D is for Diagnosis:
I always want to know what the fertility factors are for my patients. There may be something I can do to improve the situation so when we do IVF we have the highest chance for success. If you know why you need IVF in the first place, then you’re better prepared for the number of cycles you’ll need or have a better understanding of what the right protocol is for you.
How do we get to a diagnosis in understanding what the problem may be? (Drumroll please…) TESTING!
There are three core elements:
1. Eggs: How do you know if you have good eggs? There are things you can check!
- Hormones: FSH, estradiol and AMH. These are blood tests.
- Antral Follicle count: This is an ultrasound looking at the number of resting follicles seen in your ovaries.
- Fertility Gene Test: This is a blood test that can tell you if you have any genetic variants associated with early menopause or an increased risk of miscarriages.
FSH and estradiol hormone levels are checked around cycle day #3. The FSH level rises over time and as it goes up we know the egg quality goes down. The value gives us a way to predict what’s going on with your egg quality, but remember that you are not a number. We also look at the AMH level which declines over time. This hormone is secreted by cells that surround eggs so the higher the number, the more eggs a woman has left. What we don’t want to happen is for a woman to find out that she has run out of viable eggs before she is done growing her family.
I set up a very simple way for you to get these levels checked, and to review them with me over the phone or by video. The Egg Whisperer Fertility Awareness Panel is what I call it. It’s a simple, affordable, and fast way to learn more about what’s happening with your fertility. It’s something every woman can and should do?—?regardless of their family planning situation.
We also look at the Antral Follicle Count (fluid filled sacs that contain eggs). The number of follicles a woman has in her ovaries tells us more about her fertility and IVF pregnancy rate. This number is part of what determines which IVF protocol is the best for you.
Getting a fertility genetic profile before IVF is now something you can ask for too. Fertilome is the place to go. I find this test useful because it gives me the opportunity to design individualized IVF protocols based on a patient’s DNA, not just their fertility levels and follicle counts.
When we look at your age, fertility hormone levels, genetic profile and antral follicle count, doctors can give you a pretty good idea about your IVF pregnancy rate and how many cycles you may need to do in order to have the success you are looking for based on the family size you want.
2. Sperm: How do you know if you have good sperm?
- Semen Analysis
- Advanced Sperm Testing
It’s not just about how many swimmers you have but about the DNA quality too. If it isn’t easy to get to a lab for a semen analysis, consider the At Home Collection Kit. The same company also offers a do-it-yourself DNA fragmentation test too. They’ll ship you the kit with very easy to follow instructions.
Another advanced sperm test looking at epigenetics is offered by Episona. This test identifies the presence of genes that could possibly inhibit fertilization, embryo growth and even implantation. The good news is that knowledge is power and everything is actionable. If you don’t know what issues exist, how would you know what needs fixing? There are scientifically proven ways to deal with all the issues we may learn from these tests. Simple things like taking antioxidants, decreasing stress and making sure your testosterone is normal are just a few of the many things you can do to improve sperm quality.
3. Fallopian Tubes: How do you know if they’re open?
- Saline Infusion Sonogram
If I know a patient is going to go through IVF, I don’t actually need to check tubes right away. It’s still a good thing to check before your embryo transfer because if you have a condition called a hydrosalpinx (dilated fallopian tube), your chances of successful implantation are reduced. You can get a saline infusion sonogram done looking for tiny bubbles through the tubes or an x-ray test called the “HSG” that picks up dye in the tubes.
4. More Pre-IVF tests to consider:
Other pre-IVF tests to consider: thyroid, prolactin, vitamin D, cholesterol, blood sugar, and a mammogram (depending on your age) are a must. I offer extended carrier screening as well to make sure the egg and sperm genes are compatible.
I is for IVF:
Once you know the D of the D.I.E.T. it’s time to plan the IVF cycle that will best treat what you have learned about you during your diagnostic work-up. I discuss pre-implantation genetic screening (PGS) with my patients so they can find out if their embryos have a normal arrangement of chromosomes before getting pregnant. I also ask them to talk to a genetic counselor so they understand what the technology is looking for. It checks for not only chromosome issues but also for an embryo’s mitochondrial DNA count (mitoscore) which predicts an embryo’s implantation rate. Together with the embryo quality, mitoscore and chromosome information, I can rank embryos in order from highest to lowest pregnancy rates. This way my patients have all the information they need to make sure they’re fully informed about their chances before embryo transfer.
E is for Endometrial Receptivity:
Think of receptivity testing as designing the ultimate evite for your embryo party! You definitely want to know the best time for your embryo to show up and there are tests you can do to make sure of that. I run my patients through a transfer rehearsal cycle during which they take medications one would take for an actual transfer but instead of doing a transfer, a gentle endometrial biopsy is performed removing a very small amount of cells for testing. The two tests I perform are the ERA and Receptivadx tests. I then can make necessary adjustments based on the results for the actual transfer.
T is for Transfer
Be positive. Be calm. Be zen. I ask patients to consider acupuncture and learn about deep breathing and meditation practices before transfer. We want to schedule your transfer on a day when you can completely relax. I always hope for a positive outcome, but of course we prepare mentally for whatever the outcome may be. This means going into it with a clear mind, and an open heart. If it doesn’t work we need to be ready for that, and will do everything in our power to understand why and discuss what we can do next time.
So, that’s it! That’s the Egg Whisperer D.I.E.T. Simple, easy and painless, right? Well, not quite, but testing can be beneficial if it improves your likelihood of both getting and staying pregnant. At my office we like to think of IVF as meaning, “Is Very Fun”. I promise, it can be! I want to know everything I can do to help my patients achieve their goals as efficiently and successfully as possible.
Catch more of me, and topics like this through The Egg Whisperer Show. You can find all episodes on YouTube live on Wednesdays at 5PM PST. Subscribe here.