The AFA Blog

Can You be a Poor Responder and Get Pregnant on Your Own?

by Fred Licciardi, M.D.

So a little story about a couple I saw recently. She was a poor responder with borderline FSH levels, normal tubes and a favorable age. He had low sperm counts. They had been through IVF. I suggested that he see a urologist because maybe there was something that could be done to improve his counts. She still ovulates every month, so by upping the odds on the sperm side, maybe they could get lucky and get pregnant on their own.

My statements were very surprising to them. They had been told that because of her “fertility status”, meaning her FSH was a little high, pregnancy could not occur naturally, so why bother with the sperm.

This may be close to accurate but it is not completely true. Unfortunately, many couples with significant fertility problems never get pregnant, but for some, the pregnancy rate per month is not zero. Even if it is ½ percent per month, after a year, a few women with normal tubes, borderline FSH levels and good sperm will get pregnant (age helps).

Can you count on it?  No, but if there is something fixable, you might as well explore the options.

This is also the reason that some doctors suggest a laparoscopy after many failed IVF cycles. Even if the odds of tubal disease are low, correcting a small problem may improve the odds of a spontaneous pregnancy down the road.

An Alternative Solution - Herbs and PCOS - How to use them to improve your fertility.

By Stacey Roberts, BSPT, Q Herbalist, Natural Fertility

 Rachel came to me after trying to have a baby for 4 years.  She was at her wits end.  She tried IVF but had hyperstimulated and was unsure of whether to try again.

 She had not had a menstrual cycle in 3.5 years no matter what medication she was on.  Rachel used a variety of medications to try to get her ovulating but nothing helped.

 After six months on an herb formula, Rachel began to spot.  She called me, very excited.  I was actually getting a little despondent myself after six months and nothing happening.  I asked her to send in her charts so we could see what was going on and lo and behold, she wasn’t going to have a period.  She was pregnant!  Rachel has now had 2 beautiful little girls while utilizing the herbs.

 What happened?  How did Rachel conceive when she was told it couldn’t happen?  Afterall, she wasn’t even having a period.

When a woman is dealing with Polycystic Ovaries it is important to remember that this syndrome is a symptom of an imbalance in the system.  Polycystic ovaries commonly occur when a woman is experiencing insulin resistance, a precursor to diabetes.  So the very first step in addressing this syndrome naturally is through the diet. 

Step 1:  Optimize your Eating Plan

• Remove white flour products and other high glycemic foods. 
• Choose carbohydrates that are low glycemic
• With each meal make sure you have a protein and or a good fat to slow dose the glucose response in the blood.  This helps to take stress off the system.
• ELIMINATE sugar.  Sugar and sweeteners are major enemies of women with Polycystic Ovaries so get them out your the diet. 
• Eliminate empty calories from soft drinks and alcohol that also disrupt your sugar levels.

 Step 2:  Optimize a Supplementation Program

• Use a broadspectrum of antioxidants and minerals to help improve cellular health and address the underlying issue with glucose and insulin.

• Besides Vitamins A, B, C, D3, E and folic acid (a type of vitamin B) it is also important for women to have appropriate amounts of selenium, zinc, chromium, and iodine in their diet and supplementation program to improve their situation. 

• Herbs such as Gymnena (not to be taken with drugs that are used for resistance eg. Metformin and others) and Cinnamon have been shown to help support optimal glucose metabolism.

• With Rachel it was also helpful to take herbs that support her thyroid such as Withania and Bacopa. 

• Other herbs to support ovulation are Peony and Agnus Castus (Chaste Tree).

• When dealing with herbs always consult a qualifed herbalist to assess your situation otherwise you may be taking too much or too little of the necessary herbs.  And the supplementation program including herbs must only supplement the diet.  With PCOS, diet is number 1!

Step 3: Minimize Toxins

• Exposure to voluntary toxins from smoking and excessive alcohol consumption, and chemically laden skin care products, improper use of plastics (i.e. heating food in plastic containers, etc) and even air fresheners and cleaning products can impair your fertility according to various studies.

• Always use “green” products when you can and avoid products whose ingredient list is full of scientific names you cannot pronounce.

• Herbs such as St. Mary’s Thistle (Milk Thistle), Schisandra, and even Bladderwrack are herbs that can be used to help the body properly remove toxins from the system

 Step 4:  Appropriate Exercise Program

• A balanced exercise program including cardiovascular fitness and resistance training can help make the body more insulin sensitive and along with an optimal diet can reverse insulin resistance in some individuals.  Polycystic Ovaries have been reversed when hormone balance returns to normal.

• Seek out a qualified personal trainer or physical therapist to help you set up the best program for you.

 Step 5:  Support the Mind Body Connection

• Several studies show that addressing stress and the mind body connection has helped women with ovulation disorders such as Polycystic Ovaries.  In a study performed at Emory University, 80% of patients who previously were not ovulating spontaneous ovulated after hypnosis sessions. 

