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Infertility and Reproductive Medicine Moderated by Scott Roseff, M.D.


Meet Scott Roseff, MD Reproductive Endocrinologist
Dr. Roseff offers cutting-edge fertility testing and treatments in Boca Raton, FL. He believes that patient care should be individualized and compassionate. Dr. Roseff has supported INCIID consumsers for more than a decade. He goes above and beyond the norm for his patients. Dr. Roseff is a proud supporters of the INCIID IVF Scholarship Program.

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Old 12-26-2008, 11:21 PM
ehnellem ehnellem is offline
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Default Dexamethasone?

I am 26 and have PCOS. I have done 5 rounds of clomid, but only the last one was with an RE. The previous 4 were with my ob/gyn with little monitoring. I usually only have a period every 3-4 months but have had one on my own after my last 3 round of clomid (100mg). However, my RE determined that even though I have been have been having my periods, I still have not been ovulating. So, he is having me try one more round of clomid at 150mg along with dexamethasone to see if that works before moving on to injectables. I am also going to be using estradiol. I have never heard of anyone using dexamethasone for infertility and haven't been able to find much information about it. Is this a drug that you prescribe to your patients and, if so, does it work very often for those resistant to clomid?
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  #2  
Old 12-27-2008, 08:23 AM
Scott Roseff MD's Avatar
Scott Roseff MD Scott Roseff MD is offline
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Hi,

Sorry to hear you haven't conceived to date and that (with PCOS) you didn't see an RE sooner rather than later.

The success of Clomid often depends on proper monitoring; If you were only properly monitored on one cycle of Clomid, then it may be that you've failed to conceive on only one, good cycle of Clomid - Does this make sense to you?

Were you tested for insulin resistance or diabetes (to see if metformin is an option)? Are you obese? If so, this can significantly lower the odds of pregnancy success (see the article I'm quoted in at http://www.weightwatchers.com/util/a...1&art_id=62021

MOST women who menstruate between cycle days 16-34 after taking Clomid did indeed ovulate -- What tests did your RE do to determine you did NOT ovulate on the 100 mg dose??

Some studies, many years ago, showed increased ovulation rates in women who took Clomid with dexamethasone, though other studies refuted that. In general, the addition of dex to Clomid is often a waste of time (in my own opinion).

Did you develop a dominant follicle on ultrasound while on Clomid? Was your estradiol blood level elevated? If so, did you receive an hCG injection to trigger the egg to ovulate? Or, did you just not develop a follicle while on Clomid?

Looking forward to your comments and responses....
Dr. Roseff
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Dr. Roseff - South Florida Institute for Reproductive Medicine - Boca Raton, FL
PERSONALIZED/SUCCESSFUL Specialty care....

As you’re not my patient, information herein may be incomplete/inaccurate & I can't be responsible for your actions. This is for educational purposes & should never be used to replace information & care rendered by your own doctor. No part of this message may be reproduced, printed, or posted elsewhere without express written authorization of Dr. Roseff or INCIID.
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Old 12-27-2008, 07:01 PM
ehnellem ehnellem is offline
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Thank you for your response. I have not been tested for insulin resistance or diabetes, but I am not obese. I had a vaginal ultrasound on day 13 of my cycle and was told that I did not have any follicles maturing. I don't know about my estradiol level on that day, but I had been taking estradiol from day 7 of that cycle until the day of the ultrasound. My previous 3 clomid cycles were 35, 33, and 34 days long, so maybe I have ovulated previously and just not this cycle. I also wish I had gone to an RE from the beginning so I would have been monitored and know for sure. I took my last dose of provera yesterday, so hopefully I will be trying again soon. Thank you for your opinion on the dexamethasone.
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Old 12-28-2008, 10:38 AM
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Scott Roseff MD Scott Roseff MD is offline
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Adding estrogen to a Clomid cycle can possibly hinder follicle development! It also hasn't been shown, in general, to help with cervical mucus. Also, it can take until day 19-21 for follicle maturity to occur on a Clomid cycle, so checking on cd13 may show little/nothing.

Hope this helps....
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Dr. Roseff - South Florida Institute for Reproductive Medicine - Boca Raton, FL
PERSONALIZED/SUCCESSFUL Specialty care....

As you’re not my patient, information herein may be incomplete/inaccurate & I can't be responsible for your actions. This is for educational purposes & should never be used to replace information & care rendered by your own doctor. No part of this message may be reproduced, printed, or posted elsewhere without express written authorization of Dr. Roseff or INCIID.
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Old 01-23-2013, 09:12 PM
Hottie Hottie is offline
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Default congenital adrenal hyperplasia versus pcos

Hello. I am not sure how to make a new post. I have seen four different reproductive endocrinologists and I finally went to a Endocrinologist, not reproductive endocrinologist and he is testing me for CAH, late onset. There was some confusion on wether or not I have pcos and he suggested we test for this. What is your experience with CAH? How common is it? Is this why many Ivf pt's are put on dexamethasone? My question is why wouldn't reproductive endocrinologists have tested me for this? Thanks.
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