LPD advice

[tarahh]

Hi,
Here's the stats on myself & my husband:

Me: 33
AMH 2.2
E2 Normal
FSH Normal
HSG Normal
Pooled P4 (3 days) 6.82
Midcycle U/S 18 follicles left ovary
BMI 21
Physically very active, nonsmoker

Husband: 35
Post-wash IUI 0.52 mL
19,000,000 total motile
motility 57%
rapid & linear 12%
dx stage II NHL at age 29; chop-r + chest radiation
Nonsmoker

We have been ttc #1 for 13 consecutive months currently plus 3-4 months a few years back (we decided to use protection after that, we weren't quite ready). I ovulate regularly every month, between day 12 and 15. I start spotting 9-10 dpo and then have a period a few days later. Because of the low prog, I have used prog supp + iui (once with hcg trigger after u/s and once based on urine lh) for the past 2 months. I will try that for one more month, then add in clomid.

Does this seem like a reasonable course of action?

Do you think that the problem here resides with my cycle and has nothing to do with sperm issues from all the prior chemo my husband had? We have banked sperm from before he started chemo. The counts from that sperm are normal, but our RE thinks there's no advantage to using them.

Thanks for your input. I feel frustrated and just wish after all that we've been through, it would work easier.

[Scott Roseff MD]

Hi,
I need your cd3 LH, FSH, and E2 levels, as well as your antral follicle count. A midcycle U/S with 18 follicles on one ovary is not helpful information. I also need your prolactin and TSH levels.

A rapid motility of 12% is very poor. I would like to have your husband's sperm DNA fragmentation and decondensation test results. If these were poor, then coitus and IUI may be a total waste of your time, emotions, and money.

Spotting 9 dpo is abnormal and not beneficial for achieving a successful pregnancy. Most causes of LPD are due to abnormalities in the pre-ovulatory phase, so "putting a band-aid on it" with luteal progesterone is often fraught with failure. Are you SURE you're seeing a board certified RE???

Dr. Roseff in FL

[tarahh]

Hi,

Thanks for your quick reply. I'll get those values from my labs to you.

Yes, I'm seeing a board-certified RE, I chose the clinic in our city with the highest success rates.

My husband has never had any further analysis besides just the standard semen analysis. I have expressed concern to them on MANY occasions that I am worried about what effect the chemo has had. I even said that we would be willing to use donor sperm rather than ivf, and my re said there's no benefit to that.

Those were all post-wash values I gave you, I don't know if that makes a difference. They claim everything looked good because the total motile was around 20 million.

[tarahh]

Wow! The nurse was fast getting these back to me. Here you go:

E2/FSH value-
First Level FSH=1.58 E2=290
Second level: FSH=5.74 E2=48.2
Antimullerian hormone=2.2
No LH or prolactin level drawn.
Pooled progesterone=6.82
Antral follicle count=21

I had the E2/FSH re-done because the first cycle was an unusual one for me and I actually ovulated 4 days after the labs were drawn.

I can tell you my tsh and t3/t4 are completely normal. I've had graves disease in the past, which was treated with PTU and has slowly resolved over the past 7 years, and I am now on no meds. My regular endo also tested for thyroid antibody levels and these are completely normal.

[Scott Roseff MD]

Sorry to hear prolactin wasn't checked -- A high prolactin can cause a LPD and increase the risk of miscarriage!

So, what was your TSH?

Sorry to hear, too, that sperm DNA analysis wasn't done - In someone with your husband's history, I would find that to be critically important....

Dr. Roseff in FL

[tarahh]

TSH was 0.52. TSI was 132% (normal is 130%), TPO was negative.

The pre-wash stats for our last iui were 4.2 mL
Conc 10,000,000
75% motlity
24% rapid & linear
31,500,000 total motile

The post-wash values were the ones I gave you above.

Do you think the sperm tests you mentioned are predictive enough of pregnancy success to change our course of action? Our RE is concerned about my husband's history as well, but thinks that we have as much of a chance of prenancy with the current fresh as trying to thaw and use the sperm from when he was sick. He said most often when someone is sick, their sperm does not do the best when thawed.

As far as my cycle, does clomid + prog seem like a reasonable thing to try next?

[Scott Roseff MD]

Hi,

Thanks for the TSH.

I think you should read this link regarding sperm function.

Regarding Clomid/prog, it's illegal for me to tell you what to do. I can only tell you your next step if you establish a doctor/patient relationship with us by scheduling a new patient consultation here.

All my best,
Dr. Roseff

[tarahh]

Thanks for all your input.

I know there's docs on both sides of the fence about what to do with tests like these. Alot of people feel there's not enough literature out there yet to influence the course of action.

I think for now we'll try the clomid and prog and see if that works for us. Your insight has been very much appreciated, thanks again.

[Guest]

I need your cd3 LH, FSH, and E2 levels, as well as your antral follicle count. A midcycle U/S with 18 follicles on one ovary is not helpful information. I also need your prolactin and TSH levels. itune

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