Frequently Asked Questions

In short: This page gathers questions from readers about their own fertility problems, with Dr. Najeeb Layyous’s answers. They cover absence of sperm and varicocele, ovulation problems and polycystic ovaries, prolactin and thyroid disorders, recurrent miscarriage, ICSI and IVF. The recurring message: an accurate diagnosis through tests first, then treatment suited to each case.

Q: I am a woman 22 years old, I am married from one year and six months, I got pregnant after one year from my wedding, and now I am in my 23rd week of my pregnancy. The problem is when I start to take my prenatal vitamins, I get constipation, and I am afraid that I harm the baby or the placenta when I push hard, and also I am afraid to get Piles - Hemorrhoids. So does the pushing hard harm the baby or the placenta? So please tell me what to do.

A: Pushing doesn’t harm the baby but causes hemorrhoids. I advice you to take Duphalac suspension as a laxative.

Q: I had to have a partial hysterectomy. I had a C-Section about two years ago, and the doctors messed up my uterus pretty badly. I left the man I was with then. I plan to be married in July to somebody else. In a conversation about the impossibility of my having a baby; I was informed that there may be another way. You may not know anything about what I need to know or where I may need to go for an artificial uterus, but in a search on the net, I found your site. I thought I could get some answers. Also maybe some information on side effects of a partial hysterectomy too. If you can help me. It would be greatly appreciated

A: Uterus transplantation is now possible: since the first baby was born after a uterus transplant in Sweden in 2014, more than 100 babies have been born worldwide. It is still a major procedure available only in specialized research centres, and it requires IVF, anti-rejection medication, and removal of the transplanted uterus after childbearing. In subtotal hysterectomy, the uterine cervix is left so you have to have a routine check up with PAP smear .no periods usually and no pregnancy.

Q: HI I am wondered if there is any way I can be pregnant with twin like any medicine, I can take it from home without going to doctor and when it is the best day after my period to get pregnant with my age 29, and I live in USA if you can give me any name for medicine, I can use it without any side effect to be pregnant with twin?

A: You should never take fertility medicines without a doctor’s supervision. Fertility injections and tablets are given only to women who need help to conceive, not to create twins, because twin pregnancy carries higher risks for both mother and babies. Around the time of ovulation (usually about 14 days before your next period) is the best time to try to conceive.

This question is answered more fully in our article on getting pregnant with twins.

Q: I am sure you get tons of Americans asking if you accept them as patients. If you dose take Americans how much do your sessions for IVF run? My husband and I were thinking about spending a summer in your country.

A: The cost of IVF – ICSI procedure is 2535 $ plus the cost of injections and medication, which differ from one women to another according to her age and state of her ovaries. Optional additions such as Embryo Glue (105 $) may be discussed in selected cases, although international guidelines note that the evidence for their benefit is still limited.

You are welcome to come for treatment and while you are here you can enjoy touring around and having a nice holiday.

Q: I want to introduce to you, my wife’s medical history and the problems that we have in conceiving a baby. Our medical history starts in 2001 when we found out that my wife has Fibroids. We scheduled a Myomectomy in March of 2001 to remove the fibroids, so we can have a baby. All of them were removed with the exception of one that was attached to the uterus. The Surgeon removed as much as he could from that one. He did not remove all of it because he was afraid it would cause too much bleeding and that he might have to perform a hysterectomy. At the end of September 2001 my wife was pregnant. Everything was going well and the baby was doing well. Middle of October my wife started bleeding but did not lose the baby. We had several sonograms to check on the baby’s health and to find out what was causing the bleeding. The Doctors couldn’t find any reasons for the bleeding and they told us it could happen without anything being wrong. The only thing they could see from the sonograms that the remaining fibroid was growing. The Doctors did not think the Fibroid was the cause of the bleeding. The baby was ok, and everything was fine except the bleeding. We had 6 sonograms during the first 13 weeks of pregnancy and the fibroid had grown to 13 cm. After a routine check up the Doctor was not able to hear a baby’s heartbeat. The following day we had another sonogram to confirm or not confirm the Doctor’s findings. The sonogram had shown that the amniotic fluid was gone, and the baby was dead. We had a D&C to remove the baby.

