Expert Q&A on fertility & conception with obstetrician and gynaecologist Prof Ellis Downes: RESPONSE

Hello.

We're running an Expert Q&A on fertility and conception with obstetrician and gynaecologist Professor Ellis Downes.

Professor Downes has been a consultant for over 15 years and has helped thousands of couples who were having difficulty conceiving, with treatments including cervical cap insemination, clomiphene-induced ovulation, follicle-tracking, semen analysis, IUI and referrals for IVF treatment. 

If you have any questions about fertilty or conception that you would like Professor Downes to answer, please post them on this thread.

We'll keep this thread open for questions until Wednesday July 2nd, and then we'll send them to Professor Downes, and upload his answers by Wednesday July 9th. 

This Expert Q&A is sponsored by The Stork, a new home conception aid. You can find out more about The Stork here.

 

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Posts

  • Hi Helen... This has come at just the right time for me thankyou!. 

    I've just last week lost our second baby... Bubs made it to 9 weeks this time (with good growth & healthy heartbeat seen at 8 weeks). 

    my question is about a condition called 'septate uterus'. When i had a scan at 6 weeks at the ER (due to spotting) the sonographer told me that i had a 'heart shaped uterus' & then the ER doc told me it was a 'septate uterus'. 

    When I had my scan at 10weeks & confirmed our baby had died I asked about the septate uterus. The sonographer (different one as at my OB's office this time) said she couldn't see it but to have a scan when I wasnt pregnant to see for sure as my lining was very thick then.

    so... Questions:

    1. If the septate couldnt be seen at 10 weeks because of my thick lining does this mean it's small enough that it is unlikely to cause problems in the future? 

    2. Could this be the cause of my 2 miscarriages? 

    3. Will a regular scan be enough to properly assess this or do I need a different type of scan?

    4. If they do find a septate... At what size is surgery to remove it recommended vs leaving it & trying again?

     

    thankyou & look forward to getting some advice as there does not seem to be much information out there about this. I am desperate to have a child but worried about trying again if the same thing is going to keep happening.

     

  • My husband had surgery in February to repair a varicocele, remove a spermatocele and 3 cysts. This was his first Semen Analysis after surgery. He had a semen analysis back in October of 2012, but it's format was entirely different.

    I know the count is quite low at 15 million instead of the normal 40 million and of course volume and viscosity are fine. Can you explain the motility, morphology, and forward progression? Is the 55 and 25% the amount NORMAL or abnormal, I guess is what I need most?

    Volume 2.5mL (reference 2-10)

    Count 6mil/mL

    Motility 55 %

    Morphology 25%

    Forward Prog. 2+ (reference 2+)

    Round ell conc: 3 (reference 0-9 wbc)

    Viscosity: Normal

     

    Sperm morphology classification system test simplate and WHO 2nd edition

  • SW2: So sorry for your loss. Wishing you much love and strength.

  • Thankyou Helen, that's really kind of you & i appreciate your thoughts x

  • Hi there, my husband and I have been TTC for over 6 months now. We are both healthy, fit and active.

    At what stage should we seek extra help? What sort of tests would our GP do for us? I hate the idea of assisted conception but we are becoming more and more desperate for a baby.

    Thanks, alx.

  • Hello,

    I would love to ask a question please!  I know it's a bit late in the day, but I've got egg retrieval next week (short protocol, on gonal-f and cetrotide, both fairly low doses)  I had my first progress scan this morning and so far all is looking good - but is there anything I can do to increase chances of conception/implantation and increase egg quality?  I've been taking good quality fertility supplements, as has my husband, eating lots of protein and drinking a lot of water! I have also completely cut out sugar which seems to be really helping with bloating etc.

    Is there anything else my husband can do to ensure a good quality sample on the day?

  • Hello all,

    Not sure if this is the right forum for my question but was just wondering if I can get advice as far as when I should stop taking the pill?

    My husband and I want to start trying in Oct.

    Going crazy try to decide weather I should stop in mid Aug  (in order to give my body a chance at having two normal periods) or Sept. (I've heard you are at your most fertile after stopping the pill) not sure if this is true..

    so confusing, please help

     

  • Hi....i have a question.....

    i came of the pill in aug 2012, ive sufferd from post pill amenrehea, it took me till feb this year to have my first natural period, then i had another one at the beggining of may then my next one on the 14th june (41 day cycle) ive also had 3 rounds of clomid that havent worked. I have been accepted for ivf but this seems scary to me, i suppose my question is in your experience is it likley that my periods will geadually return and will it be possible for me to conceive naturally? Its been a long wait to actually get A period naturally, i didnt even mind the period pains. 

    Thank you xxx

  • Yes I have a question. I'm trying to conceive. I got my first positive ovulation strip Monday June 23rd at 10:00 pm. So I waited until Tuesday evening around 5 to have sex. Tuesday I was also having mini cramps on my lower right abdomen. Also had small mini cramps on Wednsday. Now it is Thursday June 26th at 9:00 am and the ovulation test is still positive. so my question is did I get it right the first time by having sex on Tuesday. Or should I have waited until my last ovulation test was positive and waited 12-24 hours after that one. 

