Infertility, Ivf

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

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 🙂