What do i do know??
7 Replies
Emma74 - September 7

Hi i was wondering if you could help me please.
a bit of history first, i had endometriosis diagnosed in 2005 and it has since been treated and disappeared after acupuncture, however, in 1996 i fell pg for the first time resulting in an ectopic pg at 6wk+5 in my right tube they left the tube as it was not badly damaged, i then fell pg straight after but m/c at 5w+4d i didnt concieve again until 2000 and again i fell pg with an ectopic pg and had the baby and the right tube removed at 9w+4d i have since been unable to concieve naturally as my left tube is blocked. :'( i have had my 1st ivf and was lucky to concieve however at 5w+4d i suffered a ruptured ectopic in my right stump (the hosp i had my previous loss's failed to mention they had left a stump next to my uterus, everything was fine with my other baby that was in the right place and carried on growing although on the lower end of normal at 8w+6d i went to see my midwife and performed at scan baby's heart had stopped so it looked like it had died at around 7wk+5 as at my scan at 7wk+3d bubs was still fine, i had an erpc yesterday and bubs has been sent for tests.
Im due to see my ivf consultant friday to see when i can start frozen embryo transfer as im lucky enough to have 8 embies. what do you suggest i ask my consultant as i cant go through another m/c please help!!! do you think it is immune issues or just bad luck!
Many thanks


Emma74 - September 8

Sorry not sure if this has been seen ???


B. Jacobs, M. D. - September 8

I am very sorry to hear of your problems. Truly, without functional tubes, you need IVF. Success rates are quite clinic specific. Also, please note that only about 1/3 of the eggs a woman produces are capable of successful pregnancy. There are miscariages with IVF pregnancy, as there are with spontaneous pregnancys. I do not know how to prevent that.
Good luck.


B. Jacobs, M. D. - September 25

I have not seen a couple in about 15 years, where I could not find an explanation for impaired fertility. There are a few review articles in the professional literature questioning the validity of such a diagnosis. Your TSH is a little high. You have "compensated hypothyroidism. I would treat it.
Good luck.


hopeluck - September 27

Thanks doctor for your quick response.

Actually I have been leveled for "Unexplained Inefertility" because all perliminary tests like FSH,LH,E2, progesterone, HSG tests in a reproductive clinic came out normal for me. So doctor thinks there should not be any reason I should not be able to conceive. He suggests that i should go for IUI as i am 32 and ttc for 2 years already.

I spoke to an endocrinologist the other day and he says since my menstruation cycle is normal this level of TSH(3.968) might not be effecting my fertility and also even if I take medicines there is no guarantee that it will lower the TSH level. What do you think about this? Could you please give me an idea what medicine and recommended dosage you would suggest in my case. Many Thanks.


B. Jacobs, M. D. - September 27

If you take too much Synthroid, you will become hyperthyroid. You need enough Synthroid to drive your TSH to baseline, but keep your circulating thyroid hormone level within the normal range. I happen to agree with a statement published in one of our professional journals that "unexplained infertility" is not a diagnosis, and only indicates that the right tests have not been done, or they have been done incorrectly. You still do not have a diagnosis.
Good luck.


hopeluck - September 28

Thanks doctor for your reply. Below i am including all my tests and the results. I had taken clomid from Day5 of my cycle for 5 days when these tests were done in the clinic.

FSH - 7.87(D2), 8.25(D9)
LH - 5.86(D2), 13.38(D9)
E2 - 43.2(D2), 669.0(D9), 173.9(D20, this was in different cycle without taking clomid)
Prolactine - 10.7(D3)
Progesterone - 20.64(D20, this was in different cycle without taking clomid)
TSH- 3.968
Free T3- 2.52
Free T4- 1.14

Could you please let me know what I am missing here, any diagnosis that you feel must be done or any of these results which you feel is not normal. Also as you mentioned before i should take medications for the slightly elavated TSH, do you feel any other treatment needs to be done beside this?
My doctor just feels i should go for IUI, but i want to make sure i have done all the right tests before i go for it. Please let me know. Thanks a lot.


B. Jacobs, M. D. - September 28

Please see the information I hav eprovided on our web page, <www.texasfertility.com>. I have described,in detail, how I evaluate an infertile couple, and included a descision tree.
Good luck.



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