 Rachel knows the importance of addressing all of these steps at one time versus trying one thing for a while and moving on to the next without appropriate guidance.  But now after addressing her situation by following the five steps above perhaps Rachel can help her little girls avoid the difficulties that she experienced trying to conceive as well as the other negative consequences that women with Polycystic Ovaries can face, i.e. high blood pressure, diabetes, thyroid issues, and autoimmune diseases.

 It is important to note that all treatments should be done under the auspices of a trained professional.

Stacey Roberts, PT, MH, Phd-C is a leading herbalist and internationally recognized expert on complementary medicines. She is the owner of Sharkey's Healing Centre and resides in Melbourne, Australia.  She is a guest contributor to The American Fertility Association's online library, directory, and blog.

 

 

Rachael Zoe's Next Project

by Merry Armentrout

 Baby rumors have swirled for weeks around celebrity stylist Rachael Zoe, and The American Fertility Association is excited to hear the rumors are in fact, true!

“Hey everyone!” The Rachel Zoe Project star tweeted today, “I want to officially confirm to my loyal friends and followers that I am pregnant!” Zoe continued, “I feel great, Rodger and I are beyond excited and so thankful for all of your love and support.”

The final episode of The Rachael Zoe Project Season 3 showed the Stylist to the Stars visiting a fertility clinic with her husband, Rodger Berman.  After meeting with her physician, Rachel expressed her obviously heartfelt concern that after spending 15 years building her career, and now finally being ready for a family, she's being told it might be too late.

This moment is important for two reasons. The first, no matter who you are or what you do, the biological clock is a real thing and can't be ignored, or washed away by fame. Second, Zoe's forthright honesty  has helped to educate millions of viewers by continuing the conversation about infertility, a subject often associated with shame or embarrassment that is in fact  a reality that won't go away no matter how long you try to ignore it. In fact, the longer you wait, the worse it gets.  

Surprisingly to many, one in 8 couples in the U.S. is infertile.  The American Fertility Association's goal is to have everyone not only know this statistic, but more importantly understand this statistic.  Many couples will be diagnosed with unexplained infertility - a frustrating prognosis for both the doctor and the patient. Something about infertility that is 100 percent certain- age and female fertility are related. The probability of a woman conceiving decreases 3-5 % per year after the age of 30, and at a faster rate after 40. 

One step to overcoming infertility is being aware, and being aware at an early age. That's why The AFA is launching a speaking tour at college campuses in 2011. We'll be talking with young women and men about navigating career, education and family, all with the biological clock ticking in the background. Though there are advancements being made in fertility treatments, there are no treatments for "turning back" the biological clock.

To Rachel: we're thrilled your story ended positively. Congratulations and our sincere best wishes to you and Rodger for a happy, healthy baby. And thank you. Thank you for sharing your story. It's one that we hear far too often, and sadly one that doesn't always end with a baby. We hope that many of your fans - especially the young women who look up to you as a role model - heard the message and will pay attention to it as they seek out what is best for their lives. We would be honored to work with you in the future to bring this message to as many young women as possible.

 

 Photo of Rachel: www.Style.com

Video: www.Bravo.com

A Big List of Fertility Questions and Answers

by Fred Licciardi MD

Monica asked about DES exposure. Most women who were exposed to DES do not have any problems with their uterus or cervix, but a very small percentage of exposed women do. You definitely need a HSG and may need to be followed by a high risk OB if the cervix or uterus is abnormal. The older fertility doctors have a little more experience, as DES was mostly phased out by the early 70’s.

Sophia asked about what to do next after 6 failed ICSI attempts. You need to be in the best clinic available to you. You could consider travelling for a second opinion.

Mandy asked about Clomid vs Metformin. In general, I use more Clomid than Metformin. If you do not ovulate, but do on Metformin, and got pregnant easily, great, sounds good, use it again. If it took you a while consider Clomid. Doctors differ on when to stop Metformin during pregnancy, and it may depend on the severity of your case of PCO. I do not think you caused the miscarriage by changing the Metformin dose.

Laura asked if ICSI is safe. We will not know the specifics for decades. So far it looks relatively safe. You need to speak to your doctor and carefully read the consent forms.

Sperm of 20 million and 20% motility: repeat the test. You have all of the options available to you. IVF may be your best shot if the sperm counts remain consistent.

Veronica asked about ICSI in a natural cycle. You can do whatever you want, but a natural cycle, while it may be successful, has a very low pregnancy rate. Your lining is fine. If your last protocol gave you your best results, yes do the same again.

M asked about IVF for a low sperm count after vas reversal. I think the microflare is a good protocol. It’s hard to say if I think it’s best for you. It seems you did pretty well with your last, but without seeing the whole cycle I can’t say for sure. To go from cancelled to 12 eggs is quite good. Ask your doctor about keeping the same protocol but going a little longer before your hCG.

