Penn Fertility Care

Patient Resources

Ask the Fertility Expert

Air Date: Friday, January 27, 2012 | 2 pm to 3 pm EST

Penn Fertility Care specialists Anuja Dokras, MD, PhD, and Samantha Butts, MD, MSCE, answered fertility questions and reviewed the latest fertility treatment options during this live web chat held on January 27, 2012.

Featuring

Image of Anuja Dokras, MD, PhDAnuja Dokras, MD, PhD
Penn Fertility Care specialist
Director, In Vitro Fertilization Program
Director, Penn Polycystic Ovary Syndrome

Image of Samantha Butts, MD, MSCESamantha Butts, MD, MSCE
Penn Fertility Care specialist
Assistant Professor of Obstetrics and Gynecology

Ask the Fertility Expert
12:38

Penn Fertility Care:
Good afternoon! Welcome to Ask the Fertility Expert. Penn Fertility Care specialists will be answering questions at 2p (EST) today. If you would like to ask a question now, we will place it in que to have the specialist answer during the live chat.

1:55

Penn Fertility Care:
Now that we are getting close to the start of the live chat, we would like to give you some background on our participating physicians.

1:56

Penn Fertility Care:
Penn Fertility Care specialist Anuja Dokras, MD, PhD, is board-certified in reproductive endocrinology and infertility and in obstetrics and gynecology. Dr. Dokras has cared for patients for over 14 years. She is the director of Penn Fertility Care's In Vitro Fertilization Program and the Penn Polycystic Ovary Syndrome Program. In addition, Dr. Dokras oversees Penn's Donor Egg Program.

1:56

Penn Fertility Care:
Penn Fertility Care specialist Samantha Butts, MD, MSCE, is board-certified in reproductive endocrinology and infertility and is a clinical epidemiologist. She specializes in treating the multiple causes of infertility, including patients with hormonal problems related to reproduction and performs surgical procedures related to disorders of the reproductive tract (such as ovarian cysts and uterine fibroids). Dr. Butts also pursues reproductive research interests including reproductive aging, the impact of nutritional and environmental factors on reproductive outcomes and obesity-related effects on reproduction.

1:59

Penn Fertility Care:
The fertility specialists had some great questions come in prior to the chat and were able provide us with those answers. We will begin by posting some of these Q & A's while the physicians start to answer the questions currently coming in.

2:00

[Comment From Nytiaa: ]
I have a cyst on my left ovary and I want to know can I still get pregnant?

2:00

Dr. Dokras:
Nytiaa, it is important to first evaluate what the cyst on the ovary is due to. An ultrasound can usually clarify if it is a follicle, persistent simple cyst, endometrioma or a corpus luteum. Depending on what the ultrasound shows you can be counseled on its effects on fertility.

2:04

[Comment From Bev: ]
I have been trying for over a year to get pregnant but have not been able to. Is there anything I can do on my own to become pregnant?

2:04

Dr. Butts:
I would advise that after one year of trying to become pregnant you should be seen by a fertility specialist – a doctor who specializes in the treatment of patients who are having difficulty achieving a pregnancy. After a thorough evaluation of you and your partner, a specialist will be able to provide you with treatment options to increase your chances of conceiving. For women age 35 and older, we suggest they be seen by a specialist after trying to conceive for 6 months or longer.

2:05

[Comment From Guest: ]
I am a 38 year old with irregular menstrual cycles. My last normal period was February 2011. After missing three months, my Ob/Gyn prescribed medication in May 2011 to initiate menstruation. I then naturally menstruated again in June and July, but missed the three months after. Once again, I was prescribed medication to menstruate in Oct 2011. After that I missed two more months but did have a natural period in January 2012. However, even when I did menstruate, my periods were shorter in length and lighter than normal. Last week, my Ob/Gyn informed me that my blood levels indicate I am in menopause and I would not be able to conceive. I have two children and would like to have a third. Is this a realistic option? If I still am experiencing some natural menstrual cycles, do I still have viable eggs and a change of having one of them fertilized?

2:05

Dr. Dokras:
If your blood test indicated that you are in menopause, the FSH level is likely high. Women can continue to have some irregular menses for a few years during the menopause transition. The chances of having a spontaneous pregnancy during this period are low. There are usually a few eggs remaining and they may ovulate and fertilize however, the chance of having a live birth is low.

2:09

[Comment From Lexi: ]
Can I be a surrogate for my sister?

