Infertility

Are we done yet?

When I embarked on this journey, I never would have thought that I….

Wrong!

First of all, I never would have thought I would embark on this journey… Could have never seen this happen to myself, or myself being able to cope with it.

This infertility struggle is hard, unfair and hurts you precisely when you expect it the least. I still to this day wonder how come women who do not have any wish for children find themselves pregnant as soon as they are sneezed upon, while others have to fight for years to an end to achieve a dream that should be their birthright. I certainly asked myself the same question not that many years ago, from a different position-the position of the one getting pregnant on the pill. Little did I know life would soon place me on the other side of the barricade. Not that back then I felt less frustrated, mind you :))

Anyway, the point is that these days I am bitterly celebrating three years in Assisted Reproduction hell. Is it enough? Is it too much? Should I go on? When should we say enough is enough and frankly, ARE WE DONE YET? Cause I would love to make my life again about other things than OPKs, 2WW, BFNs and you name it.

At this point in my life I would have completed (please sit down) 7 IVF cycles, 6 IUI cycles with full IVF protocol, 2 Clomid cycles, 5 Femara cycles, and numerous natural TTC cycles. All those in a 3 years bracket, with all the hope, deception, rage and frustration they brought upon me. My last IVF cycle is barely over, and I am still into my 2WW-so you will say I am jumping the gun and speaking as if I knew this cycle too was doomed. The truth is, at one point it’s getting harder and harder to keep your spirits up, positivity starts to appear silly and at the end of the day it’s probably an instinct, as if to save you from the heartache that invariably follows the broken dream of yet another month passed with nothing to show for it.

For the last couple of cycles I have been telling myself: this one is my last. And yet I would find rays of hope and the courage (or craziness) to try again, for (yet another) last time.

But when do we say “no more”?

Some stop when they run out of funds to finance their journey. This is a very important aspect because infertility is not only heartbreaking and a burden on one’s mind and body, but it also destroys your budget and eats up your savings. For them in this category, the decision is easier made, for once you’re out of cash, there’s no point in asking when to stop, you know you have to do it, and here is your bank account making your decision for you. Frustrating but undebatable.Some stop when they can’t take no for a pregnancy test anymore. Repetitive failures to conceive may dig deep into your self esteem, damaging the zen of your couple and your relationships with other people around you (especially the luckier ones, and especially those who were not even remotely interested in having yet another baby, and keep whining about “these things happening to them”)

Some stop when they realise this hunt for the golden egg takes too hard a toll on their marriage. Because this is another taboo people usually do not wish to discuss: a process supposed to bring a couple together gets people apart. Intimacy is lost, desire diminishes, pressure builds up, and what was supposed to be an act of love in the pursuit of the fruit of love itself, becomes-let’s face it-a fixed schedule of lovemaking, timed by hormone levels and subcutaneous shots. And this is hard. What may start as being funny (we have to have sex NOW, I have a positive OPK) becomes a self imposed task a couple of cycles later. You eventually begin to forget yourself as a couple, and your sex life starts to be measured in ovulation tests, sperm morphology counts and number of follicles retrieved. And that’s harsh!

We are not trained for that, we grow up being told getting pregnant is easy peasy, why… everyone gets pregnant, especially when they don’t want to, so when it doesn’t happen for us, and we have to fight for it and pay for it too, it appears unfair and frustrating.

I know for me this is my last time doing IVF. Luckily it is not a matter of money, French basic insurance covers fertility treatments, or I would have never been able to have so many cycles so far. For me, having previously been confronted with loss and mourning, this infertility journey had me passing through all the stages of grieving, once more.

First, I was shocked. By shocked I mean I cried for two days in a row and lost a few pounds in the process. Don’t laugh at me, but this actually happened when I found out my AMH was 0.2….Now I know better but back then I was a sucker :))

Then, I was very excited for my first cycle, and perfectly sure it would work. How many times have you been told “never mind if you don’t get pregnant, you can have IVF”? Exactly! People outside this journey believe IVF is THE golden solution and it is infallible. Meh…Anger hit me hard when my first cycle failed. I was angry at my body, angry at my age, angry at the timing, angry at all pregnant women, angry at God. As if the whole Universe was against me.

