After a bunch of testing, I had an obgyn tell me she had no idea why I wasn't menstruating. She was extremely unprofessional and clearly hadn't even glanced at my chart. I asked about PCOS and she seemed to convince herself that's what I had. Please help me understand.
I didn't have a period for over nine months after stopping birth control and I had an ultrasound which showed cysts on my ovaries. Those are the only two markers I have. I did a ten day provera challenge and had two or three days of bleeding at the end of the ten days.
Does this seem like PCOS to you?
Bloodwork:
A1c: 5.2
Cholesterol normal
Triglyceride normal
Lipoprotein normal
Thyroid panel normal (treated with levothyroxine)
Estradiol 28
FSH 5.6
HCG <5
Prolactin 7
Testosterone 38
Iron normal
No obvious nutritional deficiencies
No periods
Mild to moderate acne (improved on provera?)
No facial haihair loss/etc
Normal BMI
Unclear history of menstrual regularity given long term use of Yaz BC
Sleep disturbance/insomnia (improved during provera challenge??)
Significant vaginal dryness (almost no discharge since stopping Yaz)
Is there something else to consider? Do I give up and go back on Yaz? I had horrible rebound acne for months getting off. Is it better to take continuous hormonal BC or to induce periods every could months with provera?
Any time you're willing to spend on this is greatly appreciated. I've been bounced around a number of doctors for this and other issues and I feel like I can't get any answers. Once I said I'm not interested in having children, I feel like I got one massive shrug and a "go back on the pill".

Good morning readers.
​
It is with immense joy and hope in our hearts, we are entering yet another promising year 2023. Every effort is directed at chasing those double red lines and it’s worth seeing a bundle of joy in the arms. We have seen many ways of confirmation of pregnancies.
​
No wonder, the human body is dynamic and has a chemical messenger of fertility.
​
The pregnancy hormone, hCG or Human chorionic gonadotropin (hCG). This is called pregnancy hormone as it is present in larger quantities and most pregnancy tests are designed to test it!
​
Fertility is a family concern and all are eagerly waiting for the arrival of angels in their arms, we are truly nostalgic about being the part and parcel of the journey.
​
The most promising moment in any human pregnancy is when the fertilized egg attaches to the womb and while resting there for a while, establishes a connection or lifeline between embryo and mother.
​
About half of IVF pregnancies fail during this phase, which we call implantation. This holds even for natural pregnancies. A lot of research has gone into analyzing or understanding what makes this implantation successful.
​
Many changes happen even in the uterine lining or endometrium. That’s why the process of Implantation is a very critical early stage in every pregnancy.
​
At one end, the body treats the implanted embryo as foreign material whereas the immune system modulates the response in such a way that pregnancy continues.
​
Implantation happens during the brief period of 8 to 10 days after ovulation. This phase is sometimes accompanied by spotting or light bleeding and cramping but is not a reliable indicator of implantation.
​
After successful implantation, the embryo and generated placenta release the pregnancy hormone or hCG. Human chorionic gonadotropin (hCG) is a hormone produced by the placenta during pregnancy and acts as a chemical messenger. hCG does the following functions during pregnancy.
​

1. It provides cushioning to the growing embryo.

​

1. More production of estrogen and progesterone is produced these hormones help thicken your uterine lining

​

1. Stops the menstruation

​
4.hCG levels rise after conception and continue to rise until 8 to 11 weeks of pregnancy.
​
5.hCG is a definite marker of pregnancy
​
Human chorionic gonadotropin (hCG ) increases as pregnancy progresses. Levels of Human chorionic gonadotropin levels double up every 72 hours. After 8-11 weeks, levels of Human chorionic gonadotropin start declining.
​
hCG or Human chorionic gonadotropin detection can be done at home through urine tests But the actual value can be received through blood work. One should always confirm pregnancy through clinical blood sampling even though your home test is done.
​
American pregnancy association has given these reference ranges for Human chorionic gonadotropin.
​
Expected hCG Levels in the First Trimester
​
Weeks Since Last Period or menses hCG Range (if Pregnant)
​
3 Weeks 5 to 72 mIU/ml
​
4 Weeks 10 to 708 mIU/ml
​
5 Weeks 217 to 8,245 mIU/ml
​
6 Weeks 152 to 32,177 mIU/ml
​
7 Weeks 4,059 to 153,767 mIU/ml
​
8 Weeks 31,366 to 149,094 mIU/ml
​
9 Weeks 59,109 to 135,901 mIU/ml
​
10 Weeks 44,186 to 170,409 mIU/ml
​
12 Weeks 27,107 to 201,165 mIU/ml
​
14 Weeks 24,302 to 93,646 mIU/ml
​
16 Weeks 8,904 to 55,332 mIU/ml
​
Kindly note, this is for reference only high or low levels of the hormone are not the key indicator of a healthy pregnancy as many factors can influence total hCG level like maternal smoking, weight, ethnicity, parity (the number of times a woman has given birth), severe morning sickness.
​
More important is the doubling of hCG levels which double every 48 to 72 hours from whatever level they started and peak around 8 to 11 weeks gestation, then decrease.
​
An hCG level of <5 mIU/ml indicates the embryo has not been implanted. Rising of hCG level appropriately is more important. If the initial value is >5 mIU/ml, then the doctor will advise multiple blood tests for a few more days to ensure a rising level of hCG. if your level remains normal after multiple blood tests, the doctor will order an ultrasound. Every doctor has their protocol driven by experience and will process it accordingly.
​
What are normal levels of hCG in non-pregnant cases?
​
For a non-pregnant woman, normal levels of hCG are usually less than 5 mIU/mL.
​
What if hCG levels are low?
​
It is possible to have a healthy pregnancy with a low hCG level especially when the values rise appropriately. On another end, it also indicates,
​

1. Ectopic pregnancy, 2. Blighted ovum (gestational sac and placenta present but without embryo. 3. Chemical pregnancy or miscarriage.4. Miscalculation of last menstrual period

​
What do high levels of hCG mean?
​
High levels of hCG could indicate:
​
Carrying multiples (twins, triplets or more).
​
Molar pregnancy.
​
Miscalculation of last menstrual period.
​
Abnormal growths on your uterus.
​
How is hCG used for fertility?
​
HCG injections can increase your chances of conception or pregnancy when used with IVF (in-vitro fertilization) or IUI (intrauterine insemination).
​
It works by inducing ovulation (release of the eggs from ovaries)
​
If a history of infertility runs in a family, monitoring hCG levels early in pregnancy can help.
​
This blog about hCG or Human chorionic gonadotropin (hCG) is a conscious effort to bring to notice the complex processes during pregnancy. It is no more simple calculations of months. This science requires the expert to interpret and take a timely call for parenthood.
​
We have referrals of many such cases of varying Human chorionic gonadotropin (hCG)levels with a history of recurrent miscarriages and multiple attempts of ARTs.
​
Many successes and every case is making us rich in experience & expertise.

Human Pregnancy

Many Republican-led states are limiting access to abortion and some Republican politicians and organizations have even said that there is never a need for abortion and that all abortions should be illegal, even when the life of the mother is in danger or when the embryo/fetus is non-viable (in other words the baby will not survive). If you don’t believe anyone could be this dumb, here are a few links for you that mention these positions:
Herschel Walker Says He Wants a Ban on Abortion with no Exceptions – Herschel Walker is the Republican candidate for U.S. Senate in Georgia
Family Research Council actively advocates for women to die. The Family Research Council is an evangelical activist group and lobbying organization. They have issued a statement saying that "Abortion is never necessary to save the life of a mother".
Tennessee proposed law makes it a felony for doctors to perform an abortion, even to save the life of the mother
Missouri seeks to ban abortion for ectopic pregnancies, with a penalty of up to 30 years in prison
Sometimes the laws proposed do allow exceptions for rape, incest, the health of the mother or severe fetal abnormalities. But often the way the laws are written are vague, meaning that doctors have a hard time telling exactly when they can intervene. For this reason, doctors have often waited until the patient is really dying before intervening to stop the pregnancy. Here is a comment about West Virginia’s new abortion ban they just passed link:

Abortion rights supporters, doctors, and legal experts say that few people will be able to take advantage of the exceptions Republicans were debating anyway. Physicians around the country have said that laws restricting them to providing abortions in emergency situations are forcing them to wait until patients are close to death to provide care. Rape and incest exceptions are typically difficult to use because sexual violence is so underreported, and many of the bills have reporting requirements. “The quote unquote exceptions that were put into this total abortion ban are that in name only,” says Katie Quinonez, executive director of Women’s Health Center of West Virginia, the state’s only abortion clinic. “They are a marketing strategy of the forced birth movement so that they can make themselves seem less like the monsters that they are.”

