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Trying to Conceive Community

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David K Walmer, MD, PhD

Joined: 02/26/2010

Expert Profile:

David Walmer, MD, PhD is a reproductive endocrinologist and infertility specialist at Atlantic Reproductive Medicine Specialists. During his 25 years in academic medicine, he served as an examiner for the American College of Obstetrics and Gynecology as well as on national practice guideline committees, working with fertility experts across the country to evaluate and update the standards for fertility care. Walmer is a member of the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility. In 2011, he was rated by Castle-Connelly in the top 1% of experts in his subspecialty. In his current practice, Walmer's clinical interests include age-related issues of fertility, fertility preservation, preimplantation genetics, premature ovarian failure, polycystic ovarian syndrome and uterine fibroids.
Walmer has a passion for improving women's health in low resource countries as serves on the faculty of the Global Health Institute at Duke University. He founded Family Health Ministries in 2000 to promote cervical cancer prevention and maternal-child health in Haiti. In 2011, Walmer helped Dr. Harry Beauvais establish a pioneering IVF program in Port-au-Prince, Haiti.

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Reply: Anxious & Confused

Dear Anxious & Confused, You are raising more than one issue that is...

Posted by David K Walmer, MD, PhD

2 Replies | Reply | Watch This DiscussionReport This| Share this:Anxious & Confused Dear Anxious & Confused, You are raising more than one issue that is...

Reply: Tubal Reversal

Having a tubal reversal is a big decision & I commend you for seeking...

Posted by David K Walmer, MD, PhD

1 Reply | Reply | Watch This DiscussionReport This| Share this:Tubal Reversal Having a tubal reversal is a big decision & I commend you for seeking...

Reply: i need help

What you are describing is not that rare. There are two potential...

Posted by David K Walmer, MD, PhD

What you are describing is not that rare. There are two potential approaches:

#1 You can undergo an extensive evaluation and plan treatment that addresses all of the potential issues that are identified.

#2 You can make some assumptions about the most likely cause of your problem and initiate therapy without a complete evaluation. This would require you to have a trusting relationship with a healthcare provider who understand your situation.

What you are describing is most consistent with what the World Health Organization calls a type II ovulation disorder. Many doctors and patients refer to it as Polycystic Ovarian Syndrome. A more informative way of describing it may be functional female hyperandrogenism resulting in estrogenic ovulatory dysfunction. This is a fancy way of saying that you have a hormone imbalance involving testosterone and estrogen. Approximately 5% of the adult female population has some symptoms of this disorder making it the most common endocrine problem that women have. Normally women's ovaries secrete estrogen for approximately 2 weeks followed by estrogen progesterone for approximately 2 weeks. Women with this problem often get stuck in the first half of their menstrual cycles and secrete estrogen continuously. Estrogen is a hormone that causes the uterine lining to grow. Over a period of approximately 10 years this unopposed growth can lead to the development of uterine cancer , which you describe. This is often a fairly treatable cancer using high-dose progesterone under the care of a gynecologic oncologist if a woman wants to conceive.

In the absence of cancer, this progesterone-deficiency disorder can be treated with birth control pills, other progestins or ovulation induction to help your body naturally produce progesterone. This latter therapy would increase the chances that you would be able to conceive. There are a number of relatively inexpensive oral medications that can be used to try to induce ovulation if this diagnosis is correct.

Three medications that are commonly used for this purpose are clomiphene citrate, tamoxifen and letrozole. I would recommend that you develop a relationship with a healthcare provider that understand your personal circumstances and is willing to work with you within your resources.

Good luck!

Dr. WalmerView Thread

Posted byDavid K Walmer, MD, PhD

2 Replies | Reply | Watch This DiscussionReport This| Share this:i need help What you are describing is not that rare. There are two potential...

Reply: estrogen patch while ttc

The dose of estrogen that you are on should not prevent you from getting...

Posted by David K Walmer, MD, PhD

2 Replies | Reply | Watch This DiscussionReport This| Share this:estrogen patch while ttc The dose of estrogen that you are on should not prevent you from getting...

Reply: Function of Genes

I was almost afraid to respond to this question. However, it's a fun topic...

Posted by David K Walmer, MD, PhD

1 Reply | Reply | Watch This DiscussionReport This| Share this:Function of Genes I was almost afraid to respond to this question. However, it's a fun topic...

Reply: New comer trying to conceive after 18 years of las...

I typically tell patients to wait about 4 weeks after surgery because of...

Posted by David K Walmer, MD, PhD

6 Replies | Reply | Watch This DiscussionReport This| Share this:New comer trying to conceive after 18 years of last pregnancy. I typically tell patients to wait about 4 weeks after surgery because of...

Reply: desperately need an answer

I delayed responding because I wanted to consult with an infectious disease...

Posted by David K Walmer, MD, PhD

3 Replies | Reply | Watch This DiscussionReport This| Share this:desperately need an answer I delayed responding because I wanted to consult with an infectious disease...

Reply: New comer trying to conceive after 18 years of las...

Yvette, It is hard to give you accurate statistics because the rate of...

Posted by David K Walmer, MD, PhD

6 Replies | Reply | Watch This DiscussionReport This| Share this:New comer trying to conceive after 18 years of last pregnancy. Yvette, It is hard to give you accurate statistics because the rate of...

Reply: New comer trying to conceive after 18 years of las...

Yvette, I think that your plan is very sound. It is a little harder to...

Posted by David K Walmer, MD, PhD

6 Replies | Reply | Watch This DiscussionReport This| Share this:New comer trying to conceive after 18 years of last pregnancy. Yvette, I think that your plan is very sound. It is a little harder to...

Reply: Baby Blues

I would recommend getting a 2nd or 3rd opinion. Irregular menstrual cycles...

Posted by David K Walmer, MD, PhD

1 Reply | Reply | Watch This DiscussionReport This| Share this:Baby Blues I would recommend getting a 2nd or 3rd opinion. Irregular menstrual cycles...

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