Let It Snow, Let It Snow, Let It Snow

Here I sit on a Wednesday afternoon watching DC clear out in anticipation of a "major snow event." In the mid-Atlantic this means that a snowflake may be spotted somewhere on the Beltway. I just returned from Boston where I spent a long weekend visiting my parents. As some of you may recall, Boston was hit with yet another major snowstorm last Friday (8-10 inches). Amazingly enough, we left DC on time Friday PM and I don't think that the kids in Boston even got a snow day! It was pretty impressive to see how clear the streets and sidewalks were within a few hours compared with the days of paralysis that we experience here. Oh well. As the Boy Scout motto says...."Be Prepared!" It helps to have a lot of snow removal equipment.

I am pleased to report that my parents continue to amaze us all with their resilience. Both are 87 years old and honestly I really thought that they were in trouble this past summer. My Mom can no longer climb up to the second floor of her house so she has dropped off of the list of active readers of this blog....that leaves 4....


The highlight of the weekend was a party for my older brother Steven who is off to Vermont to become the CEO of a small hospital in the Green Mountain State. There were 50 guests crammed into his home in Newton and it was fun to see cousins that I hadn't seen in years. Yours truly gave a heartfelt speech lauding my brother's accomplishments. My Dad, in true general surgeon form, first called me his "most verbose" child and then followed it up referring to my brother as "accomplishing more than I ever thought possible given how he was as a teenager..." Oh well. Perhaps verbose is accurate as here we are in the 3rd paragraph and you have learned nothing more about reproductive medicine.

So back to reproductive medicine....One pretty consistent truth about fertility treatment is that the treatments that are cheap and easy and require minimal effort don't work as well as those that are more expensive and more intense. However, some patients are ready for intense therapy and some cannot afford it. Also, some insurance companies mandate IUI before IVF so there are many factors that go into the decision to undergo an IUI treatment cycle. So how are the chances for success? Well, that is an excellent question....so excellent that it is today's Question of the Day from the 2nd Edition of 100 Questions and Answers about Infertility...

39. What are typical pregnancy rates for IUI?

The pregnancy rates for IUI vary widely, depending mostly on the female partner’s age and the presence or absence of any other infertility factors. In patients younger than 35 years old, an estimated one-third to one-half of patients will achieve pregnancy within 1 to 4 treatments. In patients with unexplained infertility, most studies demonstrate a per-cycle pregnancy rate of 6% for the Clomid/IUI combination and 9% to 12% for the gonadotropin/IUI combination, compared with a spontaneous pregnancy rate of less than 5% per month. Many fertility doctors will try 1 to 4 cycles of Clomid/IUI and then 1 to 4 cycles of gonadotropin/IUI. If pregnancy has not occurred after the fourth treatment, most experts would abandon these treatments and proceed with more aggressive therapy such as in vitro fertilization. The optimal number of IUI treatment cycles should be individually determined by the patient and her infertility specialist.

Some patients develop a seeming resistance to fertility medications, demonstrating reduced responses with repeated stimulations. This problem is especially prevalent in women who are more than 37 years old. Thus IVF should be considered as a first-line treatment in these patients as opposed to multiple gonadotropin/IUI cycles.