A few failed cycles later anger left place to depression. I wouldn’t say I was depressed in the medical sense of the word, for I never needed medical assistance for it. But I guess I was this close…

And then a sort of shell built around me, and I became numb. I lost my positivity, for frankly how many times in a row can you fool yourself that this time is gonna be the good one? And I became convinced that it will never happen to me. And I didn’t care anymore. I mean I would do everything that needed to be done, like a robot, like a little infertility soldier heading towards another defeat.

Emotionally, I am sorry to report, I am still there. Numb, indifferent, unable to care anymore. But this time the little soldier lost its dedication. This time I surrender and I am neither ashamed nor do I feel guilty. I did my part, we both did our best. We have been together in this journey and we have supported each other but it is time for us to find ourselves again. If the Universe cares to surprise us with a (natural) miracle, we won’t say no to it 🙂 And if it’s not meant to happen for us, we surely will find other ways to grow together and love each other and enjoy what we have including those two wonderful children of mine that he adopted and loves as his own flesh and blood.

He deserved more, and I will forever be bitter about not being able to offer it to him. But I believe there are stronger forces than us up there, and they may know better than we do. And that what is meant to happen, will eventually happen.

For once I give up control, and boy do I feel free 🙂

Love and peace and baby dust to you all ❤

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Infertility

A FRIEND LIKE CLOMID MIGHT NOT BE THE FRIEND YOU NEED (Especially if you’re over 35)

I have been lazy lately…lazy to write, lazy to start the new IVF cycle that would be my last (or so I promise myself) but there’s this Clomid topic coming up so often lately, in all three Facebook groups I am administering, and I just have to say something about it.

Me and my big mouth, y’all…

So what is Clomid? It is a medicine that works as an “anti-estrogen” i.e it tricks your brain into believing your estrogen levels are low. The brain (the pituitary gland, to be precise) then releases more of your natural FSH in order to make your follicles grow.

Clomid was synthetized in 1956 and approved for use in the USA in 1967. Due to it being cheap and easy to use it has been a first line treatment for decades now. It has been considered to be a revolution in the treatment of female infertility and the cornerstone of the assisted medical reproduction treatments.

Sure enough, medicine advanced since the 60s, many other stimulation medicines have been invented and proven efficient, yet somehow Clomid still has this aura of “inoffensive worth a try, fit for a first step” solution.

Lately, less and less reproductive endocrinologists use it, especially if you are over 35, but it is still the med of choice for many OBGYNs.

My own OBGYN prescribed it to me, at the beginning of my secondary infertility journey. And I was happy: Clomid was gonna make me a baby, yaaay!

Two cycles and a 2.9 mm thick lining later, it was obvious Clomid was not the Prince Charming I thought it was.

Now let’s get one thing straight: I adore my OBGYN – she is the most caring and sweet doctor I have ever met and she has amazing bedside manners. And she knows a lot of things and is very competent. But infertility is not her job. That’s why REs exist.

And when I went to see my first RE I understood a few things about Clomid:

  1. It dramatically thins lining in some individuals, and for some of the less lucky, this damage may be permanent.
  2. It may trigger a rapid response in stimulation and by the time your follicle is “grown” your lining is left behind incapable of catching up.
  3. It dries up your cervical mucus making it harder for sperm to swim up your uterus and into your tubes
  4. It causes cysts that stubbornly refuse to ovulate in spite of trigger administration and this may impact your future cycles.
  5. It has some nasty side effects that I will not linger on too much, but will just mention: hot flashes, headaches, visual problems, mood swings.

Lately, more and more data shows that Clomid is a bad idea for older women. Dr Sher has a very concise and documented article that I suggest you read, if you are over 35 and about to take Clomid. Not only does he recommend the use of Clomid exclusively for younger women with a normal ovarian reserve, capable to override the anti-estrogenic effects of this drug, but he also points out that used for more than 3 cycles, Clomid starts to act like a … contraceptive, no doubt by thinning the lining and drying out the cervical mucus. The link is below

http://haveababy.com/fertility-information/ivf-authority/clomiphene-for-women-over-35-bad-idea

 

There are tons and tons of women out there who swear by Clomid, and will tell you it is the best choice. Surely, had it worked for me on my two months of trying, I would have sworn on it too!

But it has not. And with a 22 mm follicle on cd 8, and a lining of 2.9 at trigger, it could have never worked. Moreover, even when I stopped Clomid, my lining stayed thin. For 6 whole months it never grew thicker than 6 mm, despite the Vitamin E, the vaginal estrogen, the acupuncture, the warm baths, the femoral massage, the red raspberry tea, the castor oil packs. I was sure I was doomed and I would be one of those who never recover after Clomid.