Emily asked about being on Metformin for 8 months. What’s the crime in putting you on clomid? You can take both. Most doctors do not follow insulin levels in their Metformin patients. Sounds like time is just passing buy.

MK: Yes, FSH levels drawn on day 23 are not useful. Your later progesterone levels look fine.

Sandy asked about PCO and miscarriage. For every doctor who says there is a connection, there is another who says the opposite. If you ovulate regularly on your treatment and you easily conceived, there is no reason to believe it can’t happen quickly again. If it took you a long time to get pregnant, you can consider getting more aggressive this time.

Kristina asked about mildly elevated THS levels, otherwise known as subclinical hypothyroidism. Your doctor is probably right, your levels are not a problem. However there are tons of endocrinologists who disagree, and would treat you with thyroid medication. In the past I did not give medication to people like you, however I got so much flack from the endocrinologists I just gave in and started treating. You can see an endocrinologist for a second opinion.

Mr and Mrs Oldham have a sperm count of 6.5 million. If your count remains in this range, IVF is by far the way to go. You can explore other options, but your highest odds will be with IVF and ICSI.
Arpee: Thank you, a search function on the blog is a great idea. I will give it a shot.

Megan has had 3 miscarriages. She has 6 frozen embryos, but had become pregnant on her own. She doesn’t know if she will have a lower chance of miscarriage if she does the frozens or tries naturally. Theoretically, in a frozen cycle you are putting more than one in, so if one embryo is abnormal, maybe one of the other ones are ok, lowering your odds of miscarraige. This effect is probably minimal but may hold true. In general I don’t like PGD, but you may want to at least consider this for your remaining embryos to lower your odds of miscarriage. No matter how you become pregnant, unless there is something else in your history, your odds of having a baby in your next pregnancy are 70% (unless you are in your 40's, then your odds are a little lower).

Chris was told to take 6 months of lupron for her adenomyosis. Get another opinion. It depends on the severity of your case. I would give 6 months of lupron only in the most extreme cases. 6 months is a lot of time to lose.

Trixie has a 10 day luteal phase. This is probably too short. A little progesterone may do. Ask your doctor.

Rose has a high estrogen on day 3, but has been taking estrogen. I don’t know if you need estrogen, but if you do, try repeating your bloods on day 4 and maybe 5. You may be able to start your cycle even though it’s later than day 3. You may have estrogen in your system left over giving you this high reading.

Someone with Klinefelters has never had a semen analysis. Yes, you need this test. If there is no sperm, find a good reproductive urologist and consider the biopsy. Ask about doing the biopsy and IVF at the same time. Many times there is a minute amount of sperm, enough for icsi, but not enough to freeze.

The day the earth shook my ovaries...

By Jamie Schenk DeWitt

As I slowly regained consciousness from my second egg retrieval surgery, a 4.9 earthquake shook the recovery room.  I turned to my right and there was my husband’s tender loving face just the way I had left him.  “It is an earthquake honey.  Everything is going to be fine.”  

I turned to my left and the nurse who got me prepped and ready for surgery was holding on to my IV stand and bag for dear life.  “Don’t worry we got your eggs out. Ten of them.”  

 I looked in front of me and there were nurses and doctors racing through the room.  I was definitely groggy still from the aenesethia, but I knew enough to know that it was an earthquake.  It registered in my brain something like, “Ohhhhh…it is an e a r t h q u a k e Ohhhh…TEN EGGS!” 

Thankfully the earthquake lasted for only thirty seconds, but as anyone knows who has lived through an earthquake those seconds can feel like minutes. There were no injuries to the medical facility and surrounding area and within a few minutes the recovery room was operating back at normal speed.  

 Now that the earth stood still once again, I could focus on having ten eggs extracted, which was A LOT for me. During my last IVF extraction, my doctor extracted 6 eggs and only 3 were viable for transfer.   I suffer from elevated FSH.  My egg production is rapidly decreasing, which makes it difficult for me to produce healthy eggs. 

After the earthquake, my doctor approached my bed with a gentle smile to make sure that I was recovering comfortably.  “We extracted ten eggs.  Several of them are premature.  We’ll just have to wait and see how they all develop over the next three days.” 

 Agh, the next three days of having to wait to see if the sperm takes to the egg.  Waiting to see if I have any embryos and then if those embryos grow into 2 cells, 4 cells, then hopefully to the optimal number of 8 cells.  

 The nurse leaned over and said “Ten eggs are great.  Your eggs are so healthy and so good that they shook the earth.”  I laughed and said, “From your mouth to GOD's ears.” But what I was really thinking was, “Please let me be so lucky to have just one of these eggs be healthy enough to grow into my much desperately wanted unborn child.”