I was almost afraid to respond to this question. However, it's a fun topic to ponder even though it might be opening a can of worms. The simple answer is no. However, experts from a variety of fields could organize an entire medical conference to discuss this question.
Identical twins provide a natural experiment to give us some insights into this question. Identical twins share the same DNA but develop into completely unique individuals. Why? One reason is that we do not express all of our genes. Some genes are turned on and some are turned off. This process is dynamic and appears to start shortly after fertilization and continues through our adult lives. In a sense, our environment influences expression of our genes. This is called epigenetics. Some environmental exposures increase our risk of developing cancer and others may lower our risk of developing heart disease.
This is an exciting area of research because it may be possible in the not-too-distant future to individually tailor medical therapies to individuals based on their known genetic code. For couples who contemplate using eggs from donors, it may also be reassuring to know that the maternal environment may influence the development of their unborn children.
I'm not sure what sparked this question, but it certainly gives us an opportunity to discuss some interesting ideas. Looking forward to see what follows.View Thread
I typically tell patients to wait about 4 weeks after surgery because of the swelling (edema and inflammatory process) that is involved in healing and could theoretically increase your risk of an ectopic. However, I did do a tubal reversal once in early-November and the patient didn't take my advice and had a positive pregnancy test on Thanksgiving. Good luck!View Thread
I delayed responding because I wanted to consult with an infectious disease specialist at Duke first. What I have learned is that it is difficult to know how to accurately counsel you about when it is safe to have unprotected sex. Most of the avaialable data reports levels of immunity after the 3rd dose of the vaccine. One option would be to have your husband's immunity checked by asking his doctor to try to estimate his current level immunity by ordering an antibody test to hepatitis B. Alternatively, you can just wait until he gets his 3rd dose of the vaccine and use the estimates of immunity that currently exist. Here is a package insert to Merck's vaccine if you want to read in more detail. http://www.merck.com/product/usa/pi_circulars/r/recombivax_hb/recombivax_pi.pdf Good luck.View Thread
Yvette, It is hard to give you accurate statistics because the rate of decline in fertility varies a lot from woman to woman and we lost the ability to observe your fertility potential when you had your tubes tied. You are at a higher risk of miscarriage now than when you were younger and you are at a higher risk of an ectopic than before you had your tubes ligated. However, your ovarian reserve sounds like it is hanging in there. If you're OK with a little risk and are in the hands of a health care provider that you trust, I think that I would remain hopeful at this point. If you want to maximize your chances of success and have the resources, I would probably try on your own or with some gentle ovulation induction for 3-6 months and then jump to IVF if that doesn't work and you are getting frustrated. IVF can maximize your fertility without significantly increasing your risk of multiples. If you have the resources, IVF centers are increasingly acquiring the ability to examine the genetics of blastocysts (day 5-6 embryos), which allows couples to transfer embryos that are chromosomally normal (46xx or 46xy). This is expensive but it almost eliminates the effects of age on fertility following an embryo transfer based on data presented recently at the American Society for Reproductive Medicine meeting in San Diego. Good luck.View Thread
Yvette, I think that your plan is very sound. It is a little harder to counsel couples who elected to give up their childbearing. We believe that all women have an age-related decline in fertility but the rate of decline probably varies a lot. The patients that come to see us are more likely to be on a steeper slope and patients who show up in the obstetricians office are more likely to be on a more gradual slope. When you stop trying to conceive, we lose the ability to observe your fertility potential. If you really want to have a child together and have the resources, I would recommend trying for a few months (3-6) and then going straight to IVF. IVF gives you the ability to maximize your fertility and minimize the risk of a multiple pregnancy. It is true that your risk of an ectopic is a little higher after a tubal reversal but most pregnancies will end up in the uterus after a successful tubal reversal. If you invested in the surgery, it is worth giving it a shot for at least a few months. Good luck!View Thread
I would recommend getting a 2nd or 3rd opinion. Irregular menstrual cycles is often a sign that something in your system may need to be tuned up (thyroid, androgen/estrogen balance, etc.) and sometimes it is as simple as taking a pill for 5 days each month and sometimes it is more complicated. With regard to your fibroid tumors, some are more likely to be associated with infertility or miscarriages and some are not. It is important to know how close they are to the uterine cavity, how big and how many there are. It is usually possible to remove fibroids without doing a hysterectomy but that is a big operation and it is important to discuss the pros and cons of this will someone that you trust. At the age of 33, you don't have to rush into making a permanent decision like having a hysterectomy. Don't stop looking until you find a health care provider that will spend time with you and help you make the best decision. Good luck.View Thread
Yvette, I hope that this happens quickly for you. I would recommend you start taking a folic acid supplement and keep a calendar of your menstrual cycles, days you have intercourse and maybe even use an ovulation predictor kit to help you assess your fertile window and to confirm that your cycles have returned to normal. If you don't conceive in the first 4-6 months, that data might be very helpful to a health care provider that you see. You may want to see someone for preconception counseling either now or if not pregnant in the 1st 4-6 months of trying. If may take a little longer at the age of 39 and your window of opportunity won't be as wide as it was when you two had your first seven children. There have also been a lot of advances in assisted reproduction in the last 18 years and just knowing about them may help you make decisions. We want you to have success. Good luck.View Thread
You are in a difficult place. We can certainly try to reassure you that exercise isn't going to be responsible for either your negative pregnancy test or a miscarriage but if you are going to worry nevertheless, that is a problem. We all have brains and we have to live with them. A healthy lifestyle is more likely to reduce the chances of having a problem in pregnancy. Regular aerobic exercise can also increase endorphin levels, which can also just make you feel better. I would begin training for a marathon if you have not been exercising at all but a moderated exercise program or maintaining one that you have already been doing is absolutely fine and encouraged. If a low impact exercise program would make you worry less then there are actually a lot of options including cycling, fast walking and swimming. You might also consider yoga. Focusing on nutrition can also be important for some patients with PCOS, Good luck... Dr. WalmerView Thread
Dear An_..,, You are correct that concerns have been raised about a possible link between vitamin B12 deficiency and both infertility and miscarriage. However, there has not been a great deal of research in this area. Vitamin B12 deficiency leads to a type of anemia called megaloblastic anemia, which is potentially problematic in a pregnant women and could lead to problems with her developing babies growth and also to a vitamin deficiency in the unborn child. This is an issue that you should address with both your gynecologist and probably an internal medicine physician to correct the condition before you attempt to conceive again. If you have access to a medical library, here is a review article that you might want to look up.
Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development. [Review> Molloy AM. Kirke PN. Brody LC. Scott JM. Mills JL. Food & Nutrition Bulletin. 29(2 Suppl):S101-11; discussion S112-5, 2008 Jun. The FDA has also prepared a nutritional guide for women who are pregnant or planning to conceive that you may also want to look at as well. http://www.fda.gov/food/resourcesforyou/healtheducators/ucm081785.htm Good luck. Dr. WalmerView Thread
There are nine different isomers (related forms) of inositol. Only one of them, mo-inositol, has shown any efficacy improving ovulation in women with polycystic ovarian syndrome. Because dietary products are not regulated the same way that drugs are regulated by the FDA, taking something that is labeled inositol, may or may not contain the active ingredient. I would recommend consulting with your doctor about this and other options before taking it.View Thread