Returning for a moment to the statement by the Family Research Council that “Abortion is never necessary to save the life of a mother”, let’s talk about human pregnancy for a bit. I think after reading this, no one with any sense would believe that “abortion is never necessary to save the life of a mother”.

Human pregnancy is dangerous

I think perhaps some of this nonsense idea that “Abortion is never necessary to save the life of a mother” might come from observations of other animals. Pregnancy complications are more rare in other mammals (such as dogs, cats, cows, pigs, etc.) than they are in humans. Of course, complications do sometimes occur in animals and they can be serious or lead to the death of the animal. But human pregnancy is significantly more dangerous than pregnancies in other mammals…and I think this is a fact that is not appreciated by the nutcases writing these anti-abortion laws.
There are numerous reasons why human pregnancy tends to be more dangerous, which I am going to describe below. Much of this stems from differences in human anatomy compared to other animals.

Bipedal status

Us humans get around by walking on two legs (bipedal), while many of the other mammals we commonly interact with (dogs, cats, cows, pigs, sheep, horses, etc.) get around by walking on four legs (quadrupedal). In fact, humans are the only mammals than continuously use a bipedal gait (some other mammals can walk on two legs for a few steps at a time - think of bears for instance). This has major implications for pregnancy. In humans, the weight of the growing uterus and growing baby are pressing down on the cervix due to the pull of gravity. In contrast, in those other animals, the weight of the uterus and baby (or babies) is pressing down on the abdominal muscles.
Why is this important? It means that there is more stress on the cervix during human pregnancy and this can result in complications. In some women, the cervix is not strong and tight enough and begins to open early before the pregnancy is ready for delivery (this is called an incompetent cervix). This can lead to premature birth of the baby before it is ready to survive outside of the uterus.
The developing baby is enclosed within a membranous sac (called the amniotic sac). This holds the amniotic fluid and also keeps germs away from the baby. During delivery, when your water breaks what is actually happening is that the amniotic sac breaks open releasing the amniotic fluid. Our bipedal posture leads to gravitational pressure on the amniotic sac, pulling it down towards the cervix. In most pregnancies, this is not an issue, but some women have a weakening of the membrane leading to “preterm premature rupture of the membrane” (PPROM). This means a person’s water breaks too early in pregnancy and the baby is likely to be born within a few days, even if it is not ready to survive outside the womb. For both the mother and baby, this premature rupture can be very dangerous because it can often lead to infection, where bacteria get inside the uterus and begin growing there. This can cause sepsis (bacteria in the bloodstream) in the mother or baby and can be fatal if not treated.
So, you can see being bipedal comes with certain disadvantages in pregnancy. But it comes with some important advantages such as us being able to use our hands to pick up, manipulate and carry objects.

Head size and the birth canal

Another important feature of human pregnancy is the close match between the size of a baby’s head and the size of the birth canal. In general, the human birth canal is just big enough for the baby’s head to pass through. In fact, the bones of the skull for the infant do not fuse together fully until some months after birth. This allows the skull to slightly deform during birth and allows the baby to pass through the birth canal more easily. The reason for this tight fit is that the human skull is greatly enlarged compared to many animals due to the fact that our brains are a much bigger percent of our body weight than any other animal. In other mammals, because the brain is a smaller percentage of the body, the skull is not so big and it is easier for the fetus to pass through the birth canal.
The fact that human babies barely fit in the birth canal can cause problems. In fact, in about 1 out of every 1000 pregnancies, the baby’s head is actually too large to pass through the birth canal, either because the baby is bigger than average or the mother’s hips are narrower than average. These cases require Cesarean section (C-section). Before modern medicine, women and their babies would die if the fetus could not be delivered.

Morning Sickness

One very common feature in human pregnancy, especially in the first trimester, is the presence of morning sickness. Morning sickness accompanied by vomiting is not typical of other mammals, even our close relatives like gorillas and chimpanzees.
For many women, they become nauseated and often vomit during this period. It is thought that this may be caused by high levels of a hormone called human chorionic gonadotropin (hCG). hCG is made by the placenta and it causes the uterine lining to grow to help support a growing embryo and it blocks further menstruation. But it also affects areas the brain and may result in the symptoms of nausea. Morning sickness is not fun, but for most women it is not life-threatening. But some women develop very severe morning sickness, which is called hyperemesis gravidarum. Women with hyperemesis gravidarum have excessive and debilitating vomiting. This can be dangerous because of becoming very dehydrated and due to loss of certain minerals called electrolytes, which are important for the body functions. There can also be malnutrition and weight loss, because the pregnant person can’t keep any food down. Before modern medical treatment, women used to die of the dehydration and electrolyte imbalances caused by hyperemesis gravidarum.

Ectopic pregnancy

One of the most dangerous complications of human pregnancy is ectopic pregnancy. This is when an embryo implants and begins to develop in a location outside of the uterus. Ectopic pregnancy is fairly common in humans (about 1 or 2 ectopic pregnancies for every 100 total pregnancies), but it quite rare in other mammals. Most commonly the ectopic pregnancy is in one of the fallopian tubes (the tubes between the ovaries and the uterus) and this is called a tubal pregnancy. But the ectopic pregnancy can also occur in other locations in the abdomen. In humans, the tubal pregnancies are about 90% of all ectopic pregnancies, while in other animals when ectopic pregnancies do occur (rare), they are more likely to be located in the abdomen outside the uterus. Scientists would like to study ectopic pregnancies using an animal model, but they have not managed to do so, because ectopic pregnancies are so uncommon in animals.
Embryos can’t develop properly when they are not implanted in the uterus, because the placenta can’t form normally. Without a normal placenta, the baby cannot grow and mature normally. So, ectopic pregnancies are never viable. And contrary to what some Republican legislators seem to believe, it is impossible to remove an ectopic pregnancy and reimplant it into the uterus. This is because the formation of the placenta is an exceptionally intricate process and during this process, the placenta has to invade into the uterine tissue. This cannot happen if you simply take an ectopic pregnancy and stick it into the uterus. Even if you were to surgically “implant” the ectopic pregnancy, it would die because there is no functional placenta to support the embryo and allow it to develop.
So, ectopic pregnancies are not viable…but they are dangerous. Tubal pregnancies can lead to rupture of the Fallopian tube. This is a medical emergency, because there is typically severe bleeding and a woman can rapidly bleed to death without immediate medical attention. About 10-15% of all maternal deaths are due to ruptured ectopic pregnancies.

Other causes of pregnancy complications

In addition to what I discussed above, there are other conditions which can become dangerous in pregnancy, including a molar pregnancy (abnormal growth of cells that normally form the placenta), placental abruption (when the placenta partly or completely separates from the wall of the uterus), placenta previa (when the placenta completely or partially covers the opening of the uterus), gestational diabetes (diabetes that develops in response to pregnancy) and pre-eclampsia (pregnancy-induced high blood pressure). All of these conditions and more can cause major problems during pregnancy. Often there are treatments, but in severe cases it may be necessary to deliver the baby early (and if it is too early for the baby to survive outside the uterus, then that would be an abortion).

Summary

In summary, there are many factors that make human pregnancy more dangerous than it is for other mammals. These include our bipedalism, the tight fit of the baby’s head to the birth canal caused by our large brains, the presence of morning sickness (sometimes severe) and the much higher rate of ectopic pregnancy in humans than in other mammals. Before modern medicine, a decent percentage of women died during pregnancy and child-birth. With modern medicine, things have vastly improved. But, women still die sometimes. And sometimes, they need abortions to prevent their deaths…If a woman has an ectopic pregnancy, it can easily kill her unless removed. Or if she has severe pre-eclampsia. Or if she develops sepsis due to premature rupture of the fetal membranes. So, the idea that there is never a need for abortion is completely wrong and anti-scientific.
Now, let's for a moment think of a made-up scenario to demonstrate the cruelty of Republican proposals to ban abortion, even in cases that would lead to maternal death.
Imagine you're a father and you just had a baby girl born to you and your wife. You love this child with all your heart. You're an involved Dad and spend a lot of time with your little girl. She is a light to your life and you enjoy the games you play with her and the funny things she says. You and her have a special bond and you are so proud of all her accomplishments and brag about her to everyone.
One day this little girl of yours is not so little anymore and she gets married. You are extremely happy for her and think she found the perfect partner to share her life with. You get along great with her and her husband. And one day soon after, you are over-joyed to learn she is going to be a mom soon!!
Everything is going spectacularly well and you are planning on being a great grandfather to your daughter's baby. But one afternoon your daughter is not feeling well. She has abdominal pain and it's getting worse. She begins to cry from the pain and you and her husband rush her to the hospital, where they diagnose a tubal ectopic pregnancy...The doctors tell you that the pain will likely get worse and the tube is likely to rupture, which will lead to a lot of bleeding and be very dangerous to your daughter's life. You and her husband are frantically asking the doctor what can be done to help her and he lets you know that the best treatment is to remove the ectopic pregnancy, but he can't do it because it is not allowed by state law...
Things get worse. Your daughter is in even more pain and begging for help...No one is allowed to do anything...And at some time, her tubal pregnancy ruptures and she starts bleeding...Now can doctors intervene? Can they try to save her? Even if they can, will it be too late?
What these politicians who write these laws are actually saying is that they don’t care if women die as long as they can get some cheap political points with the anti-abortion crowd. Please vote them out for trying to pass this kind of cruel and evil legislation.