Actually, as Dr Sher very well explains in another article, Clomid can be very useful and of assistance, if administered to the right persons. Unfortunately for older women with diminished ovarian reserve and/or a tendency of producing cysts, Clomid might work against them.

 

https://haveababy.com/fertility-information/ivf-authority/clomiphene-citrate-clomid-how-it-works-who-should-use-it

 

So what is there to be done if we cannot afford injectables, but still need a boost to ovulate?

For me, injectables were better. In terms of response, obviously, but also better for my lining.

But in between my many IVF cycles, I had to have some breaks. Having become a sort of infertility junkie (as in what hormones should we do this month to improve our chances) I considered one monthly egg was not going to be enough so I might as well try something. And I tried Letrozole, commonly known as Femara. Two nice eggs, plump lining, cervical mucus not so much, but Hey! that’s me, hello Preseed! And a great estrogen level value at trigger. Basically, Femara got me the same result as some of my high-dose stims, on less money, a bit of headache for a side effect and zero bruises around my navel. Now could a girl ask for more than that?

You will even find below a comparative study between the two, mostly in terms of side effects. Interesting read.

http://online.liebertpub.com/doi/abs/10.1089/gyn.2012.0033

I am no doctor and my aim is not to dissuade you from using Clomid and asking your doctors for Femara. Or for anything else, for that matter.

But it has struck me as crazy that there are doctors out there who prescribe Clomid in huge doses, and for much more than 5 days. Doctors that allow their patients to do several back to back cycles with Clomid (one lady was at her 7th!!!). Ever since I started this journey, and now that I am continuing it here on the blog, in front of you, my mantra has been “Know your body, educate yourself, do not follow blindly”.

And even if at the end of the day you decide together with your doctor that Clomid is the solution for you, at least you would have made this decision knowing your cards, aware of risks, and watching out for bad side effects that might negatively impact your outcome.

After all, we all want one and the same thing: to arrive at the end of this infertility road if not with success, at least with the conviction of having tried everything and having fought to improve our chances.

Although I have to agree success is sweeter. And I wish it for you as I wish it for myself 😉

 

Sources:

http://www.haveababy.com

http://www.liebertpub.com

 

Infertility

Supplements-are you taking the good ones?

We know we are born with our ovarian reserve, and the number of our “eggs” can only decrease, from the moment we are born until we completely run out of them, by the time we get to menopause. We also know the quality of our oocytes starts to decrease by the time we reach our thirties, and the chances of ovulating abnormal eggs unable to create normal embryos are higher the older we get. But is there really nothing we can do to improve this egg quality?

The truth is, this a very controversial subject. The efficiency of a treatment, be it a subscription med or a dietary supplement, can only be proven by studies. While medicines benefit from multiple studies, dietary supplements receive far less attention from the part of the medical community. Therefore less studies are performed and easier to say “we don’t know if this supplement really improves oocyte quality, because there are not enough studies out there to confirm it”. Lots of REs though, consider that even if there is not enough proof some supplements help to improve your fertility, they don’t hurt either, so you might as well take them, if only for your peace of mind. And that’s already a great starting point, in my opinion, for having the impression of doing something, instead of just playing the wait and see game, means a lot for an infertility patient. There are some supplements out there who are more spoken about, and who also benefit from some studying. Those are the ones we will discuss today.

COENZYME Q10 – is one of the most important coenzymes. It is a substance made naturally in the body and it plays a critical role in the creation of cellular energy. CoQ10 is found inside the tissue of  organs such as the brain, heart, liver and kidneys (which demand more energy) but  it exists in virtually all our cells and tissues. There are two main forms of this coenzyme, and this creates confusion.

Ubiquinone is the conventional form of CoQ 10. That is what we used to take before 2007, when a better form of CoQ10 was discovered, the Ubiquinol. The problem with Ubiquinone (the basic form of CoQ10) is that your body needs to convert it into Ubiquinol before it can improve the cellular energy your organs need to function at best levels. As we age, the body struggles harder to convert the Ubiquinone in Ubiquinol, hence the recommendation to use directly the Ubiquinol form, for better results.

Ubiquinol is known to be a very strong antioxidant and its main role is to neutralise the free radicals that can harm your cells.

