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.

thank you sooooo very much for your reply xx

Dear Angela Fish.

Thank you for your query. Your ages are not a factor. 35 for females and 40 for males seems to be the amber light. I note you have only been trying for 8 months, do not forget the time is important and at your sort of ages most would not yet be going for active further investigations and treatment. As 80% of couples like you conceive within the first year of trying and of those remaining another 50% conceive in the 2nd year. I am saying this despite your worries about semen analysis results which I personally feel are not that bad. There are different types of low morphology so I would have to know what his problem is before making further comment and also there can be simple explanations for this such as a varicocele. However as the topic has been raised to put your minds at rest I think it is wise at this stage for you to consult with an expert in the area whilst of course still trying to conceive under your own steam for you do not want I am sure to rush into considering ICSI at this stage which would be the most likely way forward.

Very very best of luck.

Prof. Harrison

We've reached 1pm so please no new questions. Prof Harrison has agreed to answer as many questions as possible that have already been posted, however.
Many thanks for all your queries and a big thank you to Prof Harrison for his extremely authoritative replies. It would be lovely to welcome the Prof back another day if he can make time in his schedule!
Web Ed Nicola

[Modified by: webeditor on August 24, 2009 01:17 PM]

Dear Claire,

Thank you very much for your query. Really the best place to answer your queries (is the hospital that you and your husband are going to for ICSI) for unless you understand exactly what is going on you will not be able to give true informed consent. In general terms however based on my own clinic here we realise that nobody knows what a normal sperm looks like but we assume a certain shape and size is correct and that if it moves it can be used. Indeed even if it does not move but looks okay some clinics as a desperate last measure would use such a sperm. Ask your clinic what their minimum criteria for ICSI are on the day.

In terms of your cycle being irregular this is not a particular problem in IVF or ICSI as except in a few centres where natural cycles are used control is taken over your ovarian stimulation by the drugs. Again the clinic you are going to will be able to explain all this. Hope this is what you are requiring and you never know maybe you will get pregnant whilst waiting.

Best of luck.

Prof. Harrison

Dear Molcat,

While I am not a great advocate of alternative therapies I have to say that in our own unit we tried out a wrist bead which when put on the wrist pressure point (Neguain, the No. 6 Meridian point on the Pericardial channel) relieved pelvic pain after egg collection better than a sham control. Additionally a study elsewhere at embryo transfer but not confirmed elsewhere showed a positive effect with the odds of pregnancy increasing by 65%. This was interpreted as meaning that 10 women need to be treated with acupuncture to give one additional pregnancy.

I think acupuncture to me is best summed up as employable in situations best described as placebo responsive a term which definitely includes infertility.

Realistically anything that can help improve your lifestyle can have a positive effect on your health but not necessarily increase your chances of having a pregnancy.

Kind regards

Prof. Harrison.

Thank you, Prof Harrison, very much for your response and for the opportunity to ask you questions, it is much appreciated.

Dear JCB

Sorry to learn of your problems and the two miscarriages you have had. The definition of habitual miscarriage classically is three consecutive miscarriages but some authorities do consider after two that tests should be carried out. I am sure if something was suspected the IVF clinic you attended would have dealt with this. As it is only 3 months ago why not go back to your clinic and discuss your worries with them. However I should warn you that in the vast majority of cases no abnormality is found. Early losses can suggest a chromosome abnormality (4-6 weeks) and later 12+ weeks a uterine or cervical problem but generally nothing is found.

Best of luck and do go back and talk to your clinic.

Prof. Harrison

Dear Jane,

Thank you for your further information. I really to feel at this stage you and your husband need to consult his specialist again for I would have hoped there should have been some response at this stage. Certainly following radiotherapy and chemotherapy sperm can return at a later date spontaneously but as he has had his pituitary removed as well this is unlikely to happen and hence his need for hormone therapy which statistics say in his situation works in up to 30% and usually within the first six months or so. If the radiotherapy was total body radiation as opposed to directed at pituitary his testes could also be affected. Again I would recommend him going back to his specialist or mentioning it at his next check-up.

Best of luck.

Prof. Harrison.

Dear All at BabyExpert

I very much enjoyed this my first every webchat and I look forward to more in the future, if the opportunity arises. Meanwhile however I hope I have been able to answer all your queries but in case I haven't please note from the 10th September my book "The Smart Guide to Infertility - Myths and Reality" published by Hammersmith Press ISBN 978-1-905140-23-7 will be available. This book covers comprehensively the whole of infertility (not just IVF) and will I hope provide a reference guide to help those in need.

Thank you again for all your queries and I hope I have been of some help to you.

Many thanks.

Professor Robert. F. Harrison.