Anything which occurs outside the body is called in vitro and when fertilization of egg with sperm occurs outside the body it is called “IN VITRO FERTILIZATION”. The first In Vitro fertilization was done in the test tube and that is why it is popularly known as Test tube Baby.
The process of fertilization which normally in fallopian tube of the woman and the fertilized egg than moves into the uterus of the woman. It an implants there in to the uterus and developed into the baby. When for some reason this process of fertilization cannot take place naturally or sperm and egg cannot be transported naturally to the tube or from the tube to the uterus or either is egg having some problem or the sperm.
Some problem in fertilization during test tube baby process we need to asses the fertilization to help fertilization we take out of the egg from the wife of egg from the woman’s ovary and in control lab and environment we fertilized egg with the help of sperm of her male partner. After fertilization the fertilized egg are cultured into the control laboratory environment to form pre-embryos and this pre-embryos are then transferred back into the uterus of the woman. If they implant and grow become the pregnancy, and hence test tube baby is most convenient process.
IVF – Step By Step
Preliminary testing
This includes first consultation, blood tests culture if necessary, hysteroscopy, D21 visit i.e. mock transfer trial, semen freezing and serum progesterone.
First consultation
We will complete a history and physical examination of both partners.
Transvaginal sonography of female partner and semen examination of male partner and culture of it, if necessary. It is helpful to bring of your old medical reports, if available.
First consultation
We will complete a history and physical examination of both partners.
Transvaginal sonography of female partner and semen examination of male partner and culture of it, if necessary. It is helpful to bring of your old medical reports, if available.
Base line blood investigation
This includes D3 FSH, LH, PRL, TSH, Major pre operative profile and other special blood investigations if necessary This will help us to choose best stimulation (Medication) protocol to complete your IVF cycles.
Hysteroscopy
If you have previously had a hysteroscopy please bring their reports. This test must be scheduled to be completed on days 5-11 of the menstrual cycle. Menstruation must be absent for this test to be done.
D21 visit
Semen freezing
Mock transfer trial
Serum progesterone
TVS
Semen freezing: It is necessary to freeze a semen specimen before your IVF cycle starts. This sample is used only as an emergency back up for the day of retrieval. We prefer to inseminate the eggs with fresh semen if possible. We will discard the sample after completion of cycle except if you choose to have another IVF cycle.
Transvaginal sonography will tell us thickness of endometrium on D21.
Serum progesterone level estimation.
Mock transfer trial: Embryo transfer is very important procedure and it is usually done without anesthesia so, on day 21 we will do mock embryo transfer to anticipate any difficulty and solution far it before actual transfer. It is painless procedure.
Development of oocytes (Eggs)
It is necessary to stimulate the ovary to produce multiple follicle (the sac that contains the egg), in order to improve your chances of a successful outcome from an IVF cycle. After the consult with the doctor, you will receive prescription for a specific type of medication stimulation protocol. There are many different medication protocols that the doctor may prescribe for you. This decision is based on factors such as your age, infertility history, a past response to these medications, and a base line FSH level. The fertility medications that are necessary to stimulate the ovary are unfortunately all injectable medications. Doctor and nurse will explain you the dosage and method of administration.
Fertility Medication
If we have more than one egg we have better chance of pregnancy of in IVF cycle. To get more eggs we stimulate the ovaries with stimulation drugs called gonadotrophins. Gonadotrophins can be manufactured from urine or by recombinant DNA technology. Appropriate type of gonadotrophins and dose of administration are selected for individual patients. Available gonadotrophins include HMG, FSH and recombinant FSH manufactured by different pharmaceuticals.
Side Effect Of Fertility Medication
Over stimulation of the ovary, It can occur to varying degrees: mild, moderate or severe.
Multiple births:
The risk of conceiving a multiple pregnancy during and IVF cycle is dependent upon your age, response to the medications, the quality of the embryos, the number of embryos replaced into the uterus and other unforeseen factors are considered when judging your specific risk of multiple births.
Common complaints:
Pain at the injection site, headaches and fatigue.
Special note:
You may have read reports that fertility drugs increase the risk of ovarian cancer. To date there are no conclusive studies that identify an association between taking fertility drugs and ovarian cancer.
GnRH analog (Lupride)
This medication is administered by subcutaneous injection. It is given to prevent premature release of the oocytes (eggs). Side effects may include: localized skin reaction, allergic reaction, headaches, hot flashes and mood swings. If your scheduled menstruation is late while on Lupron, you should have a pregnancy test.
HCG (Human Chorionic Gonadotropin)
You will be given instruction for the exact time of this injection. It is generally taken 34-36 hours prior to the egg retrieval. This medication should be injected into the muscle. This medication completes the maturation of the egg.
Progesterone
You will begin talking this naturally occurring hormone on the next to egg retrieval. This medication, assist the embryo to attach to the uterus.
The side effects that have been reported include: breast tenderness, headache, nausea, fluid retention, fatigue, mood swings, depression, pain at the site of injection (in the case of injectable progesterone).
Vaginal itching and irritation (in the case of vaginal form). If you have a history of blood clots or thrombophlebitis you should alert the medical staff.
Sperm Collection And Insemination
While the egg retrieval is underway, you will be notified by the andrology/embryology staff that a sperm sample is needed. The specimen will be processed in our laboratory and prepared for egg insemination.
Please discuss with the embryology staff if any question or concern you may have prior to the day of egg retrieval. Frozen specimen collected will be used only in case of emergency (illness, inability to procedure a specimen etc.)
Oocyte (Egg) Retrieval
The egg collection process (retrieval) is usually accomplished using the Ultrasound-guided trans vaginal method. Other methods of retrieving oocyte that are rarely utilized in our practice but are sometimes necessary, include Laparoscopy or a Trans-Abdominal approach.
This ultrasound-guided trans vaginal method of egg retrieval allows this procedure to be done in an out patient setting. A vaginal ultrasound allows for visualization of both ovaries.
A needle is inserted through the vaginal wall in the ovary. Each follicle is punctured individually and the fluid containing the egg is examined by the embryologist under the microscope until the egg is found. The duration of this procedure is usually less than 45 minutes.
This procedure is done under general anesthesia.
Incubation And Fertilization Of Oocytes (Eggs)
The eggs and sperm will be placed together in a special culture fluid and kept in incubators in our laboratory. This procedure is called insemination.
Formation And Cleavage Of Embryos
The eggs will be examined 16-20 hours after insemination for signs of fertilization. If fertilization occurs, the fertilized eggs are now described as pre-embryos or zygotes. When they divide to at least 2 cells they are called embryos.
The laboratory environment is conducive for fertilization to occur, however, it cannot be guaranteed that fertilization will occur. Typically, 60% of the eggs retrieved will be fertilized. This percentage may be higher or lower depending on each couple.
Embryo Transfer
Embry transfer (ET) usually occurs forty eight to seventy two hours post retrieval. The time of transfer will be designated by the IVF staff. The embryo(s) that is (are) assessed to be developing normally will be considered for transfer. Although a recommendation (3-5 embryos) will be made regarding the number to transfer, the final decision resides with the couple and the doctor.
Transferring multiple embryos may result in the growth of more than one foetus. If you have extra embryos after the transfer, they will be cryopreserved if they have demonstrated appropriate development.
The method used for transferring embryos is similar to that of the mock transfer. ET is performed by inserting a small catheter through the cervical opening into the uterine cavity. The embryo transfer is usually a painless procedure. There is a recommended rest period after the transfer. You will be given specific instruction prior to the transfer regarding your medications, future testing dates and activity restrictions.
Within 13 days post-transfer, hormonal levels and a pregnancy test will be done. If a pregnancy has occurred, further blood testing blood work and ultrasound will be required to assess normal progression.
Cropreservation (Freezing) Programme
The purpose of embryo freezing programme is to give a couple participating in the IVF programme the best chance to achieve a pregnancy with a maximum of safety. At the end of an IVF cycle there are often multiple embryos available for transfer. It has been found that transferring more than four embryos caries a significant risk of multiple pregnancies, while it does not increase the singleton pregnancy rate proportionately. The advantage of cryopreservation is that there may be an increased chance of pregnancy without the necessity of multiple stimulation cycles and oocyte retrievals.
The frozen embryo transfer takes place in an identical manner to a fresh embryo transfer.
Embryo selected for cryopreservation will be frozen up to three days after the egg retrieval. The embryos will be placed in a cryopreserved media and frozen in a step-wise manner. At the end of the cryopreservation procedure the embryos will be stored frozen in tanks filled with liquid nitrogen. Brought back to normal life. There is no guarantee of the survival of human cryopreserved thawed embryos. If they have not survived (as seen at the time of thawing), they will not be transferred. We consider couples whose eggs and sperm become an embryo to be the owners and persons who control their embryos. However, there is a time limit on this ownership and control.
The method used for transferring embryos is similar to that of the mock transfer. ET is performed by inserting a small catheter through the cervical opening into the uterine cavity. The embryo transfer is usually a painless procedure. There is a recommended rest period after the transfer. You will be given specific instruction prior to the transfer regarding your medications, future testing dates and activity restrictions.
Within 13 days post-transfer, hormonal levels and a pregnancy test will be done. If a pregnancy has occurred, further blood testing blood work and ultrasound will be required to assess normal progression.