2:09

Dr. Butts:
You will need to be evaluated by a fertility specialist so they may determine if you could carry a child for sibling. At this meeting, the doctor obtains a medical history from each of you to understand what your reproductive needs are and will provide you with information about what treatment options are available and what they require from you both.

2:11

[Comment From Sal: ]
I had a baby three years ago without any problems at age 31. Healthy pregnancy, healthy baby. Now I cannot get pregnant. Is it possible to be infertile after having a baby?

2:11

Dr. Dokras:
Sal yes, it is possible to get pregnant easily the first time around and then have some difficulties trying to conceive again. Your doctor will evaluate any changes in your medical and surgical history as well as your partner's history. Depending on these responses some preliminary testing may also be recommended to determine a diagnosis.

2:14

[Comment From Angie: ]
At what age do you stop taking fertility patients? I am 44 and would like to have a baby. Am I too old?

2:15

Dr. Butts:
Angie - I encourage you to have a formal evaluation so that all the elements that contribute to your fertility can be determined. While age is very important, there are several treatments that can be offered and having a formal consult gives us the opportunity to discuss those with you.

2:16

[Comment From Lisa: ]
My husband has aspermia. Can we still get pregnant?

2:16

Dr. Dokras:
Your husband will need to be evaluated for the cause of aspermia or azoospermia which is no sperm in the ejaculate. A Urologist or a male fertility specialist will perform a physical exam and order some blood tests, including hormonal and genetic tests. In many cases it is possible to perform surgery and obtain sperm from the testis. You will then need to undergo the in vitro fertilization procedure and your eggs and your husband's sperm will be fertilized in the laboratory.

2:21

Penn Fertility Care:
We have had some great questions coming into the chat. Our physicians are answering some now. Please be patient and we will have additional questions and answers in just a moment.

2:23

[Comment From Brenda: ]
I had my tubes tied (tubal ligation). Can I have the procedure reversed or is IVF better?

2:23

Dr. Butts:
Both IVF and tubal anastamosis (tubal reversal) can be effective treatments for women who want to become pregnant after having had their tubes tied. Which treatment is most appropriate for you, depends on factors unique to each individual that should be evaluated with the help of a fertility specialist. These factors include things like sperm count in the male, hormonal factors in the female and age of the female partner. We have several surgeons at Penn Fertility Care with experience reversing tubal ligations and also have a busy IVF practice with many successful pregnancies in women who have had their tubes tied in the past.

2:25

Penn Fertility Care:
While our physicians are answering questions, here is some background about Penn Fertility Care.

Penn Fertility Care provides a full range of services for couples trying to become parents. We offer comprehensive evaluation of men and women as well as treatment options ranging from ovulation induction, intrauterine insemination, IVF, ICSI, egg donation, embryo donation and pre-implantation genetics. To best determine the specific treatment to help your situation a full consultation is recommended.

2:26

[Comment From Jenn: ]
I was recently diagnosed with PCOS. I am 29 years old and wish to conceive in the next year or two. What should I do to prepare now that I know that I have this condition?

2:26

Dr. Dokras:
Hi Jen, As you may know women with PCOS have a higher risk of diabetes and high blood pressure in pregnancy. Did you have testing for glucose, insulin and cholesterol levels? This is a good time for you to have these tests and see a nutritionist if any of the tests are abnormal. Also women with PCOS may start ovulating spontaneously after weight loss and not need to use any fertility medications. We have a comprehensive PCOS center at Penn Fertility Care and you can get more information on PCOS and treatment options on http://www.pennmedicine.org/fertility/patient/clinical-services/pcos-polycystic-ovary-syndrome/.

2:32

[Comment From Carmy: ]
Do you have any financing options to assist in covering treatment?

2:33

Penn Fertility Care:
Carmy - Penn Fertility Care has financial counselors who can review your individual financial considerations in addition to your health insurance coverage. The cost of fertility care runs a broad spectrum from the moderate end with evaluation, counseling or drug therapy at one end to surgical options such as in vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI) at the other end. Please visit our website to learn more about financial options or call 800-789-PENN.

2:33

[Comment From Jacki: ]
I had an HSG last week and the doctor said both my tubes were blocked. I have to go in for an ultrasound and then we will talk about what I can do to get pregnant. Can the tubes be unblocked and is it possible to get pregnant on my own?

2:33

Dr. Butts:
Whether or not blocked tubes can be opened usually depends on where the blockage is located. Sometimes surgeries can be performed to open tubes and to remove scar tissue on the outside of fallopian tubes that prevent the tubes from working properly. Whether or not to pursue surgery to open blocked tubes also has to take into consideration if there are other factors contributing to your fertility. All of these factors should be reviewed with a fertility specialist to determine the safest, most effective treatment option. If surgery is not effective or not indicated, the best treatment option is in vitro fertilization.

