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" Man, I&amp;#039;ve been looking forward to today. Fertility expert Dr. Wisot takes the pressure off me to bring us his insightful answers to your tough questions. I want to address, for the last time, some readers&amp;#039; feelings about my blogging here now that I&amp;#039;m pregnant, and how I&amp;#039;m going about it. Here&amp;#039;s what I know: Everything is out of my control. No matter how much I want something \u2014 or fear the opposite \u2014 I&amp;#039;m not in charge here. But in the face of fear and the great unknown, I am an optimist. That&amp;#039;s who I am. I was optimistic after heartache that I&amp;#039;d find true love again. I was optimistic that, despite my age and our track record, Hunky and I would be able to get pregnant. And if we weren&amp;#039;t, I was optimistic that we&amp;#039;d be able to adopt. And now, I&amp;#039;m optimistic that I will be able to carry this pregnancy to term. Am I scared shitless? You bet. Literally and figuratively as a matter of fact. And it takes me three hours from alarm to office because I&amp;#039;m so sick in the mornings. I&amp;#039;m finally at my goal weight \u2014 not exactly how I wanted to get here. And I check the toilet paper every single trip to the bathroom to make sure I&amp;#039;m not bleeding. Once, unfortunately, I was, and had to do a TV appearance 15 minutes later. It was the worst morning of my life, followed by the best afternoon of my life, when I saw the heartbeats for the first time. I think Dr. Wisot actually put it best: &amp;quot;Pregnancy is not the goal,&amp;quot; he told me. &amp;quot;A healthy baby is.&amp;quot; I know I have a long, long way to go before I get there. So I&amp;#039;ll get there the way I know how: with humor, levity, and a full glass of optimism. Now, on to the good stuff, but first, the doctor&amp;#039;s disclaimer: &amp;quot;My answers to questions on this blog do not constitute medical advice, but are merely meant to create an educational forum for consumers. It is always best to discuss these issues with your health care provider. The good doctor&amp;#039;s answers are in bold, below. Question #1: This is an amazing resource! My husband and I are 29 and diagnosed with unexplained infertility. We are trying another round of Follistim/IUI since we don&amp;#039;t have IVF insurance until late January. During my other IUIs my follicles grew really fast (6 and 4 days of follistim). This time it is taking a lot longer (I am on day 9 and my lead is 15m). Someone mentioned something about slower growth = better egg quality and I was wondering whether this was true? My FSH is 4 and so far there have been no indications if any problems with my eggs. I was also wondering if you recommend further testing to determine why I am not getting pregnant before IVF or just moving on to IVF. Thanks. In this instance slower growth to some extent is better since it takes a certain number of days for eggs to prepare the chromosomes for fertilization. Four is very short; six is marginal. So you are now on a better track. I don&amp;#039;t know what&amp;#039;s been done so I can&amp;#039;t say what further testing might be useful. But, in general, when one has not succeeded with injectable meds and IUI, it&amp;#039;s probably time to move on to IVF. In fact, in younger patients like you, many are choosing to bypass the injectables with IUI and going more quickly to IVF because with IVF multiple pregnancy is easier to control. So, if this cycle is not successful, it&amp;#039;s probably on to IVF.Question #2: I had a normal pregnancy with birth May 2006. Dear Husband (DH) and I started TTC when Dear Son (DS) was 15 months old. I concieved the first try and miscarried at 6 weeks followed by three more early miscarriages (at 6 weeks, 4.5 weeks, and 5 weeks). All 3-4 cycles from miscarriage to conception per MD recommendations, all pregnancies on the first cycle attempted. I have had an ultrasound, HSG, pelvic MRI, FSH test, progesterone level, karyotyping, and a battery of immune system and clotting factor tests. All were normal except protein S and C and lupus anticoagulant, but repeats of these turned out to be normal. My DH had karyotyping done. All I keep being told is that due to the normal pregnancy I already had there is no reason to think I can&amp;#039;t have another, and no reason to try ART. So would you agree, and why don&amp;#039;t they look at anything else on DH? I mean I know conception isn&amp;#039;t the issue, but can&amp;#039;t sperm quality affect the outcome of a pregnancy? His parents tried nine years between children, no miscarriage, but couldn&amp;#039;t there be something to at least consider? And what other tests might you recommend for me? My OB and RE have both suggested laproscopy but with the holidays I haven&amp;#039;t been able to schedule it; is there anything else I should look at or consider? Thanks. After four miscarriages with no apparent reason I would be looking at IVF with preimplantation genetic diagnosis (PGD). I see a lot of couples with recurrent pregnancy loss and when it gets to this point we usually find that even with normal karyotypes and FSH levels they produce a high proportion of embryos with abnormal chromosomes. Two tests to consider before that step might be a ureaplasma culture in you and a Sperm Chromatin Structure Assay (SCSA) for your husband to check the fragmentation of his sperm. A high degree of fragmentation predicts poor reproductive performance. I don&amp;#039;t understand how laparoscopy would help this problem so i would ask your doctor that question. This is a very frustrating problem and I don&amp;#039;t find couples are happy hearing, &amp;quot;just try again.&amp;quot; Question #3: I am 30 years old and my husband and I have been ttc for three years. I had Endo stage 3 that was diagnosed and removed during a lap a year and a half ago. HSG, saline U/S and my bloodwork were all normal. I have no issue ovulating. My husband&amp;#039;s SA was completely normal in all categories. We have done three Clomid/HCG/IUI cycles (two follicles each time) and one Gonal F/HCG/IUI (six follicles) after the lap and have not been sucessful. Our next step is IVF. My questions are 1) Why does endo inhibit pregnancy and 2) If there is no reason other than endo for us to not be pregnant, why would IVF work when IUI and meds didn&amp;#039;t? So, in other words, are we wasting our time? 3) Would you recommend another lap to remove any endo that may have come back before doing IVF? Okay, Thanks so much! For the rest of you, &amp;quot;endo&amp;quot; is endometriosis. We really do not know the entire mechanism by which endometriosis makes conception more difficult. We suspect that it&amp;#039;s an immunologic issue. IVF can work because the eggs are removed from the body and are not exposed to the immunologic factors in the pelvis. There can still be issues with implantation even in IVF and so we often pre-treat endometriosis patients with Lupron or other drugs. Another option would be to have a repeat laparoscopy but that&amp;#039;s another surgery and I would try to avoid that.  "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.redbookmag.com/body/pregnancy-fertility/a4517/wisdom-from-wisot-wednesdays-r-ad75/>