I’ve been doing a bunch of research recently about progesterone, and thought some of it might be useful to share with others. As you can see below, I’ve paraphrased some things if they can be found elsewhere, or if they don’t specifically focus on progesterone but are necessary to understand something else.
For obvious reasons I’ve focused most on the topics that are of greatest interest to me, so this post is definitely not all inclusive. [Edit: For example, most of this pertains to medicated transfers.] If you see anything that I have written here that is inaccurate, or could be clearer, or is essential but missing, of course please let me know/ comment so we can all get smart together.

How progesterone is “supposed” to work in the ovaries/uterus:

Good overviews here: https://www.yourhormones.info/hormones/progesterone/
Where does the progesterone come from? How is it generated within the body?
Human eggs lay dormant and tiny inside follicles within ovaries until they are prompted by FSH to grow large develop, and then are triggered by LH to undergo Meiosis II and ovulate by erupting/ bursting out of the follicle. Sometimes this hurts a bit (https://www.mayoclinic.org/diseases-conditions/mittelschmerz/symptoms-causes/syc-20375122).
If all goes well, the resulting burst follicle forms/morphs into what’s called a “corpus luteum”, and begins to generate progesterone (also estrogen, but progesterone is the focus of this post). https://www.britannica.com/science/corpus-luteum
If there is no ovulation (for example, in women with anovulatory PCOS; or in a medicated FET cycle where the first step is suppression with oral BCP, Lupron, etc.), then as far as I can tell the female body pretty much won’t make any of its own progesterone.
If the corpus luteum doesn’t generate much/ enough progesterone, this can lead to hormonal imbalances like “estrogen dominance” which can cause heavy/ long/ painful periods, among other things. Fun times! (Menorrhagia: https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829 , https://www.cemcor.ubc.ca/resources/healthcare-providers-managing-menorrhagia-without-surgery)
How long the corpus luteum continues to generate progesterone after ovulation, determines how long your luteal phase lasts. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436586/#!po=61.4583)
If you don’t become pregnant, eventually the corpus luteum will run out of steam/ degenerate, and stop making progesterone, which means that there isn’t enough progesterone to maintain the uterine lining, and that prompts menstruation (some further discussion below).
Or, if you do become pregnant, the resulting HCG temporarily allows the corpus luteum to continue generating progesterone; and if things go well, at around 7-9 weeks eventually the placenta will become developed enough to take over the task of generating progesterone to support the ongoing pregnancy.
What does progesterone do?
When the cells in the lining of the uterus (endometrium) are exposed to progesterone, progesterone causes these uterine cells to become receptive to / help enable the implantation of a potential embryo in roughly the blastocyst stage. Progesterone does this by triggering the cells of the endometrium to change chemically and morphologically - prompts necessary glands to grow on the surface of the endometrium, etc. This process is called decidualization. More on decidialization here: https://en.m.wikipedia.org/wiki/Decidualization , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443857/
I have not been able to find any research that quantifies how much progesterone the uterine lining cells must be exposed to in order to successfully undergo the decidualization change. [[[ If anybody knows of any such research, please share. ]]] All I have been able to find is that “some” progesterone exposure is necessary and sufficient to prompt those changes.
Without progesterone, there’s no decidualization, and without decidualization there can be no embryo implantation - no matter how thick your uterine lining might be. This is why, for example, “natural”/ unmedicated FETs must confirm the date/timing of the patient’s ovulation (and therefore the timing of the creation of the corpus luteum and the timing of the start of biological/ “endogenous” progesterone production), so that the transfer date and time can be accurately scheduled roughly 120 hours later; why some mostly unmedicated FETs use trigger shots to control the timing of the patient’s ovulation (and therefore the timing of the creation of the corpus luteum and the timing of the start of biological/ “endogenous” progesterone production), so as to be able to accurately schedule the transfer for approximately 120 hours thereafter; and why fully medicated FET cycles are so specific about when to start exogenous progesterone supplementation (e.g., 120 hours-ish before the scheduled transfer). (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653859/#__ffn_sectitle) Discussion of the synchronization of the completion of the decidualization process (“implantation window”) with the blastocyst’s or cleavage-stage embryo’s embryonic development, the hatching and implantation of embryos, etc. are already discussed elsewhere in the wiki of this subreddit under headings/links regarding transfers - SPECIFICALLY, “How a FET works”.
Progesterone is the maintenance crew of the decidualized lining of the uterus. In the absence of sufficient progesterone, the uterine lining begins to break down, and eventually slough off through the cervix. This can happen, for example, when a woman doesn’t become pregnant in a particular cycle (the corpus luteum stops making progesterone at the end of the regular luteal phase, which eventually results in menstruation); or in chemical pregnancies or early miscarriages (stalling/ falling HCG means less fuel for the corpus luteum, therefore disintegration of the uterine lining, bleeding and potential passing of miscarriage tissues - uterine lining, embryo/fetus, and other “products of conception”).
How is supplemental progesterone usually delivered for a FET?
This is discussed at length elsewhere in this subReddit, but generally speaking there are three modes of delivering supplemental progesterone:
Orally (from what I can tell, this is not commonly used);
By injection (e.g., progesterone in oil / PIO); and
By topical/interior application (e.g., gels or creams applied into the vagina; or suppositories inserted vaginally or anally).
[Edit: If you really want a deep dive into the details of how progesterone administration via different routes is processed by the body, check this out: https://en.m.wikipedia.org/wiki/Pharmacokinetics_of_progesterone ]
There has been a fair amount of research on what methods of delivery and dosages of progesterone have the best pregnancy outcomes and are best tolerated by women IVF patients.
Relatively recent research out of the Shady Grove clinics found that daily PIO or daily vaginal suppositories plus PIO every 3 days, worked equally well; but vaginal suppositories on their own - I.e., without PIO - worked significantly less well. (https://www.shadygrovefertility.com/blog/treatments-and-success/asrm-2017-new-progesterone-study/) [Edit: here’s the link to the actual research paper: https://www.fertstert.org/article/S0015-0282(17)32047-2/abstract)
However, every body is different, and your mileage may vary - you may respond better to PIO, you may hate needles; you may respond better to vaginal suppositories but hate the “crotch spackle.” As always, advocate for yourself and ask questions.
How is the presence and amount of progesterone in the body usually measured?
Progesterone is usually measured in one of two types of units (ng/ml or nmol/L). Here’s a handy conversion tool: http://www.endmemo.com/medical/unitconvert/Progesterone.php
Progesterone can be measured with a blood test: this is referred to as the level of “serum progesterone.” (https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&amp;ContentID=progesterone)
That’s fine and dandy, but there are a few challenges with that. First, not all labs run progesterone tests in the same way - there are several assays/ methods of testing serum progesterone, so there can be variation in results.
Second, research has shown that the amount of progesterone in the blood (serum progesterone) is not necessarily reflective of the amount of progesterone in/around the uterine lining (which is where we want it to be for fertility purposes). This is especially so when test subjects (e.g., women who are human beings undergoing frozen embryo transfer) are receiving progesterone supplementation by vaginal delivery such as progesterone suppositories. (http://hormonebalance.org/images/documents/Tavaniotou%2000%20Vag%20prog%20sup%20to%20oral%20LPS%20HR.pdf)
Whereas progesterone supplementation that’s delivered by injection (PIO) has to circulate through the body’s other tissues/ vessels before it reaches its goal in the uterus; apparently progesterone supplementation that’s delivered vaginally causes some of the progesterone to be absorbed almost directly into the uterine lining via osmosis or some similar mechanism (vagina/cervix > uterus) without circulating through the body in the bloodstream. (Ibid.) My RE called this “blasting” the uterus with vaginal progesterone... thanks for the visual buddy.
Moral of the story: If you’re receiving progesterone supplementation vaginally only, or vaginally in addition to injection (PIO), the amount of progesterone actually reaching your uterine lining may be more than the amount of progesterone reflected in your serum progesterone blood test. How much more? Who the heck knows? That’s an area for future research.
The amount of progesterone present in the uterine lining could also technically be tested histologically, by uterine biopsy. But that’s way expensive, invasive, painful (ouch!!!), and as a practical matter it’s not realistic to do a uterine biopsy in the same cycle as an embryo transfer.
How much progesterone is “sufficient” to maintain the lining of the uterus: for example, how much progesterone is enough to sustain the lining of the uterus during pregnancy until the placenta takes over? How much progesterone is enough on the day of frozen embryo transfer?
As noted above, in the absence of sufficient progesterone, the uterine lining begins to break down, and eventually slough off through the cervix.
Also as noted above, measuring how much progesterone is actually present at/ near the lining of the uterus (where it needs to be for our fertility purposes) is difficult.
As you might imagine, these factors make it difficult to study how much uterine progesterone is “sufficient” to maintain a pregnancy in women in general, and in a specific patient in particular. Keeping that in mind...
In a 2018 study of 161 patients undergoing FET and using only vaginal progesterone, the range of serum progesterone on the day of transfer in the study population was between 12.65-35.78 ng/ml (by my calculation using simple addition/ subtraction, this is the widest range of standard deviations reported), and the researchers found that “there was no association between serum progesterone level on the day of transfer and pregnancy occurrence”. (http://eprints.lums.ac.i1417/)
Conversely, in a 2018 study involving FET of 244 PGS/PGT-A normal embryos, using only vaginal progesterone, the researchers concluded that “A low serum P level (≤ 10.64 ng/ml) one day before FET is associated with a lower pregnancy and LBR following FET of euploid embryos”, and patients whose serum progesterone was ≤ 8.06 ng/ml one day before transfer “had a significantly higher miscarriage rate and significantly lower live birth rate” than those with serum values above 10.64 ng/ml. (https://www.tandfonline.com/doi/abs/10.1080/09513590.2018.1534952)
In a 2015 study of 213 women transferring single PGS/PGT-A normal embryos, and using only intramuscular progesterone supplementation, it was determined that the highest ongoing pregnancy rate (70%) and lowest pregnancy loss rate (7%) were found in women whose serum progesterone on the day of embryo transfer was between 10–15 ng/ml. Serum progesterone of above 40 ng/ml was associated with the lowest ongoing pregnancy rate (33%), and so on: 15-20 ng/ml (62%), 20-30 ng/ml (52%), 30-40 ng/ml (50%). (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4595397/)
In a large (n= 4582 women) 2017 retrospective study, researchers found that “Increased live birth rates for frozen embryo transfer with hormone replacement therapy were seen with day 16 serum progesterone concentrations > 50 nmol/L (26.4% vs 11.3% for <50 nmol/L).” Presumably “day 16” refers to the day before transfer or day of transfer. Note that 50 nmol/L = 15.7 ng/ml. Pregnancy loss rates for the group with serum progesterone greater than 15.7 ng/ml (>50 nmol/L) were roughly half the rate of the pregnancy loss rates of folks with lower serum progesterone than that. The full text article is behind a pay wall, and it’s unclear what type of progesterone supplementation was used for this study. (https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/ajo.12757)
Hope all this is helpful!

