TOPIC: VESICULAR ENDOMETRIOSIS
Q	What is Vesicular endometriosis? Is this classified as a specific stage of endometriosis, or can it occur at any stage of endo? How bad is it, and can it be easily treated?
A	Vesicular endometriosis is not classified as a specific stage or type of endometriosis. The terminology is purely based on the appearance of the lesion to the naked eye – almost blister like in appearance – hence the name vesicular. Regardless of the lesions appearance, it has to be confirmed as being endometriosis by a pathologists report.
	TOPIC: EMPTY FOLLICLES
Q	What could be the possible reasons for producing many "empty follicles" in a stimulated cycle. I have recently undergone an unsuccessful IVF/ICSI, during which I had 25 follicles, of which only 4 eggs were produced.
A	Having some empty follicles during oocyte retrieval must be clearly differentiated from the so called “empty follicle syndrome” The latter is a very rare and sometimes very controversial topic. From the point of view of having 25 follicles on ultrasound and only harvesting 4 oocytes, the reasons are generally one of 4: 1)The ovary is dysfunctional and therefore only 4 of the 25 follicles could actually yield viable mature oocytes. (sometimes seen in severe PCOS patients) 2)Coasting took place to diminish the risk of ovarian hyperstimulation syndrome, during which time many of the follicles were lost. 3)Triggering took place before most of the follicles were mature and ready for harvesting 4)Ovulation had already taken place or was in the process of taking place at the time of oocyte harvesting.
	TOPIC: TRIGGER SHOT – PROFASI VS OVIDREL – ADVERSE EFFECTS
Q	Would a change in the trigger shot affect the no. and quality of eggs retrieved. During my first 2 IVF's I triggered with profasi and had good quality eggs and always more than 5 eggs all of which fertilised. I had a successful pregnancy following the second ivf. I breastfed my daugter for 10 months and started trying again after only 3 mestrual cycles. I have tried 2 ivf's since then with disasterous results...I triggered with ovidrel. Although I had 10 - 15 follicles, I produced only 5 then 2 eggs. Of the five eggs only 2 fertilised resulting in a day 3 transfer of grade 2 embys. And in the final ivf I had only 2 eggs 1 of which fertilised 2 days after retreival and then arrested. The protocols for both of these IVF's remained pretty much the same with only an increased dosage of meds. The only hormonal problem at the time was prolactin for which I took parlodel.. A lap between the 2 ivf's showed that all of my endo had cleared. I have read on some of the other forums that ovidrel may not agree with all people. Any advice/comments are appreciated. Also what other factors can result in such a drastic change in egg quality.
A	Changing the trigger from one agent to another is highly unlikely to influence the number and quality of the oocytes as all these agents have been scrutinised by doing randomised control trials before releasing the drugs for commercial use on the market. See attachment from the Cochrane Review.
	TOPIC: CERVICAL ENDO – RECURRANCE - SPOTTING DURING CYCLE
Q	I am new to the forum and am grateful to have such an excellent site to lean on. I have a question for the Doc. I had endo but was told during a recent lapscope that it had all cleared up following an IVF pregnancy. I am currently trying again and had to have a hysteroscopy to remove a polyp. During the procedure, the Dr found endo in my cervix, which he cauterized. I would like to know how common this is and whether it will recur. Would it be something that a Dr would consider if a patient presented with spotting during the menstrual cycle.
A	Endometriosis on the cervix is relatively uncommon. Cauterizing it is the right way of managing these lesions and recurrence is always a possibility. The timeframe is however not clear. Theoretically, these lesions can lead to spotting during a cycle as well as after intercourse.
	TOPIC: SEEKING ASSISTANCE
Q	In your opinion, does one have to wait the proverbial 1 year before seeking a FS consult if you have very irregular cycles? My last 3 cycles have been 78 days (OV on day 63) & 42 (OV day 29) and current cycle I OV'ed on day 36 so will be a 50 day cycle. My husband has 4% morphology but normal count & viscosity. In our situation, would it be premature to seek assistance before waiting out the full 12 months?
A	The definition of infertility (whether primary or secondary) is the inability to conceive after 1 year of regular unprotected intercourse in patients 34 years and younger and only 6 months in patients 35 years and older. This definition, however only applies to patients with REGULAR menstrual cycles. When a patient has persistent irregular, long cycles, this definition falls by the wayside and investigation and management should be sooner rather than later. It would therefore be advisable to seek assistance sooner rather than later.
	TOPIC: CLOMID AS FIRST COURSE OF ACTION
Q	My gynae suggested Clomid but he hasn't done any CD 2 & 3 bloodwork. I stopped the pill in July 2007 and have only had two 32 day cycles since then. Should I wait for my cycles to regulate or is Clomid my only option? Can he prescribe Clomid without investigating the cause of my long cycles?
A	Treating infertility or sub fertility without a proper workup does not make sense, as one needs to make a firm diagnosis in order to know what the further management should be. Without a firm diagnosis one can not formulate a plan of action. One should keep in mind that there are various reasons for not being able to conceive that the universal subscribing of clomiphene will not solve .
	TOPIC: OVARY DOMINANCE
Q	Would being left or right handed affect ovary dominance?
A	There is no evidence to support this notion.
	TOPIC: FRESH STARTERS
Q	What are the most important questions that an individual seeking fertility assistance should ask their specialist? How do I know whether the doctor I’m seeing is sufficiently qualified in infertility? Is there a specific type of registration that FS/RE’s acquire when specialising in infertility?
A	The answer to this question is threefold: 1)Learn as much about your problem as possible by reading up or visiting credible sites on the internet. By doing this, you will be able to ask him or her direct questions and comparing the answers with what you have read. 2)Reproductive medicine is a registered sub speciality with the Health Professional’s Council of South Africa. 3)Ideally, the practise you are attending should devote all their time and effort only doing infertility.
	TOPIC: PCOS AND BCP
Q	How much of the symptoms do the BCP control in PCOS patients? Does it simply mask irregular cycles by inducing a pseudo-cycle, or does it restore to an extent hormonal balance? Or completely restore hormonal balance? I was wondering how much of the lifestyle changes, like strict diet and exercise can to an extent be compromised when on the BCP? In other words, can a PCOS patient resume a “normal” lifestyle when on the BCP, or are they doomed on in the long term to a more prudent lifestyle of healthy eating and exercise to control the associated diseases of the syndrome? As opposed to their non-PCOS counterparts who can get away with less stringent lifestyle practices.
A	The cornerstone of PCOS treatment is and will always be lifestyle and diet, regardless of whether you are on the BCP. The BCP does not mask any symptoms, but rather restore the hormonal imbalance by restoring everything to a steady state. Being on the BCP can in no way compromise the effect of diet and exercise. I think “being doomed” is being hard on yourself, as a healthy diet and lifestyle as prescribed by dieticians with a special interest in PCOS is very beneficial, not only in PCOS patients, but in the general public as a whole.
	TOPIC: SPERM – SWIM UP TEST
Q	What does a swim-up sperm test measure? Is this a standard pre-IVF test?
A	In our clinic it is protocol to perform a swim up and morphology before starting an IVF/ICSI attempt. This is seen as a mock run in order to have no surprises on the day of egg retrieval. It measures the count, morphology, motility and survival. If the need arises it can be combined with a MAR.