  • hello everyone,

    My question is my bf and I have been ttc # 3 for almost two years now and nothing seems to work. I have two very healthy children already and we are both very healthy ourselves!! This month in question has me somewhat worried, because my cycle is 28 days and I usually have a period for 5 days this month it was early a few days and only lasted for 3 days then two weeks later after intercourse I bled for a couple hours.. Dark red that later turned brown.. A couple days later we had intercourse again and it was a bit painful for me??? So again a couple days later we had intercourse and everything was great!! I've never experienced this before I took a hpt today and it was a bfn! im wondering did I test too early or is it really a bfn all together and something else maybe wrong?? Please help has anyone ever experienced this?

  • Hello everyone 

    me and my husband have been ttc for more than 2 years now ,we have been and fertility appointment on april  I'm not ovulating by the way she saw my blood test which came up as not ovulating she told me to do hcosy and blood tests wich I done them . My hcosy results came on Monday  but I can't understand some things like uterus is anteverted , both ovaries normal  left ovary has a  physiological cyst and right ovary has got multifollicular appearance  with a physiological cyst .. 

     And they didnt discuss nothing at all when I finished the test they were like here you thats done and I told them that I was thinking to discuss my results and the doctor was like you will have your results on your post ..I have 0.6 cm cyst on right ovary and 0.9cm on left ovary . What does that mean what's wrong x

  • Hi I have been diagnosed with premature ovarian failure just over 2 yrs ago after stopping the pill to have another baby. I did become pregnant but miscarried at 11 weeks. I am now age 40, since aug last yr I haven't had a period on my own. two with hrt which I stopped in april, my fsh is 39, my e2 is also high,  I have had repeated ovarian cysts. I am confused this week  as I am having pelvic pain in my back and stomach (ovary area), since mon I have experienced brownish to pink like cervical mucus, sorry for tmi, is this a possible period? or a possible implantation bleed? or something I should be concerned about? thank you in advance for any help. regards Lisa x    

  • Thanks for your questions, everyone.

    We'll send them over to Prof Downes, and post up his answers on July 9th.

  • Hi Christina. We're afraid we've closed this thread to questions now, so I can't promise Professor Downes will be able to answer your friend's one.

    We'll send it on to him though - and keep our fingers crossed.

  • Morning everyone!

    We've just received Prof Ellis Downes' answers to your Qs (apols for the slight delay), so we'll post them up shortly.

  • Hello everyone. Thanks for all your questions. I'm going to answer them one by one.

  • Hi SW2. You asked about a septate uterus.

    First of all, I'm so sorry to hear about your recent miscarriage, SW2: it must be a very difficult time for you.

    If you have a septate uterus, it means your uterus has a small muscular or fibrous ridge (a ‘septum’) at its top.

    It’s quite a common condition and rarely causes a problem but, if an embryo implants on the septum, rather than elsewhere in your uterus, there is a higher risk of miscarriage because there would be some reduced blood flow to the developing placenta.

    Yours does sound like a small septum and, generally speaking, a small septum shouldn't cause any problems.

    Septums can usually be diagnosed with a pelvic ultrasound scan, but sometimes small septums may not be seen. But if you're worried, do see a gynaecologist who can check inside your uterus.

    Given that you have had two miscarriages, many gynaecologists would advise resecting the septum using vaginal keyhole surgery to reduce the chances of a problem in the future.

  • Hi BLT. You asked about your husband's recent semen analysis.

    A normal semen analysis would show at least 40% motility (i.e. 40% of the sperm are moving), with 32% moving forward (which is what the technical term "forward progression" means).

    A man's body makes a staggering 27,000 sperm a second, and it’s therefore common that many of them look abnormal under the microscope.

    Indeed men are allowed up to 96% abnormal forms before their semen analysis is no longer classed as 'normal',  so a 25% normal morphology (appearance) is very good.

    Don't forget it only takes one sperm for a successful fertilisation. Best of luck!

  • Hi Pookey2. You asked about when to start seeking help with getting pregnant.

    I'm sorry to hear you're having a problem conceiving.

    When to seek help is a tricky problem, as it depends on how anxious you are, and how old you are.

    If you're under 30, and not unduly worried, then I'd first have a year of having unprotected intercourse three times a week.

    If you do decide to seek help, your GP can easily check if you are ovulating with a blood test, check your partner’s semen analysis and may be able to refer you for an X-Ray called a hysterosalpingogram (HSG) to check if your Fallopian tubes are patent.

    These tests are fairly straightforward and will give a lot of valuable information to allow you and your partner to decide how you'd like to proceed.

    Some couples may also find DIY conception aids, such as The Stork, helpful to use in their own home if they are keen to avoid ‘medicalising’ achieving a pregnancy.

  • Hi JunoBear. Thanks for your question about how to get healthy for your egg retrieval.

    There is not much research available to guide us on this one, and you've probably seen an awful lot of conflicting information on the internet!

    Basically, I think it’s best to be as healthy as possible, have a normal BMI, and be toned (in other words, if you’re trying to lose weight, don't just starve yourself – your fat-to-muscle ratio is important in hormone production.

    Obviously, not smoking and having a modest alcohol intake is important. Plenty of fresh fruit and vegetables, along with vitamin supplements will also help. Zinc supplements can help sperm motility.

    And – though it's easy to say but hard to do – trying not to be stressed will also help egg and sperm quality. Good luck!

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