TL;DR: can I sue my gyno, or biolife plasma services on ground of miscarriage? Kind of need this long story for context. ..
Well. A bit of time has passed. I'm not sure if that matters. Unfortunately it was a very painful experience for me, and until now I have been unable to type it all out and seek advice.
I'm so sorry if this is too long, or pointless at the end. I'm obviously curious if I have any leg to stand on in regards to suing.
This is pertaining to what I believe to be medical negligence on 2 parties. And, well, I believe I lost my unborn child because of it.
I'm not trying to be an asshole, and even I can kind of see how this might have just been all doomed from the start...
I became pregant with my first child, and knew within 5 weeks thay I was pregnant. At home test was positive. I've always meticulously tracked ovulation and my cycle.
Flashforward to march 27th 2018 I noticed I was spotting. I'd never done that before when i wasnt menstruating. This would be my second pregnancy.
I thought it was implantation bleeding so I scheduled appointment with gynogolegist.
I went in the 3/29, said I thought I was having implantation bleeding, and I thought I was pregnant. Tested me; negative on the urine.
While there, during same appointment, the gyno asked if I'd like to do my pap smear. Not quite realizing I could still be pregnant, and definitely not realizing how dangers paps are if you're pregnant, I consented.
....a week or 2 later, I haven't gotten my period, still testing negative at home, and it's time to go in for my pap results.
When i get there they tell me they need to do a colposcopy. After explaining what it is, and aggain, not being made aware how dangerous it is IF one is pregnant, I consented.
...later research would inform me that there is an 80% mortality rate for fetus/embryos in utero if colposcopy is preformed....
....At this same time, about a month prior to the initial gyno ppointment 3/29/18, I had decided to start donating plasma to earn some extra cash.
There are several dozen warnings and signs prohibiting women who are pregnant from donating, because of obvious blood loss, and replacement blood thinners.
In accordance with the terms listed on the official biolife website. Women will be screened for pregnancy upon each visit. I would take that as a pregnancy test, unless it only means some type of verbal affirmation or denial.
In either case, I was not screened, by any definition,for pregnancy any of the dozens of times I donated.
...i stopped going the minute I was able to produce a positive urine at home, 5 weeks After 3/29/18...
When I went into the gyno to have them test me again, they were absolutely horrified to learn I'd been donating plasma. Doubly horrified when I started questioning the effects of having the colposcopy.
They rushed me into a room, pulled out the ultrasound machine, and there it was, a tiny little sac on the screen. No movement. I was told to come back a week later.
Felt like I held my breathe for the week, wrought with guilt...every instinct I'd had told me I was pregnant, and I hated myself for not listening to that instinct, for the procedures I'd had done...
When I went in a week later they did anotherultrasound, and there was my flicker. My little sac with a flicker, measuring now at 5 wks, even though it was 6...but It was alive.
My heart was overjoyed. I came back the next week, still flickering, just slightly bigger, but still measuring at 5 weeks, even though it was now 7. They scheduled me to come back in at 10w.
When I did, the baby was now only measuing 7 weeks....and was not moving...no flicker. Its heart had stopped beating.
I went back a week later to confirm the many had died and stopped growing.
It had.
I cannot describe to you the devastation. So I wont try to.
They called it a 'missed miscarriage, and scheduled me for a dnc....
Now...
Between the blood donations, advice to have colposcopy and other procedure, and acts of god...
I'm not sure if I actually have any case here, especially with me signing all these consent forms...
But...
I feel, that educated doctors SHOULD have made the call OR recommended that I WAIT enough weeks (5-6) for hcg to show up in a urine, or imaging on an ultrasound to rule out pregnacy, or, have at least started with ultrasound, as ABRNORMAL BLEEDING is abnormal.
The entire reason I had gone in was for what I thought and told them implanting bleeding from pregnacy. Knowing what i know now (from research) why wouldnt a specialist in that field know that implanting bleeding was one of the earliest signs of pregnancy, and said pregnancy would not come up on any tests at that point?
Why would you advise me toward getting the papsmear and colposcopy, without having ruled out pregnancy...which was the entire reason I was there.
Still turns my stomach when I think about it. I feel like someone held my hand and led me down a path in which I killed my baby....
dramatic I suppose, but I feel so repsponible for its death based off of the choices I made...yet, only made those choices based off of advice from my trusted doctors...
...so if you have any advice for me, thank you.
Location: Florida.

