Struggling with fertility is not easy. It’s important to stay positive. For example, I like to think of you being IN-fertile. As in you’re “in” the club vs. infertile meaning you’re “not” fertile. Call me crazy, but I truly believe in the fertility of everyone who walks through my door. Nobody is a number or FSH or AMH level.
What do those things even mean? That’s what I want to talk to you today.
Nobody gets married and says, “I can’t wait to meet Dr. Aimee!”
If this article helps at least one of you then my mission is complete.
I want to encourage everyone to do their best to find a positive mental attitude.
Easier said than done, right?
I think one of the biggest things associated with fertility, or struggles with it, is stress. If you’re in my office it’s not unusual for me to ask you to find your happy place. Close your eyes. Find it. When you’re going through something stressful like fertility testing or treatment you can go to your happy place and maybe it won’t feel as bad.
We don’t have a reliable test for stress. If you’re feeling stressed, why would we need a test to prove it?
I want you to be proactive about your preconception tests.
I wish we spent the same amount of time on planning a family that we do for a vacation.
Before you get pregnant it’s important to understand more about you and your partner’s body.
Preconception tests to consider include:
- Blood type and antibody screen
- Vitamin D levels
- Rubella Titer
- Varicella Titer
- Carrier Screening—genetic testing to ensure you and your partner are genetically compatible
- Ovarian Reserve tests
- Lipid panel, diabetes screening
- Age-related tests like mammogram
- Blood pressure
- BMI: Talk to your doctor about your body size and understand what your ideal weight is. You want to set yourself up for success and having a healthy physical foundation is key to a healthy pregnancy. Please remember, your fertility isn’t skin deep. Don’t let your body size keep you from getting help.
You can see your OBGYN or a fertility doctor like me and you can get the tests I described above done.
If you see me, I’ll ask you three questions:
- What do you want?
- What is it going to take to get what you want?
- Are you willing to do it?
We will work through your answers and create your Fertility Care Plan.
Let’s talk about Eggs
When it comes to eggs there are different tests you can do to look at the quality. FSH, Estradiol, Egg Count.
FSH: Follicle Stimulating Hormone
It’s secreted by our brain and talks to the ovaries. It goes up over time. If it’s trending above 10, you may have less viable eggs for your age. While the test doesn’t tell us if we have good eggs or not, measuring the FSH level at your age can be a predictor of your pregnancy rate.
Egg count is another thing we look at (Antral Follicle Count).
I want everyone to get a pelvic ultrasound. Why? Well, when you do a pelvic exam you can’t see things the way an ultrasound can like fibroids or polyps in the uterus. You don’t want to try to get pregnant for years only to find the reason you’ve been unsuccessful is that you have a polyp or fibroid interfering with implantation. Get this ruled out early on in your journey to conception.
Remember, each egg has a potential chance for pregnancy, and it only takes one egg. When we grow eggs during fertility treatment your doctor is a fertility lifeguard, rescuing eggs you would have lost. You don’t go into menopause sooner. Your antral follicle count is another fertility diagnostic test so ask your doctor what yours means about you.
I also recommend getting your AMH levels checked via a blood test.
AMH is a hormone secreted by the cells that surround the ovaries. AMH levels go down over time. This a test that you can do anywhere in your cycle, whereas FSH and estradiol are done cycle days 1–4.
Want to get your levels checked? Good! I hope you track them over time in order to understand your fertility. And there’s good news.
I’ve made it very easy to get your levels checked. I can also talk to you about what they mean for you. It doesn’t matter where you live, you can get this done this month.
Are More Eggs Better?
If you are looking for the best IVF protocol, then yes—retrieving from a starting point of more eggs is preferred. However, that’s not to say if you have less eggs that you can’t have a successful pregnancy.
Fertility Hormone Levels?—?Can I Wait?
Fertilome test?—?genome and fertility. You’ll find our your personal genetic profile. Your fertility is actually in your genes. You can base your treatment based on what you know about your DNA. You can’t ask your dad for fertility information so this test will help you get a full picture of your fertility health from both sides of your family.
