TOPIC: OVULATION AND PROGESTERONE
Q	How is ovulation determined with the use of a progesterone blood test? What is the count supposed to be post ovulation, what day is it tested? When does it confirm ovulation?
A	Progesterone levels are usually done by gynaecologists to confirm ovulation. This is usually done half way between the midfollicular and luteal phase, usually on day 21. It is suppose to confirm ovulation at a level of 10ng/ml or more.
	TOPIC: ENDOMETRIUM THICKNESS
Q	What is the ideal thickness of the uterine lining at time of ovulation (CD14) in order to conduct successful implantation when embryo arrives? Can the endometrium be too thick (how thick is too thick) or too thin (how thin is too thin)?
A	The ideal thickness is between 7 mm and 14 mm . There are however patients that will conceive if it is less than 7mm or more than 14mm. This is however in a minority of cases.
	TOPIC: PROGESTERONE MONITORING
Q	When monitoring progesterone post ovulation, what are you looking for? What types of counts on what days? And do progesterone levels indicate possible pregnancy at these early stages?
A	The best way to monitor progesterone is to do serial levels at specific intervals. This is to diagnose possible luteal phase defects, meaning not enough progesterone production to support and stabilise the endometrium and a possible pregnancy. We look for the trend of the levels rather than specific values. Should the trend be upwards over an extended period of time, it usually is indicative of a pregnancy.
	TOPIC: PROGESTERONE MONITORING AFTER SUCCESSFUL IVF
Q	If IVF is successful should progesterone testing be done along with betas? Is it safe to assume that progesterone supplements prescribed (e.g. Cyclogest) are sufficient? Shouldn't it also be checked continually in case the body doesn't respond to Cyclogest and if that's the case, what can be done?
A	After completion of an IVF cycle, it is of no value to monitor progesterone levels in the bloodstream. This is due to the so called “first pass effect” which essentially means that the progesterone levels in the area of the uterus is always higher than in the bloodstream and therefore not representative of whatever is measured in the bloodstream. There is more than enough evidence stating that if the vaginal preparation is used properly, the absorption is sufficient, hence no need for injectable progesterone preparations.
	TOPIC: IVF MISCARRIAGE
Q	There seems to be a distinct time frame for IVF embryos to not make it once the pregnancy is confirmed (from my experience between 6 and 8 weeks). Is there anything that one can do to enhance ones chances of sustaining the pregnancy during these two seemingly vital weeks? Are these miscarriages mostly due to genetic abnormality? What is most frequently the reason for these early losses?
A	The most common reason for losses during this phase (about 2/3) is non viability of the fetus due to either chromosomal or genetic defects. Unfortunately, should this be the reason, there is not much one can do to change the outcome. The other 1/3 is made up of uterine and immunological factors such as fibroids, polyps, uterine scars and immunological factors such as HLA incompatibility, clotting abnormalities and antibody production against placental tissue. There are specific investigations to rule out and correct all of these uterine and immunological factors.
	TOPIC: STARTING TREATMENT AFTER D&C
Q	How soon one can start with infertility treatment after a D&C? With the onset of the next period? Longer?
A	A very good principle to adhere to before embarking on trying to conceive after a DD & C is to have a cavity assessment to rule out any scar tissue formation or abnormalities such as placental polyps. Once this has been confirmed, one should take a break for a period of one month and then get on with conception.
	TOPIC: FET SUCCESS RATE
Q	I was given a success rate of 20 % with a FET cycle. Is that right and is it because the embryos don't always thaw properly? What I want to know is whether once the embryos have thawed properly, is there the same chance of them implanting as with a fresh embryo or is it not as good.
A	Frozen – thawed embryos loose about 50% of their fresh potential. This is due to the very stressful freezing and thawing process. Thus, fresh is always better than frozen. The quality of the embryos that are frozen is also very important and embryos should fulfill strict criteria before being chosen to be frozen. Once the embryos have thawed and PROVEN their ongoing potential by being grown in the lab for two days, the likelihood of a successful pregnancy is still lower than that of a fresh cycle.
	TOPIC: LOW SPERM COUNT NATURAL CONCEPTION – INTERCOURSE FREQUENCY
Q	What are chances of natural pregnancy with low count of 4.4 to 7.7 mil and other (morph and mot) at lowest range of "normal" as per spermiogram result sheet? Is it better to have intercourse every day or every 3 days around ovulation with low count?
A	The likelihood of a spontaneous pregnancy with a count ranging between 4.4 to 7.7 million/ml is extremely small regardless of how many times and at what intervals intercourse takes place. Counts of less than 10 million/ml is usually classified as artificial reproductive technology sperm.
	TOPIC: AMH FLUCTUATION
Q	If an AMH hormone test indicated a very low value (indicating very low ovarian reserve and function) - will this mean that the value will decrease even more over time, or can this hormone also fluctuate ? Should one be tested for AMH also over a period in time to see if the count remains the same?
A	The fluctuation of AMH is minimal and not enough to significantly influence or change a prognosis. It will decline over time as the ovarian reserve runs out towards menopause. If the level is significantly low to start out with, repeating the level does not make sense as the ultimate outcome will not change.
	TOPIC: PCOS HIGH MISCARRIAGE RATE
Q	Why do people with PCOS have a high m/c rate, and is there anything one can do to prevent it.
A	The miscarriage rate is higher due to egg quality and endometrial receptivity. This is all due to the hormonal imbalance in the ovary leading to an oocyte being released which is not of top quality. There is good evidence in the literature that taking metformin might decrease the miscarriage rate to an extent