Background
I've been tracking My cervix for 3 years. I've always used this as my marker for fertility and ovulation because it's doing exactly what I expect it to do.
I get mittelschmerz, the same day my cervix is at it's highest and wettest. This also lets me feel confident in my ovulation charting.
I had a copper IUD so FAM was never my sole Contraceptive, Just a way to very accurately predict periods.
Thanks to cervical tracking, I was able to tell that my IUD had failed and that I had an ectopic pregnancy at just 2 weeks pregnant, I had a vacuum aspiration and my IUD was removed too, this happened the day my period was due, and I experienced bleeding as a side effect of this procedure and started a new cycle the day that the post-procedural bleeding started.
The pregnancy did not effect my cycle in terms of timing, I tested HcG 2 days before my due period, Procedure the day I was due for my period, and a post-procedural bleed 1 day after my due period. I counted this post procedural bleed as the start of a new cycle.
The SO and I are both allergic to condoms, so I'd like for FAM and withdrawal to become our main BC methods while I save money for a new IUD. The plan is to use the withdrawl method when having sex on infertile days and to abstain completely during fertile days. So far we are abstaining completely until I get the hang of tracking properly.
This is the first time I am tracking temperature and Luteinizing hormone levels. I want to be as safe as possible while still being hormone free.
The problem Currently on cycle 3, day 7 of testing BBT, Cervix and LH.
Cervix peak height/CF peak and mittelschmerz taking place Cycle1:Day 12, Cycle2: Day 14. Both cycles have been 34 days long.
My Temperature isn't changing when I expect it to, I've been 36.2C every day except the day before menstruation I shift to 36.7, and then a day or two after my last day of bleeding I'm back to 36.2. I expected my temp to shift closer to days my cervix is showing signs of fertility.
Also, I bought a fuck ton of Ovulation (LH) test strips for the next 3 months to really help me get back in the habit of tracking. I've taken 75 tests so far (Two cycles, 34 days, test every day) and they've all been negative.
I am lactating, But I have been for 5 years now. I manually express once daily, only about 20ml per breast. My prolactin levels are normal, I am not on any regular medication, LAM has never been an option because I do menstruate.
I have had regular, moderate flow periods every 34 days (+/- one or two days) for the 3 years I have been tracking. I get mittelschmerz every cycle, I get painful period cramps every menstrual bleed, I have diagnosed Primary Dysmenorrhoea and every GYN tells me that Primary Dysmenorrhoea only occurs in ovulatory cycles (which I think is bullshit because the Combined contraceptive pill suppresses ovulation and it never fixed my dysmenorrhoea, But I wont argue with doctors because they studied this, I haven't)
Now I know that the next few months have the potential to be anovulatory because I was recently pregnant. But I don't know enough to be certain because my cervix is acting so fertile.
Questions
Am I ovulating? Cervix position and fluid says yes, bleeding pattern says yes, But everything else (LH, Temp) says no. What gives?
Why are my LH tests always negative? (tried a few Different brands through the 2 months, tested 3 times on days I had mittelschmerz with different tests)
What is going on with my Temperature?
Should I just continue to listen to my cervix? Am I safe?
TL:DR: 3 years of cervical tracking and monthly mittelschmerz. Recently started Ovulation tests (LH) following 2 week pregnancy surgically terminated. All LH tests negative despite Cervix doing fertile cervix things, What could be going on?
I know that no one here can give me a "100% safe, carry on" But I'd love to grab some thoughts and opinions and any references or websites that you'd recommend for me to read up on.
Thanks!
Also sorry if I'm using acronyms people aren't familiar with, I use Kindara so I've picked up a lot of slang from that app and I don't know what is well known and what isn't.

Verified? (This bot cannot verify AMAs just yet)
Date: 2014-03-04
Link to submission (Has self-text)

