Mon 24 Aug webchat with Professor Robert Harrison

Join us 12-1pm on Mon 24 August with author and IVF expert Professor Robert Harrison. Prof Harrison has 35 years experience in this area and is the author of The Smart Guide to Infertility. Post your questions here and he'll do his best to answer as many as possible during the live session.

[Modified by: webeditor on 24 August 2009 10:12:11 ]
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Posts

  • Hello Professor Harrison,

    Thank you for this opportunity.

    I am 27 and have PCOS, my husband is 31 and his tests have been fine, we have been trying to conceive for three and a half years and have never been pregnant. I am overweight and at the moment my BMI is about 38, but i have not always been so heavy, at the start of our trying to conceive journey i weighed about two stone less. I have a period once or twice a year, the most regular i have been was three to four times a year when i first started at the age of 12. I had a lap & dye in 2006 and my tubes are clear, i had ovarian drilling in 2006, we did seven cycles of Clomid (various doses) in 2006 and i have been taking Metformin since 2006, i have tried several natural approaches too. I ovulated once with Clomid on the first cycle but no pregnancy, none of the treatment regulated my cycles. We did two IUI's last year and although i ovulated we did not get pregnant. We do not meet the criteria for IVF on NHS ( i have to be 30)and cannot self fund at this time, I have been having reflexology with two acupuncture needles, at the start i had three sessions and stopped, four weeks later i ovulated!, no pregnancy. I have since started having it again. I know that weight loss can only help but i am struggling with this, i can lose some but then find the diets hard to stick to and then end up gaining the weight back and more, exercise i find difficult due to the fatigue i suffer from. I guess what i'm asking is....what can we do next?, what is the best plan of action?, can you advise anything that can help?. Sorry for all the information but i wanted you to have the full picture of our situation.

    Thank you so very much for this,

    Gemma
  • Hi. My husband and I (he's 30 and i'm 27) who are generally fit and healthy have been trying for our 1st baby for 7 months now. When would you advise we see our GP for some tests?
  • Hi,

    Professor Harrison here, looking forward to trying to answer your questions.
  • Good Afternoon Professor Harrison

    My husband and I have just been referred to Leeds hospital for ICSI. We are still waiting for the letter to come through but wanted to know how long the process usually takes and what's involved. Our local GP wasn't too forthcoming when I asked and only provided a factsheet which explained what ICSI was. Also on the NHS do we only get one attempt? And if we are lucky what will happen if we want another child?

    Thank you.
  • Hi Gemma,

    Thank you for your question. It appears that your real problem is that you are not ovulating due to PCOs. It seems to me therefore that treatment should concentrate on this first. I know you have had some clomid and have also been on metformin and had ovarian drilling. You have also tried alternative therapies. I know you realise that you are overweight and you must be fed up with being told of the need to diet. However without lowering your BMI you are handicapping yourself severely as anyone with a BMI over 35 has an up to 49% less chance of conceiving compared with those in the normal range. Even lowering it a few numbers will help for you will improve your chances of conception by 4% with every drop in unit. There really is no other way. Therapy not yet tried would of course be gonadotrophins but the danger of these in a situation that you are at present in to my mind outweighs the benefits. Indeed don't forget that with your present weight even if you did conceive there would be a greater chance of complications. Do not give up you are only 27 and I am sure you will find the fatigue you have will be much less once the weight comes off. Get your GP to send you to a dietician if that has not already happened who may be able to discuss other therapies as well as diet.

    Very best of luck.

    Prof. Harrison
  • Dear 27 and husband 30.

    Age is on your side. Therefore unless there are underlying illnesses that could prevent conception you should be safe enough to follow the WHO definition of infertility as failure to conceive after one year of unprotected intercourse. Therefore leave it for another 5 months. Data shows 80% of couples having regular intercourse successful conceive during the first year of trying (70% take home a baby) and of the remaining 50% will conceive during year 2 naturally (40% with a live birth). While these chances drop as age increases (female over 35, male over 40) are the amber lights you still have plenty of time on your hands.

    Kind regards


    Prof. Harrison
  • Good afternoon Professor Harrison

    My husband and I have been trying for a baby (our first) for 18 months. I am 35 and my husband is 37. We did achieve a pregnancy in January this year, but I miscarried at five weeks.

    My fertility tests show that all hormones are at an acceptable level (I ovulate) and my tubes are clear. My husband's two sperm analysis showed 30% motility and 4% (first test) and 6% (second test) morphology. Volume and sperm count were both very good.

    We are both generally healthy - non smokers, healthy diet, target BMI range, low-moderate alcohol consumption. We take the recommended vitamin supplements.

