Infertility, Ivf

Are we done yet?

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


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 ūüôā 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 ūüôā

Love and peace and baby dust to you all ‚̧

Infertility, Ivf

Priming protocols-what with and who for?

I am going to address a very debated topic and one of huge interest for those who carry the tags DOR or POF and need ovarian stimulation for assisted reproduction.

The way IVF works, we all know the more eggs we make, the better it is. And this because in vitro fertilisation is all about narrowing down the chances to finding the best egg(s). It is a matter of logic because more eggs retrieved will give us more fertilised eggs, hence higher chances of pregnancy. Also, women who respond better to stimulation protocols usually have a better egg quality (PCOS do not enter in this category of better egg quality, we will discuss this later on). Last but not least, “the more eggs the merrier” principle has also financial connotations. With prices so high for stimulation meds, monitoring, retrieval and laboratory, you’re far better off paying thousands and thousands for ten eggs than for one.

While women over 35 and those under 35 but dealing with POF and DOR might be worse responders than the fertile population generally is, lots of protocols have been invented and experienced over the years, some of them with great results and quite encouraging pregnancy rates. One of the approaches is that of using luteal phase adjuvants, hoping to create a better environment for the follicles and preparing the ovaries for the following stimulation cycle.

BIRTH CONTROL¬†– By far the most used approach before a medicated cycle. Its main purpose is to give your ovaries a rest, and give them the chance to start the next cycle with a clean slate. Useful for reducing cysts, it also comes, unfortunately, with a bad side effect: the dreaded suppression. BC¬†pretreatment in IVF protocols establishes an estrogenic environment and increases sex hormone-binding globulin levels while decreasing follicular androgen levels. But by putting the ovaries to sleep the risk is they might not wake up well enough… Sometimes, we end up with a lower antral follicle number, and we are facing the need of stimulating for a longer period of time, and with higher doses of stims, which might in turn, affect egg quality for older patients.

Here is a very interesting study, where  even young egg donors have experienced lower AMH levels and lower numbers of oocytes after being put on birth control.

If in the case of a young donor, having  5 eggs retrieved  instead of 10 might not make much of a difference, because donors are chosen to be young and healthy, therefore having a great egg quality, things are quite different with us, older women, where quality as well as quantity might be a problem.

TESTOSTERONE PRIMING-¬†Relatively new, ¬†and controversial. If you listen to Dr Sher, a very famous and respected Reproduction Endocrinologist, you should run away from testosterone exposure, especially if you are not very young anymore. If you listen to me, LOL, my biggest failure of a cycle was the one I primed with testosterone gel. While I usually would have an antral follicle count of 9-10, one week of testosterone gel reduced my AFC to a whopping 2 (two), and thats what I got until the end of stims, when I told my RE there is no way I am going to waste an IVF cycle on two eggs, and converted to IUI. Even he himself later admitted that testosterone priming was a mistake in my case (I was 41 at the time, this might have been a reason) and he is known to be a very stubborn and proud one…And it was no coincidence: all the other cycles I ever did (and we are talking 12 with full protocol, my afc was never under 8)

This being said, there are many studies out there who scientifically prove testosterone priming works for many low responders. If you read this analysis of several studies (https://¬†you will see the mean age of the patients was 36-37, so there….probably that’s the key, being younger is better for testosterone priming. I personally guess there is no way of knowing until you try.

Oh, and most important: I grew no beard during the treatment, neither did I engage in violent exchanges with people in pubs ūüėõ

ESTROGEN PRIMING–¬†It avoids the suppressive effect of BCP on the ovaries. In addition, the use of estrogen during the pretreatment cycle prevents premature recruitment of follicles that can reduce the number of follicles available for stimulation. Studies have shown that this protocol allows more gradual and coordinated growth of follicles resulting in improvement of embryo quality and quantity. For me this has been the only way I could avoid the growth of the horrible LEAD follicle, the scarecrow of IVF…I personally took estrace pills, but patches are used with the same success.

