the urologist is whether we should even be TTCing during the Parlodel treatment. We plan to ask the RE but as we live on an Island and are trying to schedule a telephone conversation (the RE visits the Island quarterly and meets with people referred by local doctors). Answer: The elevation of prolactin is not terribly significant. But counts of 14 and 8 million and motility of 4% and even 30% indicate significant issues with your husband&amp;#039;s sperm which, unless the urologist is treating a definite definable problem, sounds like it would need more aggressive fertility treatment if you don&amp;#039;t get pregnant soon. I can&amp;#039;t think of a reason that you should not be continuing to try. "^^<http://www.w3.org/2001/XMLSchema#string>
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