At what point should you try in vitro fertilization?

Q. I have endometriosis and have had a biopsy, laparscopy surgery, the tube dye test, many ultrasounds, and much blood work. My husband has had a semen analysis. Once I had the surgery they said I was clear of the endometriosis for now. All my other tests and my husband's test came back fine. I tried Clomid for six months and had three tries at artificial insemination with the Clomid. No luck. I am now on my third try with injections of Repronex and artificial insemination. They just recently did a FSH test for my egg quality and quantity. It came back as 9.2. They said anything under 10 is okay. I am 30 years old and wondering if any other tests should have been performed. They say 3 chances on the shots are probably enough. Then we're looking into in vitro. Any thoughts or suggestions? I have also begun seeing a chiropractor for stress/relaxation techniques. I just want to be sure that we've done all that we can before we take the next step to in vitro. Thanks for the help.

A: Your history is quite common. The steady progression from diagnostic evaluation through oral Clomid to injectable gonadotropins (Repronex, Gonal- F and Follistim) results in progressively more pregnancies with each month of treatment - - to a point. In general, if pregnancy is not achieved after three to six cycles of gonadotropins, IVF is the next step.

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