You might want to read this study and also this analysis of several studies

I believe it is essential to have a doctor you really trust. I, for one, could not trust any doctor who insults my intelligence by imagining that in this age and time I have no ways of gathering enough information as to educate myself on matters concerning my health and my life. Would this auto-education give me a medical degree? Obviously not! And I do not pretend it does. What it does give me, is at least basic knowledge, so useful in understanding where I stand, and if the direction I am heading to is the good one. It gave me the power of standing up and saying NO, when I knew for a fact that the approach I was suggested would be wrong for me (I wish I knew what I know now, when I was suggested the testosterone priming…) It gave me the power to fight me RE for the estrogen priming protocol, that as an anecdote he himself invented, but not so much used afterwards, for fear of oversupression. I fought him and he gave in, and later admitted I was right. It also gave me the power to say NO to him for yet another high dose stimulation protocol, and when he wouldn’t give in and would insist low dose is “counterproductive” for low responders (sic!) I would say bye to him, and find another RE who was willing to try on me my estrogen priming low dose protocol. And we got 8 eggs, instead of my usual 2-3.

I don’t know if it is my journalistic background, or maybe just me being a stubborn Aries, but I am a strong believer in the “Knowledge is power” part, as much as it might sound ¬†like a cliche.

Apparently you believe so too, or else you wouldn’t be here, trying to find out more ‚̧

Sources: NCBI



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.




I wish I didn’t have to…

I wish I didn’t have to write this blog.

I actually never imagined I would, neither could I have imagined to be staring at Infertility’s ugly face one day.

Yet here I am, and here’s my story…

I am 43, living in Paris, France. I am the fortunate and very happy mother of two amazing teenagers, born from a previous marriage. Left widowed when my kids were young, I met the love of my life, an amazing man who loves my children as if they were his own, and to make this love official, he adopted them. My husband having no biological kids, the natural next step was to try for a baby, a fruit of our love, a most desired addition to our very happy family.

We started trying to conceive in April 2013, and having never had any fertility issues whatsoever, I was absolutely convinced we would soon be blessed with a positive pregnancy test. And we were! In May of the same year, i.e after the first month of trying, we found out we were expecting.

Having had some surgery on my cervix several years before, I expected a cerclage would have to be put in, and it was, at 12 weeks. That’s when we run all types of tests to make sure our baby was healthy for I was 39 and the risks would have been higher than for someone younger. Tests came back perfect, the stitch was in, and the hell was about to get loose, but little did I know…

After 3 weeks of complete bedrest due to contractions post TVC, my cervix getting shorter and shorter, after 3 visits to the ER bleeding because the stitch tore through my cervix, my water broke one night, and we lost our baby boy at 15 weeks. I will spare you the details of our heartbreak, though even if some of you cannot relate, you definitely can imagine what it felt like.

As devastated as I was, I knew the time was not on my side, and if I wanted to have a living baby, I had to move fast. I also knew a TVC would never be in the cards again, so I would have to find another solution. This solution presented itself under the name of Transabdominal Cerclage, currently known as TAC, and it was placed by the famous Dr George Davis, in the USA in the spring of 2014.

Free to try again, relieved by the pressure of cervical incompetence, we started TTC as soon as we wear cleared, in July.

One month, two months, three months…..nothing. I bought my first ovulation tests, used them and again…one month, two months….nothing… Fear would creep up my spine and I started googling, and reading….and I found out about AMH. Got it tested…0.2…my world fell apart. I lost 4 pounds from crying over that week-end. I wish someone told me the real truth about AMH back then, and how it was far from being the be all end all….but there was no one back then. So I suffered more or less in silence and went to see my obgyn who put me on Clomid and trigger. Fail.

Between March 2015 and this moment- May 2017, I have seen two REs, consulted  another one over the phone and email, had 6 IUIs with full IVF protocol, 6 IVF with 12 embryos transferred in total, 4 cycles Femara and trigger only, numerous timed intercourse monitorized cycles. All fail.

I am a moderator for two amazing groups on FB, one for low amh and DOR, the other one for high FSH and TTC over 35, and during these two years of hope, disappointment, pain, heartache, frustration, hope again I had the chance and privilege of virtually meeting amazing women, brave and fierce, who would not give up on their right of being informed and their right of having a word to say in the way fertility professionals choose to deal (or not) with them.

My blog springs from my desire of helping women get educated on issues like DOR, POF, Low AMH, High FSH, and all the fertility problems that they bring with them.

I am no doctor, I do not give medical advice. I am just pointing into directions that have been useful to me, that helped me understand exactly where I stand and where I should be headed.

If anything, this blog is meant to empower you, Ladies, to understand what doctors do not explain to you, and to make you understand you have the right to choose what is best and more appropriate for you. The way I wished someone did explain to me. And the way someone eventually did, later on, when I found my wonderful FB groups.

You are more than welcome and I hope you will feel at home and loved here <3.