LATEST QUESTIONS


What is AMH?


May 7th, 2009

Good article explaining the basics of AMH:

Anti-Müllerian Hormone (AMH)
Müllerian Inhibiting Substance (MIS)

http://www.repromedix.com/pdf/AMHbL17CF181.pdf


I’ve had my adenemyosis removed twice already surgically and still have not had a successful pregnancy and its grown back again. My question is can another surgery be done to remove it again so we can try one more time or is it not recommended. As far as you know have women had more than 2 surgeries to remove this and was is a success?


May 4th, 2009

The question is how severe is the adenomyosis is. If it is localized and can be excised completely, then surgery is a possibility. However, if it is diffuse and clearly the reason for the failure to conceive, surrogacy may be the only option.

- Answers kindly provided by Dr. Stephan Volschenk -


Maybe a silly question, but here goes: Why do we need to use injectable or vaginal progesterone in the 2WW? Why can’t one use oral progesterone? (I assume it must be absorbed from gastrointestinal tract as progesterone is in birth control pills.)


May 4th, 2009

This is due to the “1st pass” phenomenon. Oral absorption is not nearly sufficient enough to obtain and maintain adequate levels in the uterus.

- Answers kindly provided by Dr. Stephan Volschenk -


Is it true that the second IVF is supposed to be more likely to be successful than the first, and if so, why?


May 4th, 2009

Statistically the likelihood of a good outcome during the 2nd or 3rd attempt is higher. This is due to the fact that so much information, that were previously not known, is now available and can be used to optimize and tweak the next attempt.

- Answers kindly provided by Dr. Stephan Volschenk -


I read this article in the FitPregnancy magazine about a lady 41 years old, 11 IVFs down [some number like that]. All failed. Through research, fertility doctors in the UK where able to find out one of the possible causes of the failure for implantation.


May 4th, 2009

You are referring to polar body biopsy and CGH. The technology is still very much in its infancy, but holds a lot of promise for the future. It  is not available locally yet and only in a few selected units in the rest of the world due to the fact that it is relatively new.

- Answers kindly provided by Dr. Stephan Volschenk -


How successful would IUI be, if I have PCOS (my eggs don’t mature) and my husband has poor sperm quality. The quantity of his sperm is around 7 million plus minus. There is also a possibility of a chromosome problem with hubby’s sperm … perhaps more of XX chromosomes?? I know that will be dealt with when the sperm is washed. The FS said that we would have anything from a 40% – 60% chance of success and I am presuming that would be 3 cycles. He said that if after 3 cycles we have no success we will move onto IVF. Honestly though do you think our chances would be good taking all of our problems into consideration?


May 4th, 2009

If the male partner has a chromosomal abnormality that has been documented, the sperm should not be used for IUI at all. Furthermore, the success rate of  IUI’s in people without any problems at all is between 18-20% per attempt. If you have compromised gametes, this chance of success will clearly be less.

- Answers kindly provided by Dr. Stephan Volschenk -


What is the ideal time/follicle size to use Ovidrel trigger in a IUI/timed cycle? What is the range if there are 2 follicles at different sizes? What is the disadvantage of triggering too early? (Do those eggs still have a chance?)


May 4th, 2009

The size for trigger is 18mm. With 2 follicles present, one would time the trigger on the size of the leading follicle, i.e. as soon as the leading one reaches a mean diameter of 18mm.

- Answers kindly provided by Dr. Stephan Volschenk -


I had a natural IUI cycle cancelled because my lining was only 7mm. I’m going to try again next month using injectables (Menopur).


May 4th, 2009

Menopur is likely to increase the estrogen level. The growth of the lining is dependant on the amount of estrogen, hence the use of the Menopur. Presumably you have had some sort of cavity assessment to exclude any pathology inside the uterine cavity that might lead to a thin lining?

- Answers kindly provided by Dr. Stephan Volschenk -


I’m a surrogate. When they did my bloods for progesterone they said mine was 37 which were low. I was on Gestone once a day and now they have added clyomed as well. What should my progesterone be? The beta was High which they said was good but I’m worried about the levels now I can only do my 6week scan in 1.5weeks should I be worried?


May 4th, 2009

As long as the Beta in doubling every 48 hours and there is no bleeding or cramping, the pregnancy is ongoing until proven otherwise.

- Answers kindly provided by Dr. Stephan Volschenk -


If I have an AMH of 0.6 and FSH of 5.5, stage 3 endo removed in AUgust last year and 30 years old, would IVF be my only option? We’ve been doing IUI with donor sperm (due to DH having azoospermia)but we have been unlucky 8 times


May 4th, 2009

With an AMH of 0.6, a history of stage 3 endometriosis and failed inseminations with good quality donor sperm, IVF is without a doubt the next step sooner rather than later.

- Answers kindly provided by Dr. Stephan Volschenk -

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