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.

 

 

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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 🙂

About

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.