MYO INOSITOL- initially used in PCOS patients and for fighting insulin resistance, this nutrient has become the golden weapon in the infertility battle. It has been proven that, at a dosage of 4 g daily (most studies use this amount as reference) it has improved the ovarian function and number of oocytes retrieved in patients undergoing IVF cycles, and who have previously been considered poor responders.

The following is a link to a 2011 study aiming to evaluate the pregnancy outcome after the administration of myo-inositol combined with melatonin (will talk about it later in this article) in women who failed to conceive in previous IVF cycles, because of low egg quality. The results were crystal clear, everything was better post treatment : number of mature oocytes retrieved, fertilization rate, number of total embryos and number of top quality embryos.

https://www.ncbi.nlm.nih.gov/pubmed/21463230

Here is a more recent study (2015) showing Myo-Inositol supplementation might be beneficial for previous poor responders during IVF cycles.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464995/

MELATONIN is a hormone produced by the pineal gland, and it regulates sleep and wakefulness. Many of its biological effects in humans and animals are produced through activation of melatonin receptors, while others are due to its role as an antioxidant. As a medicine it is used to treat insomnia, and is usually sold over the counter in many countries. The negative effect of the oxidative stress on fertility is no longer a secret. Clinical studies have tried to prove the effect of melatonin as an antioxidant on egg quality. The results of those studies suggest that melatonin supplementation (in conjunction with Myo-Inositol or not) may lead to better pregnancy rates in IVF cycles. Amazingly, not only egg quality was improved in  patients who were administered melatonin during the follicular period, but progesterone levels were also significantly higher in patients who received melatonin during the luteal phase.

Here is a review of several studies with very interesting findings https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209073

The majority of the studies have used 3mg of Melatonin every evening as standard dosage. You will also want to be very careful when taking melatonin during a natural cycle, not to go over the standard dose. It has been proven that taken at high doses (6mg and more) melatonin actually prevents ovulation.

DHEA– naturally existing hormone, the most abundant circulating steroids in humans, that the female body converts into androgens, mainly testosterone. That means DHEA already exists in our bodies, we are producing it, but its levels decrease with age. It is sometimes used as an androgen in hormone replacement therapy for menopause. Lately it has been more and more used particularly during IVF cycles to treat women with DOR (diminished ovarian reserve).

Clinical studies have proven that at a dosage of 75 mg daily for a period of at least 3 months, DHEA increased IVF pregnancy rates, increased antral follicle counts, increased quality and quantity of eggs and embryos, decreased risk of miscarriage and chromosomal abnormalities. DHEA supplementation works by restoring the abnormally low androgen levels in patients with DOR due to advanced maternal age or premature ovarian failure.

Here is one link to two of these studies

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3112409/

https://academic.oup.com/humrep/article/25/10/2496/2385689/Addition-of-dehydroepiandrosterone-DHEA-for-poor

ARGININE- is an amino acid that plays an important role in cell division, the healing of wounds, removing ammonia from the body, immune function, and the release of hormones. It can be found in almost all dietary protein : eggs, meat, fish, nuts and supplementation has been proven efficient in improving fertility in both women and men. How does it work ? Arginine is believed to improve blood circulation to the uterus, promote healthy sperm production, improve the production of cervical mucus and increase the libido. There are not many studies focusing on arginine, more research needs to be done, but many fertility specialist recommend this « miracle mollecule » which is already included in most prenatal vitamins anyway.

ROYAL JELLY-Royal Jelly is a strong nutrient produced by young worker bees in the hive. For 2-3 days, these bees are fed only on royal Jelly until they reach maturation and produce enough Royal Jelly to feed the female larva, which develops into Queen Bee. Queen bees are fed their entire life only Royal Jelly while worker bees are feed Royal Jelly for only the first three days of their life. This diet is responsible for making the queen bee 40 to 60 percent larger than a worker bee. There are not many studies on humans, but there some on animals amnd their conclusions suggest Royal jelly might improve fertility. Beware of adverse reactions thouugh : those with allergies to bee products are to avoid this supplement.

FOLIC ACID (Folate, Vitamin B9) is a form of Vitamin B. It is no longer a secret for anyone trying to conceive, that the first supplement you will be recommended by your doctor is going to be the Folic acid. It has been proven for years and years to prevent neural tubes defects and congenital heart defects in newborns, and actually low levels in early pregnancy are believed to be the cause for more than half of babies born with neural tube defects. There are no common side effects, even if taken for long periods of time. Humans can not produce it so it is important to get it from diet (and supplements). Food supplement manufacturers often use the term folate for something different from “pure” folic acid: in chemistry, folate refers to the deprotonated ion, and folic acid to the neutral molecule—which both coexist in water.