    We sre starting IUI in September, and I will be stimulated using menopur. I understand there are different drugs for stimulating ovulation for IUI (and it is possible to to a round with no drugs at all). How do hospitals choose which drugs to use - are there are any significant differences? I have read a lot of different success rates for IUI, varying from 4-25%. Is age a factor? Is there anythign else I can do to increase my chances of success?

    Thank you.
  • Dear Molcat 09

    I am afraid I cannot answer questions about a specific hospital and number of attempts seem to vary on the NHS depending on the lottery. I practice in Ireland so cannot help you with that side of your questions. I would recommend you contact the unit directly and I am sure they will be able to answer your queries.

    In terms of the process itself there is very little difference between IVF and ICSI except that in ICSI single sperm are injected into single eggs whereas in IVF the sperm are place near the eggs and have to swim in to fertilise under their own steam. Units can vary in the length of time it takes once you sign up but taking the actual start date of the treatment as day 1 using the classical down regulation protocol which last for a minimum of 14 days and is then followed by ovarian stimulation (response dependent) for another 10 to 12 days you should be at egg collection around 21-23 days later and embryo transfer some 2-3 days later if transfer on day 2 or 3 and day 5 if blastocyst. However units vary nowadays in their stimulation protocols so I strongly urge you to get in touch with the unit in Leeds and ask them to send you their information booklet for unless you are properly informed in advance of what you are going in for you will not be in a position to give proper informed consent.

    Regarding a second child if embryos have been frozen this of course would give you further attempts otherwise the alternative would be to go through the whole process again. Don't forget ICSI is for male factor infertility, however unless sperm count is zero there is always a chance of conceiving naturally before the treatment or after it. In our unit here we found 21% of people who had a baby with us had another one within 2 years without any treatment (a very positive placebo effect).

    Best of luck in Leeds all units there are superb.


    Prof. Harrison
  • Dear Professor Harrison

    Thank you so much for this oppotunity.

    In brief I have been diagosed with POCS & although i have semi regular cycles i rarely ovulate. Im 31 & my partner is 39.
    My last CD21 bloods came back at 1.5 (i believe they have to be 30+ to show ovulation).
    I have been to see gynie & am waiting for CD3 & CD21 bloods to be repeated & also for a HSG to check my tubes.
    I did concieve last August but sadly miscarried at 6 weeks,so gynie didnt think that tube would be blocked.
    I guess what id like to know is what my chances of concieveing again would be if i recieve treatment,(clomid has been mentioned) & also more for my partners sake, am i at greater risk of another miscarrige as he took our loss very hard.?
  • dear prof harrison,

    my name is stacey. my husband and i have been trying for a baby for 3 years now. we have been refered to a consultant twice who have reccommended ICSI, but due to the fact that i am only 21 our local PCT will not fund us until im 23. i find this highly upsetting but appreciate what they are saying. the problem is my husbands sperm count ,it is incredibly low if i remember rightly the hospital said that he had 2.75 million sperm in his sample. this is due to a testicular torsion when he was a young adult.

    is there anything we can do to inprove our chances of natural conception??? as 2 years is a long wait for us.

    and do you have any idea how long the waiting lsit is for cambride/ely ??

    thank you for your time
    love Mrs E xx (stacey)
  • Prof. Harrison,

    Thank you very much for your reply. Unfortunately when i asked my GP to refer me to a dietician i was told i could not be. But i will visit him again and ask again.

    Thank you,

    Gemma
  • Hello Professor Harrison,

    My husband and I have been trying for our first baby for 8 months now. I am 32 and he is 34. Initial semen analysis results (3 tests in total) have indicated low morphology at 8%. Motility is better at 50% and count around 20m. I am also due to undergo tests, however we are fairly confident that the problem lies with my husband and not with myself.

    My question is, do you consider my husband's results to be problematic? Are our ages a factor? Could it still happen naturally for us, assuming that I am ok (I realise this is a big assumption)? Finally, I have quite a high pressured job, could stress cause fertility problems?

    Thank you for this opportunity and sorry for so many questions.
  • Dear MrsD.

    Very sorry to hear that you miscarried in January, however I look on this as a very positive sign that another natural conception is likely to be not far away seeing as the fertility profile is excellent as is your lifestyle. I assume that you have been suggested IUI because of the age and length of fertility factor. There are many different ways of approaching IUI in what appears to be an unexplained infertility situation. It is an empiric therapy and natural and stimulated cycles can both be used. Some use the milder clomiphene citrate to stimulate rather than the gonadotrophin you have been allotted to. Certainly these later seem to give a higher pregnancy rate per cycle of around 18% compared with clomiphene citrate 11% but close monitoring is needed and multiple pregnancy and hyperstimulation are commoner. Overall whatever is used no date anywhere gives results consistently above 15% per cycle although two IUI's per cycle seem to slightly enhance the chances. The latest figures in Europe from 19 countries give an overall clinical pregnancy rate of 12.6% in women under 40 years of age and 8.2 over that.