Questions	Answers
Has it affected your relationships? If so, how?	It has made me very cautious in having any sort of relationship. I have very little self confidence at all due to the lack of development, even though I have a sex drive. I lack the social skills to ask women out and prefer to remain on my own.
	I am still a virgin at 43. I had chances when younger, at University but did not see them at the time. Now I keep myself busy with other things. I have got used to the single life I think I will stay like this.
	Most men with KS do have physical & emotional relationships but I have not seemed to find the right person yet.
At least you're a wizard.	Wish I was, it would make this a lot more easier to deal with at times.
I had chances when younger [...] but did not see them at the time.	I know but most people do not have the additional problem of being so underdeveloped they even doubt they can have sex.
Man, this describes a lot more people than you think.	I know I can have sex, but it does not stop me being so ashamed and embarrassed about the way I look down there.
Do you feel like if you where given the opportunity to start treatment earlier that you wouldn't have deficiencies in your social skillset etc ?	I believe my condition and lack of treatment as a teenager has led directly to my lack of social skills. I do not think I have a bad personality and get on well with my close friends.
In other words, is it your condition that has caused your lack of social skills, or is that just your personality?	I am just not very good in social situations and making new friends.
RandomActsOfBlowjob. It's a subreddit for sexual favors for people who have had difficulty with their sex life in the past and could use some experience/confidence. Check it out.	Interesting. I might take a look at that later. Thank you.
Call girls man. I'm 100% serious. Save up for an expensive independent one. Be open with her. If she doesn't want to, I guarantee she'll know the perfect person to recommend to you.	Tried it twice. It is not for me. My moral objection kicks in when I try it.
You can develop social skills at any age. I was that super shy kid through college. Now I'm outgoing and work in sales. All I did was force myself into every uncomfortable situation i could knowing I had to sink or swim. SPOILER ALERT: you'll swim ;)	I hope so.
Do you appear prepubescent, or have hormone treatments caused you to go through puberty artificially?	I had hormone replacement therapy which produces most of the changes seen at puberty such as hair growth, muscle growth, libido, voice breaking. So outwardly I look "normal" if only about 5 years younger than I am.
	I have no testicular growth. So the testes are the same size and shape they have been since birth. I have had very little penile growth, but it is just about inside the lower end of the normal range.
	The testes will remain small & dormant unless I go onto specialised fertility treatment when they can grow only for as long as the treatment lasts, once you stop treatment the testes will shrink again.
Do you think we could see a photo of you? (I'll understand if not.) And, well, do you ever feel as if mentally your less mature/more inclined to childish activity? I guess what I'm asking is do you feel like an adult?	I might be able to sort a photo out but if you Google "Kallmann syndrome" I appear in a lot of photos and videos. I feel like an adult certainly, but before treatment I looked over 10 years younger than I was and could not shave so I did have problems at time being taken seriously at work.
Why is it under-diagnosed in females especially?	It is easily missed as there are lots of different reasons why women do not menstruate and Kallmann syndrome or CHH are low down the list of possible causes.
	Often women are put straight on the oral contraceptive pill and the causes are not fully investigated. They are then given fertility treatment so it is impossible to tell what the natural hormone levels are.
	KS in women is about 5 times as rare as it is in men but there is no obvious genetic reason for this.
Link to i1.ytimg.com. Probably him I assume, since this guy appears in a lot of the photos videos.	Ashamed to say it, but yes that is me.
How is your singing voice?	Hopeless.
	My voice broke around 23-24.
	There is a type of singer called "castrato", where they castrated healthy boys to produce a distinctive voice. Thankfully that does not happen any more.
	There is a jazz singer called Jimmy Scott who has KS and refuses treatment to keep his voice distinctive.
Perfect, thanks. I have reapproved your post.	Thank you. Sorry for the confusion. I am very real.
No worries; it happens all the time. Have a good AMA.	Thank you. I have put a link to my You Tube account as well. So hopefully that will be further proof.
I've never heard of this diagnosis before. Fascinating. Did your genitals develop normaly as if you had puberty, or did that only happen when you got treatment? (I'm not entirely sure how puberty is for men, as I'm not a man). How did you feel when you finally got a diagnosis? Did it take you long to accept it?	No, I had very little genital growth. No testicular growth and very little penile growth which was both embarrassing & annoying at the time.
	I was relieved to get the diagnosis. I was able to put a name to the condition and I was not a "late bloomer" as every doctor had told me I was up to that point.
	I think I am content with the diagnosis now. I get satisfaction in talking to others with the condition and helping if I can.
So what has the testosterone replaced that puberty normally would have covered? Is your voice deep? Body hair? Muscle mass? And if I may ask, did your penis grow from it?	My voice broke and I developed a bit more body hair. I started shaving and my energy levels and libido increased.
	My penis has never really grown since childhood so it is small, but just about at the low end of the normal range.
	I have never had any testicular growth.
Most of our sense of taste comes from our sense of smell; does your lack of smell affect your sense of taste as well?	Yes, I have sense of taste but I am sure it is totally different to somebody who can smell.
Edited: spelling.	I probably can not detect delicate flavours but I certainly have foods I do and do not like the taste of.
I hate to piggy back, but does Kallmann's cause anosmia (inability to perceive odors)? Or do you have anosmia due to other reasons?	They are directly linked. There is a problem with the development of the brain in the first 10 weeks of life which causes both the anosmia and the puberty failure.
I thought having a baby face was bad! How many times have people told you it'll be great when you're older and still look young? I'd cry.	It is a big issue when you are in the late teens and 20's because that age gap is so obvious and it is difficult sometimes to date in your own age range.
	I am over now, so looking 35 is not a problem but looking 15 when you are 20 is a much bigger problem.
Is there any knowledge you wish you could have given your younger self?	Absolutely...
	Gaining the correct diagnosis and treatment at 16 or 17 would have made a major difference in my social life.
	I stayed away from so many social situations when younger, it became so routine. I would go back and tell myself to be a "normal" teenager and not let my condition hold me back.
Does the testosterone you are given allow you to be fit and build muscle? Or is there othwr missing elements?	Yes, the testosterone I take would allow me to fit and build muscle if I wanted to but I am not fit at the moment and a bit overweight.
	Some of my fellow KS friends are very fit and looked very toned. You would never suspect they had a medical condition.
Do you have any siblings? Do they also have Kallmann syndrome?	One brother and one sister and no they do not have Kallmann syndrome.
How did you cope with the idea of not procreating? That is, if you ever wanted to.	I have accepted it, it was never really an issue for me.
	There are fertility treatments available and some of my KS friends have had children of their own.
	I do not have a strong desire to have kids of my own but might be open to having a relationship with somebody who has got kids already.
There are fertility treatments available and some of my KS friends have had children of their own.	Fertility treatments for women with KS tend to work quicker as they have the immature eggs already in the ovaries.
Yeah, I have a friend with KS and she has a kid. Had to go through treatments but it did not take her too long to procreate.	For men it takes a while for the testicles to develop in order to produce sperm.
Have you ever had a crush on a girl/boy that is not sexual?	Yes, totally.
	I have had sexual and non-sexual crushes with people of both sexes since treatment.
Do you think this has affected your professional life in any way, and if so, how? Or, to be more direct, what is your job?	I am biomedical scientist working in blood transfusion labs.
	I do not think it has affected me directly. The fact I can not smell gets noticed from time to time but it is not an issue.
	The fact I am bit of a loner and like my own company occasionally makes people think I am totally anti-social but people soon get used to me I think and I just get on with my job.
How did it effect you in high school?	High school was fine for me. I was ok academically.
	It was obvious that I was "late" but I was not bullied over it. I have heard some bad stories of how some of my fellow patients were treated but my school days were ok.
	I did keep myself to myself though and tried to keep out of trouble.
Very interesting question. To add, what kind of decisions to you find yourself making thats different to others (since sex probably isnt a factor)?	I think with my level of development it takes courage to have a sexual experience with anybody. You have to love & trust that person.
	I know I can have sex but there is a huge potential for embarrassment if it goes wrong.
	If I had started sex younger I do not think I would have a problem but the older I get the more difficult it is to start.
	Most KS guys have sex, and if they start younger they get over any problems easier. Once they start the drive & excitement takes them on. I have never met the right girl at the right time to have sex.
As a young male I would get erect if the wind blew too hard. The mere thought of a naked girl caused all sorts of problems. Did you go through this or was this something that was absent because of your condition?	I had no sex drive at all in my teenage years and did not even masturbate until I was 18. It was almost like I was still waiting for things to happen. This was pre-internet days so porn was not easy to come by. It would be totally different for young KS guys these days.
	Now, on treatment I have the same drive and reactions as any other man and get morning erections and everything else you would suspect.
Were you bullied as a kid for being "Different?"	No, I think I was quite lucky at school. Everybody knew I was late but for the most part I was left alone.
	One guy made a joke in class about the fact he was twice as big as me already, but he was laughed at for taking so much notice of other guy's dicks.
	I think I was fortunate that I was best friends with one of the cool kids in my year group which might have spared me a bit.
How on Earth did he manage to see your penis during class?!	In the showers after gym. We talking in class in the lesson afterwards.
Why would you want to induce fertility and pass this genetic defect to another generation?	Good question and this is a reason why some of my fellow patients will not take fertility treatment.
	I do not think the condition is serious enough to warrant that though. With early diagnosis and treatment the condition is manageable and people have a totally normal healthy life.
	Problems normally start with the late diagnosis & treatment. If you know what you are looking for you can diagnose it early.
TRT? No MMA fights for you, sir.	Indeed. I would fail any professional drug test going.
Do you...jizz?	Yes, but we tend not produce as much semen as most guys as our testicles are so small.
Not sure if this is a stupid question, but the whole "balls dropping" thing that kids associate with puberty didn't happen to you right?	The balls are inside the scrotum as normal but they have never grown in size since childhood.
did that occur when you started treatment?	Some men with KS do need to have their testes dropped into the scrotum after birth if they are left inside the body and this can be a symptom of Kallmann syndrome but it did not happen to me.
Did you ever have problems in a locker room setting?	I tended to hide myself away in the locker room. It was so obvious I was late but there was another guy in our year who was late, who started at about 16. I did avoid showers for a while.
Visually you were different correct?	These days I am not too bothered about it and just try to get on with it.
Thanks for answering my question! I tried to think of a politer way to put it, but I just went with the straighforward ask.	Some guys with KS are born with un-descended testes, but that does happen with "normal" men as well.
Is there anything in particular we can look out for in younger people (say 12, 13) that might be a sign of this syndrome?	Some other symptoms to look out for which appear in some forms of Kallmann syndrome.
What were your feelings towards the opposite (or same) sex going through high school while everybody's hormones were going crazy?	I had no sex drive at all at school. My sex drive only really started at 23 when I was diagnosed and put on correct treatment.
	I had no real idea what sex was when I was that age. I knew what it was biologically but I did not have the emotional or physical drive I have now.
	I was a bit socially isolated so really did not notice when my peer group started having sex. I was never at those sort parties. It all passed me by, which sounds strange now but that was the way it was then.
Since your diagnosis/treatment started have you balanced that out enough to begin experiencing and feeling desire and urges and things of that nature?	Yes but I think I am too shy to fully commit. I have tried a couple times but ran out of confidence.
	Now I tell myself I am content the way that I am and it might happen one day.
Confidence is key, it'll come in time. I wish you the best and thanks for the AMA.	I hope so. I like talking about the condition if it helps to raise awareness and helps others get diagnosed.
You say in college you concentrated on academics and sports? Do you mean following sports or playing? I would assume playing with your peers would have been extremely challenging given they were all pubescent and you were not. Essentially a boy playing among men.	No, I was never very sporty but I enjoy sports so I officiated cricket and basketball.
	I referee and score basketball matches and umpire and score cricket matches. I am a good scorer in both sports and have officiated at international level at both sports.
	I always found it difficult being in the changing room with "men" and made excuses to leave early and shower else where. Slowly I got better and now I am less cautious in being in changing rooms though I will never be totally comfortable.
Has any of your fellow patients decided not to take any medical treatments?	Yes, I think most of us have gone without treatment at some point.
	Some people do not like the sex drive if they are not in a relationship. Some people do not like the mood swings some of the treatments produce. Some people find it hard to get treatment if they do not have insurance.
	You can live without testosterone but it does put you at high risk of a couple of conditions and you may not have a good quality of life.
Oh wow I'm more curious about that you don't have a sense of smell. Is your taste affected much without a sense of smell?	I do have a sense of taste but it is probably not as refined as most people.
	I can taste wine, cheese, coffee, mint and so on but probably can not detect subtle flavours.
How do you feel this has affected your youth? (16-20 or around that age)	Yes, I think I did miss out on a lot when that age. I think I was socially isolated which was partly my own fault as I was ashamed at not developing they way everybody else was.
	I think I missed out on the emotional development of that age, gaining the experience of talking to girls and asking them out.
Does this syndrome have effect on aging? Do you age slower?	I do not think so. Now I have normal testosterone levels I look closer to my real age than I did when I was 20.
You mentioned the specialised treatment for growth down below, what does that involve? Like an injection every x days, or a full hospital treatment sort of thing?	Fertility treatment can induce testicular development and sperm production.
	Normally it is three injections of hMG or FSH three times a week for upto 2 years.
I have IHH, like Kallmann but I can smell. I did HCG injections three times a week for 9 months each time. My wife is pregnant with our second child.	I have been on hCG in the past myself and respond to it.
	Congratulations on your second child.
Did this affect your height growth as well? I've never heard of this, but I have a younger brother who has been seeing doctors, including an endocrinologist. They haven't pinpointed anything, they just say that "his body thinks he's only 13, but he should start growing soon." He's still around 5' tall, although most men in my family are over 6'. He's 18. How were you diagnosed? Is it a blood test? Would you ever eventually have gone through it, with the condition just making it very delayed, or is it permanent without hormone therapy?	My growth spurt did not occur until I was 20 - 24. With treatment I am now just over 6 foot.
	I would not have gone through puberty without treatment.
	There is no blood test for Kallmann syndrome directly, it is more a case of ruling out everything else.
	Levels of LH and FSH in blood can be measured which would be very low in Kallmann syndrome. A MRI can be done to see if the olfactory bulbs (responsible for sense of smell) are present. If they are missing it could indicate Kallmann syndrome.
	It is a permanent condition in most cases. Some form of treatment would be required life long.
Is the missing sense of smell always a symptom of this?	It is a symptom of Kallmann syndrome.
	There is a condition called CHH (congenital hypogonadotropic hypogonadism) which has the same symptoms but with a normal sense of smell.
I must ask: Is it a reasonable thing to want fertility? Considering the risk of passing your condition to your child, does that weigh on your decision to want fertility?	There is no way of predicting the chances of passing it on. It is by no means certain I would pass it on.
	The condition is not life threatening or life shortening.
	With prompt diagnosis & condition it is easily managed. A lot of the problems with the condition are down to late diagnosis. If you are know about the condition you can spot the signs and get an early diagnosis.
	I quite understand if people say they do not want to take the chance but I do not see it as that serious a condition to have to make that choice, but it will be a personal choice between couples.
Did your sexual desire for other people happen overnight? As in you took meds and had kind of a wet dream the same night? or was it more gradual? Did you even have a wet dream? Thanks for this AMA! very interesting/ Hope you live a good, fruitful life! All the Best :)	It was a gradual awakening for sure.
	I had no sexual desires before the age of 19 that I can remember.
	I have never had a wet dream that I can remember and the first time somebody asked me that when I was 18 I had no idea what they were talking about.
How you survived High school or college years?, did you get bullied or sometin?	School was ok, I was not bullied. I was left to my own devices most of the time. Everybody knew I was "late" but nothing bad happened.
	College life I concentrated on my academic work and sports and tended to ignore what else was going on. I was good at keeping myself to myself.
Does this also cause infertility in women with the disease?	The condition affects women in the same way, they will not progress through puberty and will be infertile without treatment. Their treatment is slightly quicker than for male fertility treatments. I think there is a big problem of social isolation if people do not develop at the same time as their peer group. As a teenager you learn the social skills of interacting with others. If you feel you are so physically behind your own age group it can be difficult to fit in and do the same activities as everybody else. Some people are left with the feeling that they are the only person in the world not going through puberty and no doctor will take them seriously.
How has this mentally affected your life? Has it ruined opportunities for you? What opportunities did it create?	I think I have missed out on opportunities but partly this my own fault as well.
	I have had chances in the past but did not have the courage or drive to go through with them.
	Now I tell younger guys with KS to make sure they make the most of any opportunities they get and not let KS hold them back.
What is your height / weight? *Is it closer to that of an adolescent or an adult?	Adult weight and height now I have been on treatment for almost 20 years. I am just over 6 foot and slightly overweight.
How has the late diagnosis affected your relationship with your parents? Is there a genetic component to the condition?	The condition is purely genetic but I think I am the only person so far with the condition.
	If I ever did have children there is a chance I can pass it on.
	My condition is rarely mentioned in my family.
If I understand your condition right, would this syndrome left unchecked cause you to be a modern-day counterpart to the castrati of older times? Without the castration of course, just never reaching sexual maturity.	Yes, we would be tall, look young, be infertile and our voice would not break.
Could you explain why this condition leads people to become tall?	Height is controlled by the hormone called growth hormone. It makes the long bones grow.
	Testosterone stops bone growth by fusing the end plates on the bone, strengthening the bone and preventing further growth.
	At puberty growth hormone causes the growth spurt up to the predetermined height when testosterone (or oestrogen in females) kicks in and prevents further growth.
	Without the testosterone or oestrogen at puberty there is nothing stopping the long bones from growing so you can get extreme height.
	This is one reason why testosterone treatment is not started too early at 12 or 13, you have to allow for normal height to be reached first.
Any pics from when you were an adult but before treatment?	There are on my Facebook which is open for anybody to find.
	I am not sure how I can post photos here. I might try to post photos on my blog site if that will help.
What were you thinking when you were growing up and didn't experience puberty? Did you go to doctors early and they missed it or did you just wait until your 20s?	I first went when I was 16 and kept being dismissed as a "late starter" or "late bloomer" even at the age of 19.
	I kept being told to "wait and see". At the time I did not know any better and just accepted what the doctors said.
	I did not see my first endocrinologist until I was 23.
What happens if you don't take anything/don't seek some sort of treatment?	The patient would be infertile and have poorly defined secondary sexual characteristics. They would feel tired, lethargic and have no sex drive. They would be at high risk of developing osteoporosis and diabetes.
Would Kallmann syndrome be revealed by blood test? I am on a testosterone treatment aswell. Just curious because Kallmann syndrome was never mentioned when I was at my doctor.	There is no one blood test for Kallmann syndrome, but if you have very low levels of gonadotropin hormones called LH and FSH it could indicate Kallmann syndrome.
	LH and FSH are released from the pituitary gland and act on the testes to produce sperm and testosterone.
	It depends if your testes are the normal size. In Kallmann syndrome our testes remain the pre-pubertal size and never grow.
Do you have anosmia too? If so, what's it like dealing with that.	Yes, I have anosmia.
	I do not think it bothers me too much.
	I drink milk that has gone off every so often and often forget I have left the cooker on.
	I have lived with it for so long it is normally other people that remind me that I can not smell.
Were you planning on offspring or adoption to avoid passing on the gene for the disorder?	There is no guarantee about passing the gene on. The genetics of having Kallmann syndrome is far from being understood.
Link to www.bmj.com. I'm guessing this is you? I think you're doing a great thing here to do this AMA, definitely raises awareness of KS.	Yes, that is me.
Sorry if the question has already been asked, I havent seen it in my feeds. Is your body able to grow facial hair? Do you still have a baby-face like face. Thank you very much for this AMA!	I can shave now. I shave every 5 to 6 days. I did not start shaving until my mid-20's when I started full dose testosterone treatment.
How does this syndrome affect your life expectancy?	No change on life expectancy at all.
	Low testosterone would put me at risk of developing osteoporosis or diabetes though.
Couldn't you have become immortal by never technically becoming older than 21?	No, wishful thinking that perhaps.
at least convinced themselves they are better off this way.	I certainly have convinced myself I am happy like this, even with my friends trying to encourage me.
	I talk to my fellow KS friends and they have sex and relationships. I am left behind at the moment.
I'm sure you are truely happy, you haven't just convinced yourself. Many people are happy despite difficult disabilities and circumstances in their life. And many people are unhappy despite being in pretty good circumstances.	You might be right. I am probably content just to get on with things. I have met the "right" person twice so far but it was at the wrong time for me.
Don't give up on finding someone. But also don't believe people who tell you that you need to have someone to be happy.	There is still time I agree.
Theres always eharmony.	I am on Match.com :-)
No way. I just received my blood test that I did because I am 17 and not showing any signs of puberty. Blood test said that my body made very little testosterone. I also can't smell.	Get them to check your LH / FSH levels as well.
	17 you should have started by now. Make sure you are sent to see an endocrinologist straight away.
	Contact me for more information if you wish.
Great AMA OP. I see you answering questions candidly all the way down the page, I can tell you are legitimately interested in education and awareness of the condition.	No, I would not get any beard growth with no treatment.
I see you're clean shaven in the pictures I could find, but I saw you shave every week or so with treatments; as a beard-clad man, I'd like to know if your facial hair would grow in if you weren't receiving treatments.	My testosterone level off treatment is barely above zero.
Don't worry mate. You will be fine in the long run!	I am fairly ok with it now. Good and bad days.
	I am mainly doing this to highlight the condition to any younger people who might be going through the same. It is not a well known condition and if I can help others get diagnosed & treated it will be worth it.