There have been lots of studies proving the importance of Folic Acid intake before and during early pregnancy.

Here is one you might want ot read

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218540/

and also the reccommendation of the World Health Organization on this subject

http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/neural_tube_defects.pdf

There are of course, other supplements more or less proven to increase fertility: Vitamin D (previously discussed in the article about the AMH), Vitamin E (used usually during the follicular phase in order to thicken the lining), DHA (not to be confounded with DHEA), Maca, Vitex…and many more.

I tried to focus on the ones who have been more or less medically proven to actually help on improving pregnancy outcomes after administration, during natural or medicated cycles.

Obviously,   not everything is for everyone, and in order to avoid doing more harm it is best to discuss supplements intake with your doctor. In case your doctor is not very pro-supplements, you can always pull out “the study” and show him you did your research. That is what I did, and frankly…it worked 🙂

Sources: NCBI, WHO, OXFORD ACADEMIC

 

Infertility

The CD 3 tests-how important and what do they predict?

If you are familiar with fertility treatments or  if you just had an assessment of your ovarian reserve because you are trying to conceive, the term “3 day tests” rings a bell to you.

Day 3 testing (can also be done and day 2 or 4) consists of bloodwork used to measure hormone levels (FSH, Estrogen, Progesterone, LH) and a scan, meant to measure the number and size of your Antral Follicles. Your AMH level can be measured anytime and if you need to have it measured more than once, it is preferred to do so using the same laboratory, because measurement scales vary for every lab.

E2 (Estrogen) is the main female reproductive hormone, it is being secreted by the ovary and helps to stimulate follicle growth and prepare the lining for implantation, in case conception occurs. The majority of the fertility clinics would want you to have an E2 level under 50 (some under 80) on your day 3. Too high an estrogen level on this day might suggest you have a cyst producing estrogen, in which case stimulation might not be advised. Feeding it stimulation meds, the cyst might not only “eat up” the meds destined for your other normal sized antrals, but also grow and grow until it bursts. A too low estrogen level is not ideal either, suggesting diminished ovarian reserve and possibly  peri/premenopause. Also, very important, when your Estrogen levels are high, the value of the FSH is artificially lowered.

FSH (Follicle-stimulating hormone) as the name tells us, is the hormone that stimulates the ovary to make the eggs grow. Released by the brain, the FSH tends to get higher and higher as we age, and our ovaries struggle more and more to produce an egg. The ideal FSH level is under 10, the lower the better. Some clinics would accept you for fertility treatments with an FSH under 15, but there are tons of studies out there showing success rates diminish seriously as 3 day FSH levels increase. That might explain why older women with high FSH have better chances getting pregnant naturally than with IVF treatments. This being said, if you need help to procreate, there are lots of clinics who offer natural IVF for women with high FSH-meaning no meds, egg retrieval for possibly just one egg, and fertilisation as needed (normal or ICSI, IMSI etc)

LH (Luteinising hormone) helps mature the follicle and eventually, when an LH surge occurs in the end of the follicular phase, helps the release of the mature follicle. The ideal level is under 7 mIU/ml with a ratio LH:FSH of 1:1. An LH much higher than the FSH might be an indication of PCOS (Polycystic Ovary Syndrome).

P4 (Progesterone) should remain low during the follicular phase (under 1ng/ml) and rise after ovulation, as proof the ovary released the egg. The low limit used as indicator for ovulation at 7dpo is 5, but the higher the better. Some women with low progesterone might need progesterone supplementation in order to maintain pregnancy.

AMH (Anti Mullerian Hormone) is a free circulating hormone released by the small antral follicles present in your ovaries, and it is used to assess your ovarian reserve, as in “how many eggs do you still have”. Taken alone, it doesn’t amount for much, and it is far more reliable when discussed in conjunction with the other day 3 levels, and most important, with the day 3 scan. Also, it is important to know that the AMH level has been proven to be artificially lowered by low Vitamin D levels.