    In terms of how hospitals choose what drugs to use the majority will have a protocol and I would have thought it wise to ask why Menopur has been chosen in your case rather than alternatives.

    The very best of luck.


    Prof. Harrison
  • Thank you Professor Harrison.

    That's really helpful.

    I know multiple births can bring complications, but I confess I would be absolutely delighted with twins!!

    Thank you.
  • Dear Jane Shaw,

    Thank you very much indeed for your query. Delighted to learn that you do have a daughter already. You do not say what type of pituitary tumor your husband had and what the treatment was that he needed to keep him safe and well. I am assuming that his pituitary hormone output that stimulates his testes has been destroyed and that he is now on replacement gonadotrophin therapy either FSH or hCG. This can be very effective indeed so I would not give up yet although I would have thought by now that some response would have been seen. I would strongly suggest discussing the issue with your GP and the clinic that you went to with IVF so that a watch can be kept on your husbands sperm count and if possible consideration be given to freezing some if sperm appear again or maybe even consider testicular biopsy if his hormone levels suggest there has been some recovery. In both these situations ICSI might then be on the cards using his sperm rather than having to at some future date consider donor sperm. In terms of your irregular cycles unless semen of quality returns I personally could not see much point in active therapy with fertility drugs.

    Kind regards


    Prof. Harrison
  • Thanks for your reply. Unfortunately I had a HSG which found I have a blocked tube and my husband's sperm count was under 6 million with low motility so I'm not too optimistic about conceiving naturally. Would you recommend accupuncture while undergoing ICSI?
  • Dear Professor Harrison,

    Many thanks for this opportunity.
    I am 30 and my husband is 35 and we have been trying for our first for 2 yrs. Had a spontaneous preg after 13 months and miscarried at 7 wks. I have had normal 21 day progesterone, LH/FSH, HSG, US and my husband's semen analysis has varied from pretty bad to normal.
    After 2 below normal semen analyses, we had IVF in May and got a positive, only for there to be no heartbeat at 7 weeks. I went on to miscarry naturally at 11+1 wks. Interestingly, the semen analysis for the IVF was normal.
    I have pushed to get seen in the local recurrent miscarriage clinic as I see this as being more than just bad luck. I am worried that tests will show that there is a chromosome problem with either of us and that having our own baby is never going to happen. We are reluctant to have IVF again until we have ruled out problems and are still trying naturally.
    I just wondered if you had any advice for us. Is it likely that there is something abnormal that's causing this, or is it quite common for a woman's first 2 pregnancies to end in miscarriage? Also, I had no symptoms in either preg-is this something to watch out for in the future? Would you advise taking empirical Aspirin in the meantime, in case there is a clotting problem?

    Many thanks for your expert advice.
  • Dear Princess Star,

    Thank you very much for your query. Delighted to learn that you did conceive spontaneously so why should you not again? I note you have PCOS but you haven't said if that is associated with body weight, if it is don't forget that for every unit of BMI over 30 there is 4% drop in fertility as you do not ovulate efficiently in that situation and if under 18 again ovulation may stop.


    Apart from weight loss or gain as I am sure your Gynaecologist will confirm that if needed clomiphene citrate is the most effective and safest ovarian stimulation therapy for PCOS. Giving pregnancy rates of over 40% . In terms of increased risk of another miscarriage over and underweight can play a part in this but statistically you have no greater chance than anybody else following one miscarriage of miscarriage again the next time you conceive (1 in 5).

    Kind regards



    Prof. Harrison
  • Dear Stacey,

    Thank you for your query as I practice in Ireland I have no idea as to waiting lists in Cambridge or Ely but maybe if you ring the clinics they will be able to tell you or via your GP. I note you are only 21 and that your husbands sperm count is very low. However it is not zero and there are always chances of conceiving afterall it only takes one sperm. Although you may eventually come to ICSI this does not mean that you should not carry on enjoying making love as often as you both would wish. I realise it is a very stressful situation for both of you and nothing I can say will change that but please do not give up intercourse at all because you may think it is futile, because it is not. Trying to concentrate at a particular time of the month only adds to the stress and I cannot recommend it, basically do it when you fancy!!!!

    Very best of luck.


    Prof. Harrison

    P.S. When you do get to ICSI your chances will be optimum because of your age.

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