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“Fertile” women have poor pretesting too

December 29th, 2012

So, you finally decide to take the leap and pursue IVF for family balancing. You schedule your consult and get your pretesting orders- FSH, AMH, Antral Follicle Count, maybe a HSG. But, you’ve had children before! Why do I need pretesting when clearly I can easily conceive children on my own?!? Turns out that “fertile” women can have poor predictive outcomes with IVF too. Who knew?

Many of the families seeking family balancing are in their 30’s when beginning the IVF process. Many times, it is shocking when the physician delivers your pretesting results with an “I’m sorry” attached. I am here to tell you that just because you have children, IVF is not easy. Ever.

When I decided to go the High-tech route for my son after 3 wonderful daughters, I started researching when I left the anatomy scan with DD3. I wasn’t as sad as when I had found out that DD2 was another girl but I didn’t feel this was the end of the road for our family. I do believe good things come in three’s but I was open to 4 good things!

So, off to google I went and came upon the term “Family Balancing”. Yes! That’s it! We just need some balance. I read and learned all I could about the process, understood what all the terms meant and the overall process involved. PGD was really evolving at this time and options like GSN and CGH were coming available which sounded like it would help the pregnancy rates.

Fast forward from the birth of DD3, and at 6 months postpartum, I walked into the hospital pre-op testing clinic with my 6 month DD. I had orders for infertility testing with me and proceeding to give several vials of blood and wait.

When the results came to me via email, it was very surprising to say the least. Day 3 FSH of 10. What? I was 34 with a 6 month old DD conceived the first month trying! I was very healthy, great BMI, but I had 3 naturally conceived children already! How can this be? 10 is seems is the cutoff for when you fall into that category of “may not respond too well” to the meds. I was now classified as a “Poor Responder” as a woman with 3 children already. Seriously. How can this happen. Well, it gets worse.

My doctor had also ordered a clomid challenge test. So, after taking clomid days 5-9 of my cycle, I returned for the day 10 portion of the testing.

Day 10 FSH- 14, AMH of .75

From the lovely online chart- “Reduced ovarian reserve. Expect a reduced response to stimulation and some reduction in embryo quality with IVF. Reduced live birth rates on the average.”

Now, I am in an even worse category. How can this happen? How can a “fertile” woman with a 6 month old have poor pretesting showing a reduced ovarian reserve? Since founding this site and helping others through this process, I can now say that it happens all the time.

At GenderDreaming, we have worked together to find supplements that will help increase our chances at having IVF work for us and we talk about this in our discussion forum. There are supplements that we have found can have a positive effect on your fertility and of course, choosing the right RE and protocol is critical.

My motto is “Proven fertility trumps poor pretesting any day.” They don’t have pretesting stats on fertile women. We are collecting that data ourselves!

As for me, after one cancelled cycle and months of supplements, with one in particular for the next 8 months, I came out of ER with 23 eggs, 10 of which were mature and fertilized and one baby boy who is now over 2 years old. So, don’t let poor pretesting fool you. It just may be a lot harder to find success than you first thought! GenderDreaming.com

Categories Elective IVF for Gender Selection
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Pretesting for Elective IVF

by Gender Selection Guru

April 13th, 2011

Pretesting- Assessment of Ovarian Reserve

Pretesting is a big step in the IVF world. You might assume you will pass with flying colors because you have conceived easily on you own- the first month trying even! Well, you cannot assume anything about your ovarian reserve. Even the most seemingly fertile woman can have poor pretesting. There are some things you can do though if your pretesting comes back with a poor prognosis for IVF success.

Blood tests
Depending on the individual couple’s situation, various blood tests on either the female or the male may be needed. Blood tests that might be needed include:

day 3 follicle stimulating hormone (FSH)

estradiol (E2)

AMH

Day 3 FSH– It can actually be done anywhere from day 2-4 and it is a simple blood test meant to measure the amount of FSH in your bloodstream. FSH, otherwise known as follicle stimulating hormone, is a hormone that tells oocytes, or premature eggs, to begin growing. Each oocyte is contained within a follicle, or little fluid sac. In general, under 6 is excellent, 6-9 is good, 9-10 fair, 10-13 diminished reserve, 13+ very hard to stimulate

Estradiol(E2)- Also done between days 2 and 4 and 25-75 is considered normal. Levels on the lower end tend to be better for stimulating. Abnormally high levels on day 3 may indicate existence of a functional cyst or diminished ovarian reserve. If your e2 is abnormally high, it can make your FSH appear to be falsely low.

AMH– anti-mullerian hormone is a substance that is produced by granulosa cells in ovarian follicles. It can be done any day of your cycle. AMH blood levels are thought to reflect the size of the remaining egg supply – or ovarian reserve. AMH levels probably do not reflect egg quality. An AMH over 1 is in the normal range and 3+ is considered possible PCOS range.
You can have these tests ordered by your OB and it could be covered by insurance if you have diagnostic coverage, which most plans do.

They will also require you and your DH to have a full infectious disease panel done.

Antral Follicle Count(AFC)
This test is also done between days 2-4 of your cycle. Antral follicles are small follicles (about 2-8 mm in diameter) that they can see – and measure and count – with ultrasound. Antral follicles are also referred to as resting follicles. Some Res do not use or rely on AFC at all because it changes from month to month. What I do know is that the month you cycle, they will have you come in prior to starting your meds and see what your AFC is. So whether or not they tell you it matters, you will want to know what your AFC is to be able to make an informed decision about your protocol and if IVF is even an option for you so know your AFC!
Generally, less than 4 is not good. 7-10 is a reduced count and anything over 10 is definitely workable with IVF. Don’t get too hung up about AFC though because it does change.