How About Sperm?
When you look at the overall sperm count it’s called a semen analysis. I can’t tell someone the count is good and embryo development will be good. Or that the count is good and there won’t be any issue with miscarriage in the future with this sperm.
There are tests that make a difference in how we help patients. RepoSource has made it easier for men to do semen analysis at home. They have a temperature controlled kit that they send out to people and then they do an analysis of the sperm.
Older Male Partners Do Lower Chances of IVF Success
We are under the assumption that it’s about having older eggs and that’s what impacts your chances of getting pregnant. However, older fathers (anyone over 40) or if you’re a smoker or have hypertension has a reduced chance of IVF success. The other thing you can do is look at the fragmentation of the DNA of the sperm. This DNA test is temperature controlled through RepoSource. I get a DFI % and this tells me if you should consider IVF. The cool thing about sperm is that you can improve the quality within months through lifestyle changes.
There’s another test that good for people wanting to consider IUI, it’s called the Cap-Score. The Cap-Score will help determine exactly when you should time the insemination for IUI. This is important for anyone, but particularly critical if you’ve already pre-decided that IVF is not an option you want to pursue?—?for financial or other reasons.
The fallopian tubes are like the diameter of a strand of hair. So there are a few ways of looking at the tubes—one is the saline infusion sonogram. A speculum and then the catheter is placed to push fluid through the uterus. FemVue offers the test to see the tubes on ultrasound to confirm they’re open.
The other thing is it the hystero- salpingogram (HSG) where dye is placed through the fallopian tubes. This test is historically painful, but it doesn’t have to be with the right pain management. I for one do not believe my patients should experience pain if there’s a medicine to help make them comfortable. Hello, modern medicine! It’s there for us to use! I recommend to all of my patients to take a valium and a Tylenol with codeine 30 minutes before the procedure. You want to make sure that you have a driver. Talk to your doctor beforehand so that you don’t have pain or any PSTD after this test.
ReceptivaDx is a test to help see if there is Endometriosis in the lining of the uterus. What it’s looking for is a marker of inflammation for endometriosis called bcl6. This is usually done between cycle days 7–11 and it’s a biopsy so it can be painful if you don’t have pain management. Talk to your doctor about what’s involved in the procedure so that there are no surprises for you. I want you to go into this and any other procedure prepared. Remember that no question is a dumb one.
Another test you may discuss with your doctor is a hysteroscopy where a thin camera is inserted into the vagina to examine the cervix and inside of the uterus.
To be clear, I am not suggesting that you need ALL of the tests. I simply am giving you an overview so that you can have enough baseline knowledge to have a conversation with your doctor. What you need will be unique to your fertility diagnosis. (Remember you can understand your diagnosis by getting your TUSHY checked—tubes, uterus, sperm, fertility hormones, and get your genetic profile.)
Igenomix helps us determine your endometrial receptivity.
Preimplantation Genetic Screening (PGS) can improve pregnancy rates. Embryos can look pretty on the outside, but it doesn’t mean they have the genetic integrity to turn into a viable pregnancy on the inside. I want patients to know what they can examine before implantation.
Genetic carrier screening tests evaluate the genetic compatibility between you and your partner or sperm donor. If you are both carriers of a disease you can choose to test embryos pre-implantation. This also gives you the opportunity to discuss what your options are and to prepare for possible outcomes.
Ultimately, whatever your situation I want you to keep calm and get ahead of infertility. I want everyone to reach their goals while experiencing the least amount of heartache and tears.
Please remember too that I am not being paid by any of the companies I mention. I am simply sharing what I know and recommend to my patients and based on their individual fertility diagnosis.
As always please reach out if you have any questions or topic suggestions for future shows.
Send me a note: [email protected]
You can also catch more of me and topics like this through the Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Instagram and on Wednesdays at 4 PM PST. Subscribe to the podcast too!