Ovarian ultrasound/scan: it is meant to count and measure the antral follicles. The antral follicles are small follicles (between 2-10 mm) found in your ovaries at the beginning of the follicular phase. They are an extremely important and very useful assessment of the way your body might respond to fertility treatments. Each antral contains an immature egg that might develop and ovulate. During natural cycles, the body recruits what is thought to be the best follicle, and makes it grow and eventually ovulate once the Estrogen level is high enough (200-600 E2 level/mature follicle) and the LH surge occurs. In stimulated cycles, all antrals have potential to grow, and even sometimes, some more follicles pop up during stims.

Those are the main tests performed during the day 3 assessment. The list is not exhaustive, though. Depending on your clinic and your health issues, you might have your prolactin and thyroid levels checked, or any other test your doctor might consider appropriate.

Unfortunately, there are some clinics who perform this testing once a year, and consider it available in subsequent cycles. Whether for logistic or financial reasons, this is bad. Hormones fluctuate every God given month, and once you have your period, they are reset and you start the new month with a clean slate. It is possible to have an FSH of 6 in January, and an FSH of 14 the next month, and you surely won’t have the same response to meds during those two months if you are to cycle. Hence the importance of demanding those 3 day tests at the beginning of each and every cycle using stimulation meds, to spare you the heartbreak, the false expectations and yes, the waste of money.

In a future article I will bring to your attention a list of supplements with great effects on your fertility, and the links to the medical studies that attest it.

 

 

Infertility

Low AMH- the villain, but how bad indeed?

A rather recent discovery (1990’s) the Anti-Mullerian hormone has become the bad guy of fertility assessments. Lots of medical articles about it on the web, but in normal non medical language, what is the AMH, where does it come from, why is it low (if it is low), can we make it grow, and most importantly: how big a role does it play in our fertility?

We, females, are born with a certain ovarian reserve, i.e a certain number of eggs. We are born with them and we grow old with them, ovulating more ore less one egg every month, ever since we start having our period and until we get menopaused, unless we are pregnant, on birth control or having anovulatory cycles.

This means our eggs age as we age, which is not fair, but hey…what is fair when it comes to women and their womanhood, compared to men? (don’t get me started…)

It has been discovered that the shell of our eggs produce this hormone, the AMH, and it circulates in the blood, where it can be tested any day of the month, unlike the other fertility assessment tests known as Day 3 tests, that we will talk about later. We know AMH can fluctuate, but not by much, and that different labs can produce very different results, which is why it is essential to have this test done in the same lab, if you need to have it tested several times.

AMH being the reflection of our ovarian reserve, it is natural it decreases with age, as our ovarian reserve is depleted. Therefore, women over 40 are expected to have lower AMH levels. Fertility wise, a low AMH is considered to be under 1 ng/ml. This being said, pregnancies are known to occur even when AMH is undetectable. We all know someone who knows someone who, in their early or mid-forties thought to have reached menopause, only to discover the menopause was in fact a baby 🙂 So basically, every woman in her late 30’s and early to mid 40′ who getting pregnant, gets pregnant despite low AMH levels (we might safely assume that practically every woman of this age has low (er) AMH levels, cause that is the way things are)

And we get to the burning question: is low amh REALLY linked to infertility? Does having low AMH mean we cannot get pregnant? The answer is NO.

More and more reputable reproductive endocrinologists worldwide admit lately that AMH is actually too new to be able to give an accurate image all by itself. That while it can give us an idea of how a woman might respond to fertility treatments (in case she ends up needing them, that is) AMH doesn’t mean much when taken separately. Instead, a better view on the female fertility is given by the AMH level corroborated with the Day 3 Tests and the Antral Follicle Count.

One thing is clear and most experts agree on it: AMH has to do with egg quantity, not quality. Therefore, while you may produce less eggs for IVF in case IVF is what you need to get pregnant, they can still be of decent quality, depending on your age. Or, better yet, if you do not have any reason to do IVF, and so you are not interested in the number of eggs, you can relax, low AMH doesn’t mean your eggs are not good anymore. Again, depending on your age.

When we find out our AMH is on the low end, the first question that comes to mind is “can I make it grow”? Well, no you can’t, not really. Since AMH is a reflection of the quantity of eggs we have left, it is just logical that not being able to increase the egg reserve, it is impossible to “grow” the reflection of it in your blood stream.

