BONUS 267: Treating Unexplained Infertility

July 10, 2020

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Today’s bonus episode guest is Dr. Allison Rodgers. She is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility and has been practicing medicine since 2004. Dr. Rodgers currently practices at the Fertility Centers of Illinois. Her personal experiences with both secondary infertility and pregnancy loss have given her a unique insight into reproductive medicine in order to help you beat infertility.

Episode Sponsor:

Infertility Coaching with Heather Huhman

Dr. Rodgers begins by answering six listener questions. The full questions are read on the air, but here are brief summaries:

  • Mira is 39, single, and using a sperm donor. She’s gone through two IUIs and three stims, but a high percentage of immature follicles has prevented transfers. She asks if there are any recommendations that could lead to a better outcome.
  • Keshia and her husband are battling male factor infertility, and their clinic has suggested IVM. She asks about the IVM procedure and the timeline as compared to conventional IVF.
  • Melissa has uterine factor infertility and has tried to conceive for five years. After four failed IUIs, she has her first IVF soon, so she asks what she can do now to prepare for success.
  • Carolyn asks how Asherman’s syndrome can be treated naturally.
  • Sarah heard BONUS 190 on progesterone. Her progesterone numbers are around 11, but she’s heard that with Clomid, they should be around 15. She asks about the difference in the number guidelines and whether she should ask her doctor for progesterone supplementation.
  • Kelly has had two missed miscarriages, and her RE recommends several more tests before the next FET. She started a new prenatal supplement but asks if there is anything else she should try.

Dr. Rodgers and Heather continue the episode by discussing how to decide when it’s time to move to the next stage of treatment:

  • Does unexplained infertility really exist? If so, why and how common is it? (Why is reproductive medicine not advanced enough to determine all causes of infertility?)
  • ASRM recently published an evidenced-based guide for treating unexplained infertility, based on a literature review of 83 studies. What is a literature review, and what are its limitations?
  • Each recommendation in the guide is given a rating for quality of evidence and strength of evidence. Can you walk us through both of those?
  • Timed intercourse with Clomid
    • What does the research say? What is recommended and not recommended, and why?
    • What is the strength of evidence and strength of recommendation?
  • Timed intercourse with Letrozole
    • What does the research say? What is recommended and not recommended, and why?
    • What is the strength of evidence and strength of recommendation?
  • Timed intercourse with gonadotropins
    • What does the research say? What is recommended and not recommended, and why?
    • What is the strength of evidence and strength of recommendation?
  • Natural cycle IUI
    • What does the research say? What is recommended and not recommended, and why?
    • What is the strength of evidence and strength of recommendation?
  • IUI with Clomid
    • What does the research say? What is recommended and not recommended, and why?
    • What is the strength of evidence and strength of recommendation?
  • IUI with Letrozole
    • What does the research say? What is recommended and not recommended, and why?
    • What is the strength of evidence and strength of recommendation?
  • IUI with a combination of Clomid or Letrozole and gonadotropins (low-dose and conventional-dose)
    • What does the research say? What is recommended and not recommended, and why?
    • What is the strength of evidence and strength of recommendation?
  • IUI with low-dose gonadotropins
    • What does the research say? What is recommended and not recommended, and why?
    • What is the strength of evidence and strength of recommendation?
  • IUI with conventional-dose gonadotropins
    • What does the research say? What is recommended and not recommended, and why?
    • What is the strength of evidence and strength of recommendation?
  • IUI trigger timing
    • What does the research say? What is recommended and not recommended, and why?
    • What is the strength of evidence and strength of recommendation?
  • IVF and IVF with ICSI
    • What does the research say? What is recommended and not recommended, and why?
    • What is the strength of evidence and strength of recommendation?
  • Overall, what are the conclusions of this guide? What is the best path for couples with unexplained infertility?
  • What questions does this guide leave unanswered for future research?
  • Is there anything else you’d like to add?
  • What words of hope would you offer to couples with unexplained infertility?

Have a question you want Dr. Rodgers to answer next time she’s on? Click here.

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