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" We&amp;#039;re back with the one, the only, the baron of baby-making, fertility expert Dr. Arthur Wisot. There were a few late-breaking questions that came in that we won&amp;#039;t get to this week, but will definitely address next week. And keep posting your great questions in the comments section of any blog entry. The important 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.&amp;quot; The good doctor&amp;#039;s answers are in bold, below. Question #1: I am on break after another negative beta and will probably move to IVF in the new year. Since I am not doing any treatments I was planning on enjoying a few glasses of wine over the holidays but am now concerned that could effect my chances with IVF. What do you reccomend? Thanks.  Answer: Although abstinence from alcohol is most important while one is actively trying, some of the effects can be longer-term. So it would be best for both partners to abstain even in the rest period. To be practical I certainly would avoid binging and confine any drinking to small amounts on special occasions.   Question #2: I was put on 1500 mg Metformin for PCOS on Oct. 14th, and I take 1500 mg Vitex since around the same date. How long should I allow for this regimen to continue without seeing my doctor again? This is all from a primary care physician, not a reproductive endicrinologist. We were thinking of going back to the doctor in January for more follow up and more aggressive treatment. It seems you would agree that Metformin is not the &amp;quot;dream&amp;quot; drug that I had hoped it would be, but at the same time, I don&amp;#039;t want to give up hope that it will work. Should I give it all more time, or go back to doctor ASAP? Should I stop taking the Vitex? Am I taking too much Vitex? Thanks! Answer: Metformin may be very helpful if you have Polycystic Ovarian Syndrome (PCOS) but it restores ovulation without other fertility drugs only in about 30% of PCOS patients. If you are young, I would give it about three months to see if it helps by itself. If not, I would recommend seeing an reproductive endicrinologist to get on the right other medication quickly. Primary care physicians usually do not treat this extensively. Vitex is a folk remedy which I do not usually recommend. It can have effects on one&amp;#039;s hormones and other female conditions, not all beneficial. It is specifically prohibited in pregnancy.  Question #3: Hi, doctor! I am 33 years old and I have a beautiful daughter who just turned 2 and we have been trying for our second for about nine months. My husband and I recently decided to go for some testing. My blood tests all came back normal (according to my ob/gyn) but my husband&amp;#039;s sperm analysis came back with some issues. Although his count was ok (44 million), he had 2% morphology and 38% motility. Assuming his follow-up test comes back with the same numbers, I had a couple of questions: 1) Is there anything he can do to help those numbers (he is incredibly healthy, active and 33 years old, and takes a multi-vitamin every day)--we read about Maca or other anti-oxidants--thoughts? Would you recommend he see a urologist? 2) Is there a chance that an IUI would be successful with those numbers? I am really looking to avoid Clomid but am open to it before trying IVF. Thanks so much!! Answer: The morphology is a significant issue. A visit to a urologist who specializes in male fertility could uncover a correctable reason. Antioxidant vitamins might have a small effect but I have not seen dramatic improvements which basically changed the treatment required to achieve success. Clomid would add little to help this situation. IUI could be helpful by delivering more sperm more efficiently. Ultimately IVF with ICSI might be necessary to overcome a significant morphology problem.  Question #4: Hi, Dr. Wisot. Thanks for taking our questions. My situation is: I am 36, my husband is 34. We have been trying for about 2 years. We had the workups, and it looks like I am okay, ovulating on my own, etc. My husband&amp;#039;s semen analysis showed slightly low sperm count (initial value, before washing, at 19 million) and low morphology (initial value, before washing, right at 4% using kruger strict). Motility was great. We are proceeding with IUIs (just had our first). We have chosen to try unmedicated IUIs since it looks like I am producing and ovulating on my own. We did not want to try Clomid right away for me because of a) the costs, b) the side effects, and c) the chance of multiples. We are paying for all of this out of pocket, and an unmedicated cycle is about $1000 cheaper per cycle. Our doctor is really pushing for the Clomid or stims. My question is: Are we really decreasing our chances on an unmedicated cycle? Should we just move to Clomid? Percentagewise, would it make that big of a difference for chances? Thanks! Answer: Between this and the previous question it sounds like there is an epidemic of morphology issues. Actually, I think I am seeing a lot more couples with exactly this problem. Clomid and stims only may increase the number of follicles produced and make the IUIs timed more precisely. This may help a little but it does not help most couples when the strict morpology numbers are so low, especially if that&amp;#039;s combined with a low count. So your instincts are correct. Save your money and if the IUIs are not successful it might be actually more cost-effective to go to IVF with ICSI. I hope your husband has seen a urologist to check for correctable reasons and, of course, is avoiding the bad habits that can causing the problem like smoking, heavy drinking, and drugs including body-building supplements and steroids.  And a really big thank you:I want to post a HUGE Thank You to Dr. Wisot. Really, it is phenomenal that you take your personal time to answer our infertility questions here! I hope you know that it is extremely appreciated and immensely helpful to all of us. No wonder you were named a &amp;#039;Super Doctor&amp;#039;--clearly you are!! Thank you, thank you, thank you!! Response: Thank you for the kind words. I have always been impressed that a little knowledge can go a long way to help this process proceed more quickly and successfully.  Cheryl is a good example of this. She had the advantage of a friend &amp;quot;in the business,&amp;quot; and through me learned what she needed to do and used the information to guide her to success. Now she has me helping you. Be careful where you get your information, especially on the web (except for this site and my site) because there is a lot of hype out there. So learn all you can. Ask your doctor any questions you think are important and help him/her make good decisions. "^^<http://www.w3.org/2001/XMLSchema#string>
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