Last updated: 2014-03-08 10:26 UTC
This post was generated by a robot! Send all complaints to epsy.

Hi girls,
So I've been on keto and exercising for like 2 months now. I'm not overweight but still had some kilos I wanted to get rid of. It's going great so far, i lost like 3 kilos but then i exercised less i gained back.
Anyway, I've been on the pill for several years now and never had any problem. I sometimes forget to take it but i take it either within 12 hours or on the next day and never had any problem, any unplanned pregnanct or any change in my period.
Since I'm on keto, I forgot to take it once or twice and took it as soon as I noticed, like I usually do, but unlike usually, I noticed some spotting, slight bleeding. I asked some girls which are not on keto and they told me the same happens to them sometimes when they forget to take their pill on time, so I didnt worry and assumed it was normal, since I took my pill one day late, and this change was due to the diet which was probably playing with my hormones, or my body just needed to adapt.
The problem is last week was supposed to be shark week, during which I dont take my pill for 7 days, have my period, and take it again on 8th day. But this time I didnt get my period, nothing. So I got worried and took a pregnancy test at the end of the week. It was negative. I'm considering dropping keto because I'm worried about this whole no period thing. The lack of menstruation is probably due to keto, even though I didnt loose much weight. I found this link http://www.paleoforwomen.com/how-extremity-can-make-even-the-best-diet-fail/ which explains why low carb diet can lead to lack of menstruation but I wanted to ask if anyone ever experienced the same thing.
If I stop my low carb diet, will my period come back ? If I don't have my period, does that mean there is a problem with my body ? Is it then dangerous to stay on keto ? Also, the pregnancy test was definitely negative, and I took it after 7 days without my period, so if the reason for no period was pregnancy, I would have had sufficient HCG in my body for the test to be positive. But could the low carb diet play with my hormones and trick the test to show negative when it's positive ?
Thanks for the feedback girls.