The testing is more of a big picture summation. Meaning, if your FSH is good, your AFC is average and you AMH is normal, you should stim well. If you FSH is just okay, your AFC is low and your AMH is normal, you might still respond just fine but you won’t know until you try, unfortunately. Just remember this- Proven fertility trumps bad pretesting any day of the week! You can have poor pretesting and still have IVF work for you. They do not have statistics on what “normal levels” for fertile women should be.

Semen analysis
This is only required when using MicroSort. MicroSort has specific morphology and motility requirements in order to be able to use MicroSort. When just doing IVF with PGD, a SA is not required.
HSG

The hysterosalpingogram, or HSG is done in order to assess the anatomy of the endometrial cavity of the uterus, such as an abnormal shape or structure, an injury, polyps, fibroids, adhesions, or a foreign object in the uterus. The HSG is usually scheduled to be done between days 6 and 13 of the cycle – this also depends on the specifics of the woman’s normal cycle.

The RE’s office can perform this test OR you can ask your OB to do it.

Clomid Challenge Test
This test is ordered by some RE’s to help predict how one might respond to the fertility meds and it is another indicator of ovarian reserve. Basically, they draw blood to test your Day 3 FSH and then have you take 100mg of clomid day 5-9 and then take a Day 10 FSH level. If either the Day 3 FSH level or the Day 10 FSH level in a clomid challenge test is elevated, it is considered abnormal. A high FSH level is a sign of poor ovarian reserve. This is true if either the first or second FSH level is elevated. If your FSH comes back elevated, it does not mean that you cannot attempt IVF. It just means that you are going to have to use a more aggressive protocol and have to potentially use a higher dosage of stimulating drugs.

Categories Elective IVF for Gender Selection

A High Tech Story- From One to Four

by nuthinbutpink

December 17th, 2010

This is a collection of posters’ experiences with High Tech, the good and the bad. Their stories can provide hope, great information and sometimes, a reality check.

Feel free to read their stories and one day add your own!

From One to Four

My high tech journey begin in August 2009. I had an early miscarriage and even though we hadn’t been trying we decided that now we would. We were not sure how many kids we would end up having as our first baby had severe reflux so we decided to go HT for a girl, in case she had reflux too – in which we’d have a pigeon pair and our baby days would be over!

Things got going fairly quickly and within about 6 weeks from the initial idea we flew from Australia (where we live) to LA and underwent cycle no.1. We used Microsort and PGD (although I was never 100% comfortable with the PGD as I believe it can damage otherwise healthy embryos). We got 15 eggs but only 4 successfully fertilized, and 2 baby girls made it to transfer. I was convinced we would be one-hit-wonders and come home pregnant with twins but it was not to be. BFN.

I was devastated when the first cycle failed but tried to get pregnant naturally but again had an early miscarriage in December – which was when we decided to go back to the USA and try again in Feb 2010. This time I raised the idea with my husband of putting 3 back, he said no. I was desperate to get pregnant and convinced this cycle would also fail. At the same time, someone else I k new put back three 5 day old blasts and got a BFN so I was convinced even with 3 our chances were low.

This time we got 9 eggs, 6 fertilized and 3 made it to transfer day. Our doctor (Dr F at HRC) recommended that based on my history with miscarriages and failed cycle, that we transfer three. I was happy to do so but left the decision up to my husband. He decided to go ahead and transfer all three because the embryo had a better chance in me than being successfully being frozen and thawed.

This 2^nd cycle we decided to just use IVF with Microsort and not use PGD. I simply wasn’t comfortable with unnecessarily stressing the embryos and believed that if we ended up with another boy it was meant to be.

I had my first (extremely) faint BFP 3 days after blast transfer. By 5dp5dt the BFP was clear. I was exstatic! I was finally pregnant again and it was most likely (approx.. 85% chance) a girl. Blood tests confirmed the pregnancy and showed a perfectly normal beta, consistent with one embryo.

I knew theoretically that we may have multiples but based on my beta I was only expecting one – and to be honest was terrified I’d had a missed miscarriage and we wouldn’t find a beating heart. Ultrasound day came a few weeks later and I will never forget looking at the screen and wondering what the ultrasound lady was looking at. It couldn’t be my ovaries, I could see three round things..

Then she said it – “Yep, there’s three!” I think I asked “three what? And was told “three babies.” “Do they all have heartbeats?” “Yes.” I couldn’t move. I almost couldn’t breathe! My husband took a deep breath and came to give me a kiss and tell me it was going to be fine. He looked amused. I felt a mix of terror and total regret. Our son was only 14 months old at the time – how would triplets affect his life?

It took a few weeks to get used to the idea of triplets but I started researching that very first day which helped a lot. I learned what I could do to help avoid severe pre-term labour, and started a very high calorie diet (weight gain in the first trimester is associated with longer gestation in higher order multiples). We had to get very organized early as I went on bed rest at 20 weeks but in reality needed to sleep a lot during the whole pregnancy – being pregnant with triplets is exhausting.

The pregnancy itself was pretty good for a high-risk pregnancy. I had no bleeding or preterm labour and we made it 33 weeks before we had to deliver due to triplet C being growth restricted. I went into a scheduled c-section and delivered three healthy babies 7 weeks early – 2 baby girls and one beautiful baby boy!

It’s a few months down the track now and things have definitely changed in our house – we need help with the house and the babies and almost always have someone here helping. Feedings require two people, but of course we also have our first son who is 2 now so things are busy!

But we would not change a thing. We have been blessed with four beautiful kids who make us smile every single day.

Categories Elective IVF for Gender Selection
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Archive for Elective IVF for Gender Selection – Page 7

“Fertile” women have poor pretesting too

Pretesting for Elective IVF

A High Tech Story- From One to Four

From One to Four