But there might be a catch here. It has been discovered that Vitamin D, one of the vitamins with crucial role in conception (and not only) might influence our AMH levels. If your Vitamin D level is low, this may artificially lower your AMH levels. Once you get proper supplementation of Vitamin D and your vitamin D levels get back into the normal range, you may have the surprise to discover your AMH level is higher. Which again, doesn’t actually mean your AMH has “grown” but just that it has been brought back to its place.

Studies show that humans do lack Vitamin D as a general rule, and more than that, there is also a matter of proper absorption when it comes to vitamin D. Here is a good read that might bring a scientific view on the matter

https://www.ncbi.nlm.nih.gov/pubmed/22508713

How much Vitamin D is needed? Read here to find out:

http://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893

And last but not least: when you are told your AMH is “low”, what exactly does “low” mean? We shan’t forget that AMH has different values for different ages, and what is low for a 25 year old, might be perfect for a 38 year old. Here is a chart explaining it clearly

amh-levels-and-age

Sources: Harvard Health Publications/The National Center for Biotechnology Information

 

Infertility, Ivf

How many eggs are not enough?

There has been a question asked very often on IVF with DOR pages: how many eggs are needed for ivf and what is the inferior limit?
One of the big paradoxes of this DOR/IVF thing is this one: most of the RE’s recommend DOR/POF patients to hurry and do IVF cause “they are running out of time (and eggs)”
The RE’s also say that for IVF to be successful, the more eggs, the better.
We all know (personal experience mostly) that DOR/POF patients have anything BUT many eggs.
So how do you marry DOR and IVF with the “many eggs needed” approach?
Well, you don’t!
Unfortunately medically assisted procreation has become more and more of a business lately.
What started out as a genuine desire to help infertile couples procreate, turned into the rush for the golden egg in the eyes of fertility clinics that are being more and more numerous, some offering bargain packages that would make Walmart and Costco green with envy.
Patients are put on birth control so that they all fit in the same batch, they all have their periods and stimulation schedules coordinated
It has turned into a huge business bringing millions and millions in for clinics
Do we as patients benefit in the end?
Sometimes we do, and when we get to hold our miracle babies we would forget all the bad and focus on our success
But what happens with the ones that don’t fit?
Clinics mostly focus on success rates, cause that’s what brings in the cash. And more patients.
Therefore they cherish the convenient patient the most: and that would be the youngish couple with male fertility issues, the patient with bad or no tubes, the pcos patient…
And what about us? The DOR, the POF, the over 40 patient?
We can’t be put on birth control cause it’s suppressive, we don’t fit in batches cause our periods are irregular, our FSH is high, our response to meds is under average and we certainly don’t raise the success rates of any clinic with our 2-3 eggs retrieved…
Heck, some clinics don’t even let us get to their door, we are being served the donor egg speech over the phone and told that an AFC of less than 4 is Grandma style so… bye Felicia…
And that’s why I am focusing on empowering women to stand up for their rights and ask for what they truly deserve: a tailored made medical approach.
When you buy shoes, you don’t go in a shoe shop that sells only size 7 shoes, cause you might be wearing a 5, an 8 or even a 10!
You won’t buy size 7 shoes if you’re wearing a 9, right? You pay for them, you might as well get some shoes that fit you well!
Do you pay the RE?! Oh hell yes!
Do you have to accept whatever the RE serves you, without the right to ask for something else, or to go somewhere else to someone who cares to work for and with you!?
No way!
That’s why I encourage ladies in my FB groups to keep up looking for THE good RE, the one who is less interested by the stats, and more interested in giving them what they need and want.
There are doctors like this out there, ladies!
Some of us have been lucky to have found them, although more often than not, not from the first try 🙂
There are the doctors who don’t choose their patients based on the number of eggs they produce.
The ones that give DOR a chance.
The ones that are not afraid of low stims and natural IVF, the ones that retrieve two eggs, or maybe just one, without adding frustration upon frustration on a woman already having to deal with the disappointment of not being able to get pregnant in the first place.
So to answer the question: what is the inferior limit for ivf and how many eggs do we have to have?
Well … certainly 15 eggs have a better chance of success than 1 egg only, it’s a matter of numbers and of narrowing down the chances to the best one.
But that doesn’t mean that 1 egg shouldn’t get the opportunity of a chance!
Of course that with one egg chances are about the same as with iui, but let’s not forget iui is not always an option, and for couples who absolutely need ivf, one egg should be given just about the same credit as more eggs.
We should all be given our chance, and the right to follow our dreams 🙂