Although every patient has the same goal, establishment of a healthy, ongoing pregnancy, New Jersey fertility doctor Jane Miller does not use a one –size – fits –all approach to treatment. That’s why the initial consult and testing – all the detective work that precedes treatment – are so important. Every patient is unique. When choosing a treatment for ovulatory dysfunction the patient’s age, weight, past reproductive history and presence or absence of a male factor must all be considered in addition to the etiology of the problem.
The luteal phase, the second half of the cycle following ovulation, is the part of the cycle in which the hormone, progesterone, comes into play. On a natural (unmedicated) cycle progesterone should peak around the 21st or 22nd day of the cycle. (Day 1 is the first day of bleeding.) As progesterone is necessary to support the uterine lining which, in turn, allows the fertilized egg to implant, a too-low progesterone can prevent the lining from maturing sufficiently to do its job. In this case the luteal phase can be too short. Oddly enough, in order to correct a “defective” luteal phase, treatment is aimed at improving follicle development in the follicular phase, the first part of the cycle. Gonadotropins – medications injected with tiny sub-cutaneous needles – can accomplish this. Supplemental progesterone treatment is often added , as well, after ovulation.
New Jersey fertility doctor Jane Miller encounters this problem in many women in their late 30s and early 40s but she has found this situation in selected patients in their mid 20s as well. What is a normal – although not desired – finding in a woman of 38 or 39 may indicate an “egg issue” in a 25 year old. For all women with diminished ovarian reserve gonadotropin treatment coupled with IUI (intrauterine insemination) or IVF (in vitro fertilization) should yield success in 1 or 2 treatment cycles. If not, genetic testing should be offered to the patient. A karyotype – a reading of the woman’s chromosomes and/or genetic testing of her embryos (fertilized eggs obtained via IVF) may be appropriate. A patient’s subsequent treatment is then advised based upon the results of these tests.
PCOS is not just one syndrome. It is a spectrum of abnormalities in metabolism as well as ovulation. For the overweight woman with this diagnosis weight loss – accomplished by strict diet and physical exercise – may be sufficient to restore ovulatory cycles and thus allow pregnancy to occur “the good old – fashioned way”! But there are thin and normal – weight “polycystics” as well who clearly need medical treatments to enable ovulation. New Jersey fertility doctor Jane Miller often couples these treatments with IUI or IVF. Again, the initial consult and testing help her to select the safest way to accomplish pregnancy in these patients. Patients with PCOS often have an excessive number of follicles that can potentially release an excessive number of eggs when ovulation is induced. For these patients IVF and embryo transfer of only 1 or, at the most, 2 embryos into the uterus is the recommended route to a safe and healthy pregnancy.
When a woman stops having regular monthly cycles before age 40 it may be because there are no more eggs in her ovaries. In this situation ovulation induction with medications is not appropriate as these medications can only stimulate the growth of eggs that are already there. Unfortunately we cannot “make more eggs”. We can, however, help these patients have healthy, ongoing pregnancies with eggs from healthy egg donors. The donor eggs are fertilized with the desired sperm (husband’s, significant other’s, sperm donor’s) and the resulting embryos are transferred to the patient’s uterus. Again, New Jersey fertility doctor Miller transfers only 1 or 2 embryos into the patient’s uterus. If there are additional embryos of good quality they may be cryopreserved (frozen) for future use by the patient.