Q: We tried for a year to get pregnant again. With no success, We thought that the Fibroid was the problem. We went to a Doctor, who performs embolization of fibroids. After getting an MRI, the Doctor informed us the Fibroid was dead and there was no need for the procedure and that the fibroid had shrunk to about 8 cm. My wife went for her annual checkup and explained to the Doctor that she hadn’t gotten pregnant after trying for a year. The Doctor schedule an HSG to check on her Fallopian tubes. The results of the test showed both of her tubes were blocked, and the Doctor could tell us the reason for the blockage. So after I visit your web page, I found a lot of information I need to know. My question to you is can my wife’s tubes be unblocked with surgery? And can we have a baby without having IVF? If there is surgery for the blocked tubes what percentage is successful? Cause here in the US no Doctor will perform that type of surgery because there is IVF, and that’s what they prefer to do. My wife and me are coming to Jordan for a visit in September/October and I would like to have an idea of what options we have. By the way, my wife is 34 years old. Thank you very much for your time and I hope to have a baby will be under your help.

A: The success of surgery for the tubes depends on the degree of damage and the skills of the surgeon. I advise you to go for IVF and not the surgery because it’s more successful, and the tubal blockage may recur. I would like to examine her before giving you my opinion for the surgery.

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Q: 41 years old male, married since 1983, teacher, complain from infertility since marriage. He asked many doctors with no benefit…Systemic enquiry: all are normal… No history of previous mump or other operations or accidents except infective hepatitis of mild type with no sequel .No birth injury, infant or childhood previous medical illnesses apart from febrile convulsion for two attacks with no complication.

• FAMILY HISTORY: his father died since 1980 as a complication of diabetes mellitus. His brothers are suffering the same conditions .They are living in the same housing conditions (their ages 40 and the second 31).His uncle son with two other neighbors also suffer the same illness. He is not alcoholic, no tobacco, no any history of drugs .N0 siblings. PHYSICALLY: in good condition, with no abnormality seen.
• INVESTIGATIONS DONE: many seminal fluid analysis reveals: Volume ranging from 1-4 ml, Viscosity: high or normal. Color: white, milky or gray, PH: alkaline, Sperm concentration: 5ml Active: 10%-20%, sluggish: 10%, Immotile: 80%.

Sperm morphology: normal: 60%, abnormal: 40%, no pus cells.

Cytogenesis report :( 1987) G-banding investigation of peripheral blood culture reveals {46, XY}

with no obvious chromosomal aberration.

• U/S: both testes are normal in size &texture with moderate left side varicocele diagnosed as mild hydrocele.

SERUM HORMONES: at 2/6/2001:S.FSH= 14.9 mule/ml

• S.LH =13.0 mule/ml

S.Prolactin =375 mule/ml

• L H: 7.1 mule/ml
• FSH: 1.0 Prolactin: 6.0 TESTESTERON: 1.75 ml u/ml…
• AT? /11/1985 Spermatozoal antibody report: Serum: positive titer 1:128.
• AT 11/7/1993 seminal plasma: positive titer 1:32.
• S. testosterone =42.6 mule/ml

Drugs taken: 1. Clomid 2.Pregnyl inj. 3.Systanon inj. 4.Proveron 5.Prednisolone & other steroids 6. Multivitamins 7.Parlodel with no response.

A: After 19 Years of marriage and trying different treatments, I think it is time

For treatment by ICSI, That is Intracytoplasmic Injection.