2:35

[Comment From Sarah: ]
I don't entirely understand why there is a diagnosis of unexplained infertility. Can you explain what this is?

2:35

Dr. Dokras:
The diagnosis of unexplained infertility is made when all the preliminary infertility testing for your partner and you is negative. I usually inform my patients that it doesnt mean that there is no cause for infertility, but it means that we currently have not found any problem. A number of these couples find an explanation for their fertility problems if they are treated with in vitro fertilization. This treatment gives us an opportunity to examine the eggs, assess fertilization and grade the quality of the embryos. There are a few couples however, where we may not find any obvious cause for infertility.

2:40

Penn Fertility Care
While the fertility specialists are answering questions we would like to inform you of Penn's Donor Egg Program. Penn Fertility Care offers you the convenience of providing a fertility evaluation and the IVF procedure, all within one location. To learn more about egg donation services for both the egg recipient or donor, please call 800-789-PENN or visit the Donor Egg Program page.

2:43

[Comment From Dan: ]
I had a vasectomy after our 3rd child. Ten years later, we are considering having another child. Can you please let me know our options?

2:43

Dr. Dokras:
There are two options available, which are surgery to reverse the vasectomy or in vitro fertilization. The outcomes of the reversal surgery decrease with time post surgery. You will need to review this with the Urologist. Also, your partner should be evaluated to confirm that there are no other factors that might affect fertility.

2:50

[Comment From Shannon: ]
How do I make an appointment with your center?

2:00

Penn Fertility Care:
To contact Penn Fertility Care please call 800-789-PENN (7366). If you would like to schedule an appointment, you can do so over the phone or you can Request an appointment online. Penn Fertility Care offers three convenient locations:
Hospital of the University of Pennsylvania
Pennsylvania Hospital
Penn Medicine Radnor
Visit us at pennmedicine.org/fertility.

2:53

Penn Fertility Care:
We have had some great questions today! We would like to inform participants that due to the time, we will take one more question and then close the chat.

2:57

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3:00

[Comment From Jill: ]
I'm 30 and trying to conceive for the first time. I have a regular cycle but each month I spot exactly 5 days before my period starts, every month. Is this a possible sign of infertility? Wouldn't implantation be difficult if spotting is occurring?

3:00

Dr. Butts:
The spotting may not be a problem for your fertility, especially if you are up to date with your routine gynecologic examinations (which would involve a pelvic exam and a pap smear). If the spotting persists and is a concern to you, I would recommend addressing it with your gynecologist who could order tests to evaluate it further. Also, while you are trying to conceive it is important to take a prenatal vitamin or a multivitamin with folic acid. If you have not become pregnant after 6-12 months of trying (depending on your age) you should have an evaluation by an infertility specialist.

3:01

Dr. Dokras:
Looks like the session is wrapping up. Thank you everyone for your participation. We hope our insight has helped. Dr. Butts and I appreciate your time and would be pleased to see you in our practice to provide a full fertility evaluation, diagnosis and treatment options.

303

Penn Fertility Care
Thanks for the questions everyone - and many thanks to our fertility specialists Anuja Dokras, MD, PhD, and Samantha Butts, MD, MSCE. If you would like to schedule a consultation at Penn Fertility Care, please call 800-789-PENN or visit the website at www.pennmedicine.org/fertility.

As a reminder, if you are in need of immediate medical attention, please contact your physician or go to the nearest medical center.

Disclaimer

This public web chat provides general health information for educational purposes only. The information offered through the Penn Medicine web site is provided with the understanding that the participating health care professionals are not engaged in rendering medical advice or recommendations. Information should not replace necessary consultations with a qualified healthcare professional to meet your individual needs. In case of emergency call 9-1-1 or go to the nearest emergency medical facility.

Due to space and time limitations and other considerations, Penn Medicine does not guarantee that it can provide an answer to all submitted questions. Individuals submitting questions do so with the understanding that they may not receive a direct answer to their question.

Questions may be consolidated, revised, held for future postings, or deemed inappropriate for this setting. Penn Medicine website moderators retain editorial control over content and choose the most relevant questions for the experts. Experts can decline to answer questions.

Views expressed are those of the participating fertility specialist and do not necessarily represent the official opinion of the University of Pennsylvania Health System (Penn Medicine) or the University of Pennsylvania, unless explicitly stated with the authority to do so.