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Q: I have been married for three years, I am 22 years old. In the first year I had difficulties for several months (about six months) to get pregnant. Finally, I was advised to take Clomid tablets which helped me and resulted in conceiving and normal pregnancy after 2 months. After few months of my first baby I decided to have another baby. I got pregnant easily without any medication but I had a miscarriage after 8 weeks. I waited few months more and get pregnant again but unfortunately I had miscarriage again after about 5 weeks. Now I would like to get pregnant again but I am quite worried that I may have same problem. Also, here in UK the GP, s do not send patient to see specialist unless the patient had miscarriage for three times, which I don’t prefer to do after all suffering I had in my last two miscarriages. Could you please advice me what to do?. I have been advised by some people who have been through same experience before to use Progesterone injection or Duphaston tablets. Is it OK to use these tablets and are there any side effects (I do not suffer from any illnesses)?

A: Having miscarriages is distressing. The reason that in the UK the GP’s do not send patients to see a specialist unless the patient has miscarriages for at least three times is that scientifically, about 60% of abortions are caused by chromosomal abnormalities and nothing can be done about them. Normal pregnancy follows and the pregnancy continues without treatment. Current guidelines recommend starting investigations after two miscarriages, so it is reasonable to see a specialist now. Progesterone can be helpful in some situations: vaginal progesterone is recommended if you have bleeding in early pregnancy after a previous miscarriage, and Duphaston (dydrogesterone) may be considered for women with repeated unexplained miscarriages. Please discuss the right option with your doctor, and take folic acid before and during early pregnancy.

Q: I want to ask if you know if there is anything that can be done to stop women after the age of 40 getting brittle bones, e.g. vitamins, food etc? Also my mother has just had an operation on both her knees where a piece of metal replaced the bones that has rubbed against each other and disappeared, what I would like to know is is there anything she can’t do to look after herself after the operation e.g. what to eat what kind of exercise to do, also what to try and avoid and also what type of vitamins to take? I have a sister who is 40 years old and has been married for over 7 years but unable to have children, she is married to someone who has been married before and he has children from his first wife so he is ok, but my sister has tried fertility treatment but it did not work, she saw the doctor and he said that her ovaries have shrunk, is there any advice you could give to her or anything that would be of help to her?

A: To stop getting brittle bones , women should start increase her calcium intake either from food by taking lot of milk enriched in calcium in addition to milk products or by taking calcium tablets plus vitamin D e.g. : Oscal-D daily . Also exercising is very important and the best exercise is walking . If the woman has menopausal symptoms or has reached menopause early, hormonal replacement therapy may be considered, as it also protects the bones; the decision is individual and should be made with her gynecologist after discussing benefits and risks. Your sister case needs quick interference because she is 40 yrs old. I suggest measuring her ovarian reserve with an AMH blood test and an ultrasound follicle count; if the reserve allows, she can start ovarian stimulation and continue with an IVF-ICSI program without delay.

Q: My daughter is extremely sick with her second child. She is depressed, has no energy, nausea, vomiting, etc. Her doctor says this is all-normal and has only treated her with I.V. bags just to keep her hydrated. I know there has to be so much more that can be done or tried. Ginger teas, ginger ale, etc. has not helped. I need more information. In addition, this doctor claims that he will be able to tell the sex of the child at 12 weeks with 3D. Is this possible? I always thought and have been told you cannot really tell the sex of the child until the 5th month.

A: Severe vomiting in pregnancy (hyperemesis) can be treated safely. First-line medicines include antihistamine anti-sickness tablets such as cyclizine or promethazine, or a doxylamine-pyridoxine combination; metoclopramide can be used as a second option, for short periods only. If she cannot keep fluids down, she should be assessed in hospital, where IV fluids, vitamin B1 (thiamine) and injectable anti-sickness medicines can be given. As far as the U/S. yes it’s possible to know the sex of the fetus at 12 wks but preferably between 13-14 wks as the clitoris can sometimes be mistaken for penis at this age.

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Q: I’m 24 years old married lady. This is my first pregnancy and I’m in the first week of my 6th month. My pregnancy is going fine but I’m suffering from a strong acidity in my throat. I feel that my throat is burning but there is no pain in my stomach. This acidity is very strong so that I can’t sleep at night. When I have it, I drink cold milk which makes me feel better but it takes some time. This acidity started slightly since last month ( 5th month) but it has become stronger lately. Since that time I tried to avoid oily and spicy food as much as I could but still most food items cause this acidity like white or yellow cheese, labnah, eggs, etc…

and there are some questions I would like you to answer if possible:and there are some questions I would like you to answer if possible:

• 1. what are the reasons for this acidity?
• 2. I heard that pregnant ladies get it at the last stages of their pregnancy like 8 and 9 month? why did I get it that early and does it mean that their might be any problem?
• 3. does this acidity mean that my baby’s hair is growing as most old ladies think?
• 4. what food items you advice me to eat as breakfast, lunch and dinner so i avoid having acidity?
• 5. does drinking cold milk or eating some pieces of almond makes me feel better when I have acidity?

6) what is a safe acidity medicine you advice me to take when acidity gets worse?

A: 1. Reflux oesophagitis is common in pregnancy and sometimes it starts early; this is a normal variation. I advise you to start with an antacid or alginate syrup (such as Gaviscon) after meals and at bedtime; if it is still severe, your doctor can prescribe a medicine such as famotidine or omeprazole, which are considered safe in pregnancy

2. No. Heartburn in pregnancy is caused by pregnancy hormones relaxing the valve at the top of the stomach and by pressure from the growing womb; the belief that it means the baby has a lot of hair has not been proven.

3. As you said, avoid hot spicy and oily food. Lot of fresh vegetables and fruits.

4. If it relieves you, yes you can.

Q: I am married and I have one daughter she is now 27 months thanks god she is healthy baby I never have any problem with her sorry I make the question very long but I am from Jordan and live in CA united state, I had last year at 02/14/04 miscarriage and another one at 05/23/04 and I was pregnant this year and the doctor give me progesterone 400 to keep the baby but they tray to see the hart beat they cant .now I am bleeding and I make ultrasound they say they cant see the hart beat and the sac the same size from the last week (from conception day 7.5 week) .

A: If the fetus is not viable, you have to do evacuation of the pregnancy and certain investigations should be done for you as you aborted 3 consecutive times. You can go to page habitual (recurrent abortion) in my website.

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Q: I want to ask you if smoking reduces my pregnancy.

A: Yes, smoking can affect the fertility of both male and female, and there is no safe amount, so it should be stopped completely by both partners, including shisha and e-cigarettes.

Q: concerning the gender selection service at your clinic

• In your estimations or close speculations:
• How many days does it require me and my husband to finalize the operation completely?
• How much would it nearly cost us?
• I live outside Jordan and need to have a good idea about this issue before visiting you in the near future.

Thank you very much and best regards.

A: From the first day of cycle until the program finishes completely requires around 20 days

You can read more information on the website

Q: I have visited your site. and exactly the gender determination methods

• part. I saw the Chinese table for baby gender determination. and i
• checked other sites for this table when I knew my baby gender… there was
• a difference. your chart gave a boy and the other charts gave me girl.i

checked three other tables and they all gave me the same result (GIRL) while yours gave me boy.

just wondering why is the difference???

A: There are many kinds of Chinese table, and they give different results because none of them has a scientific basis; studies show they predict the baby’s sex no better than chance. Only ultrasound or specific medical tests can determine the baby’s sex.

Q: I would like to know whether the hernia affect my fertility or not?

A: hernia has no affect on fertility

Q: I have a query regarding important days for getting pregnant? Does only one day in a cycle guarantee pregnancy? Or are there four to five days to get pregnant in a cycle for a woman?

A: Women with regular cycle. the days of ovulation will be between the 12th and 16th day of the cycle. but this is not accurate. by transvaginal ultrasound we can determine the exact date of ovulation.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist