FERTILITY ANSWERS: tracking ovulation, Improving AMH and Sperm causing miscarriage
Hi, I’m Dr. Marc Sklar, also known as the Fertility Expert. And for over 19 years, I’ve been working with couples from all over the world and locally here in San Diego, at both my clinic and through my online coaching program to help you get pregnant. And every week, almost every day, if not almost every hour, I get questions from all of you. Whether it’s right here on YouTube through my videos, or in one of my other social media outlets, I get tons of questions. I do my best to answer those questions, but I can’t always get to those questions and be able to answer them. So today I’m going to do something that I haven’t done in a long time, but I’m really excited to do it, because I love these episodes. I’m going to be doing a Q&A session to answer your questions right now on this video. So hopefully you all are as excited about it as I am, and that you keep watching to learn all the amazing information I’m going to share by answering your questions.
But before I get started with that video, I do want to give a quick shout out to the sponsor of this week’s video Fairhaven Health. Fairhaven Health puts out some amazing supplements like FH Pro for men and women. If you want more information on their products, use the link in the description below.
All right, let’s get started answering your questions. I’m going to look down at my screen so I can read the question. We’re going to put the same question up on the screen here for all of you. So the first question that I thought was really useful is this one, it says, “Thank you. Really useful video, but I’m having irregular periods. How can I know that my ovulation is on the right time?”
Well, it’s such a great question because ovulation is one of the most important variables that we need to track and understand to be able to conceive naturally home and give yourself a fair chance. So, one of the first things that we have to remember when we’re looking at ovulation is one, do we have a regular cycle? I think she’s saying I have irregular cycles, but I do want to touch on this. If you’re having irregular cycle, then most often you’re ovulating in the middle of your cycle. So if it’s a 28-day cycle, you’re going to be ovulating on cycle day 14. If you have irregular cycles, then what do we do about that? Well, there’s a couple different methods that we use to track.
First and foremost, you can use one of the amazing apps that I have discussed in products that I’ve discussed in the past. Some of those are going to be the Mira app, the Ava app, or the Tempdrop app. I say app, but they’re also products in and of themselves. They all work a little bit differently. So depending on what information you want to track and what you think is best for you, you might want to visit some of those products. I do have videos on all three of those products, talking about them, which you can see and check out later, but they allow you to track different things. So some of them will allow you to actually track, like what’s called an ovulation predictor kit, your LH surging. And so that’s the key hormone that surges during ovulation. Others will also allow you to track other hormones as well, like estrogen and progesterone, and you can also track your temperatures. So temperatures are easily tracked with a thermometer at home, but it can be difficult and complicated. So I like to use the Tempdrop app for that. And that is a band that attaches to your arm and that will track your cycles or your temperatures more specifically. And then you can track your cycles and ovulation through that app over the course of your cycle.
So that’s one of the ways that you can track your cycles and ovulation, but then you can also track for symptoms or signs. So do you have breast tenderness, ovarian cramping, some cramping over your ovaries when you release the eggs, or a shift in your cervical mucus or an increase in your libido. Those are some key markers that you can use to track your cycles. And if you put all of that together, I think you can find out when you’re ovulating.
The second question is an extension or dovetail to the first question. And I’m going to read that right now as you’ll see the question on your screen. So it says, “If a home ovulation test says I’m ovulating…” That’s what we talked about before, by the way, the OPK, the ovulation predictor kit. “Does it really mean I’m ovulating if my progesterone level is borderline low after ovulation?”
I think we’ve got to separate this answer. The first thing is, “If the OPK shows that I’m positive at home, does it mean that I’m ovulating?” The answer is yes. If the surge is high enough, it should trigger that OPK to show that you’re ovulating and it should mean that you’re ovulating. Now, the second part to this question is, “But what if my progesterone levels are low? Does it really mean that I’m ovulating?” It still means that you’re ovulating, but it means you’ve got lower progesterone than is ideal. And that can be a reflection potentially of how strong that ovulation was. Because if that ovulation was stronger, then the progesterone, theoretically, coming from that egg or the corpus luteum would be much higher. So that’s one piece of that.
The other pieces that yes, you could still have low progesterone, even if you ovulated and we need to support that. So those are two different pieces to the same question. And it’s an extension of the first one, which I didn’t cover in the first answer, because I knew I was going to be covering here, which is progesterone is something we can also use to track if we ovulated. Now, there’s two different pieces when we’re talking about progesterone in this way. One is, is the progesterone high enough to say that you ovulated? And so that could still be yes, and you could still have low progesterone. So typically if we see that progesterone be over, let’s say eight or nine, then that should signify that you ovulated, but an ideal level for progesterone, seven days post ovulation, which should be its peak, should be somewhere between 15 or 20 or above. And those are two different things. Hopefully that helps as well.
I love answering fertility questions. That’s why I’m loving this video right now. Hopefully you are too. If you are, giving me a thumbs up and let me know. And if you’ve got questions of your own, put them in the comments and I’ll do my best to answer them now. But if I don’t answer them now, I’m going to be doing more of these and I’ll be able to answer those in a future video for you as well. So stay tuned.
Now, let’s get onto the third question, which is, “Hi, my AMH has dropped from 3.2 in November to 0.89 in August.” So let’s just say about nine months later. “Can this dramatic drop be correct in eight months?” She said eight months. It’s a little bit more than that. “I turned 40 in March. I am due to start IVF at the end of the month, and this has completely devastated me. I was on Estrofem for priming and Primolut to regulate period for this IVF. Could this have affected the number? I would be very grateful if you could answer this question.”
The first thing that we need to talk about is AMH. AMH can fluctuate. It’s not the most static number that there is, and AMH alone can shift. Now, I know you’ve been told that it should never change and so forth. And I have many videos on this topic, but yes, I see AMH fluctuate all the time, and it shouldn’t be a huge thing that dramatically upsets you or pushes you in the wrong direction. This is not an uncommon thing to see. And I would still say that even though this was a big drop from 3.2 to 0.89. At 40, 0.89, almost 0.9, close to 1, should also be just fine. So that’s the other piece of this. And you are not just one variable. So what else is in your picture? What else is your body telling you? How is your FSH? How is your LH? How is your estradiol? How are your other hormones? What’s your antral follicle count look like? How healthy are you? There’s lots of variables that we need to take into account besides just looking at AMH and letting that consume us. So yes, it is a variable we need to think about, but it shouldn’t be something that totally derails us from getting the results and moving forward in the way that we can and should.
Now, the other piece that she said is that she was on hormones, leading up for priming. And I do think that that could have impacted these results because those hormones are going to quiet your ovaries and cause them not to be as productive in that timeframe as they should be. And it’s not uncommon for me to see as a result of that, that your AMH goes down because you’re not releasing and recruiting as many eggs as you should or would in other circumstances. So I’m not surprised by this. I’m also not worried about this, and I want you to stay positive and hopeful that you can and will still get pregnant regardless of what your AMH levels are.
Number four, this is all about sperm. So I’m happy to cover this one as well because we don’t talk about this enough. So it says, “Hello, Dr. Marc, after my miscarriage at nine weeks,” which I’m really sorry to hear about, “the OBGYN suggested a semen analysis and found out that 40% are abnormal sperm morphology. My question is can abnormal sperm fertile the egg? That will cause a miscarriage? Thank you in advance. God bless.”
This is a great question, but I think we need to take a step back here and talk about sperm in a little bit more detail. First and foremost, the thing that we need to know and recognize is the majority of sperm that men produce are abnormal and that is considered normal. So that’s the first thing. That’s right. You heard it. Men primarily produce abnormal sperm because if you have your normal count, let’s just say it’s 50 million sperm concentration or count, your motility and your morphology are percentages off of that. And what’s considered normal in a motility percentage is 40 to 50% or more is considered normal, which means about half of the sperm that you’re producing do not swim properly and that’s considered normal. And then with morphology, what’s considered normal is 4% or greater being normal. That’s right. So 4% normal forms or morphology is considered normal, which means 96% of the sperm that you produce are abnormal and that is considered normal. So those are things that we need to consider when we’re looking at this.
Now, I do not know what type of test she did when it comes to morphology, because she might not have done what’s called a strict Kruger’s morphology and that’s the parameters I was just giving. But if she did a different test, then those parameters could also be bigger. And in this case, I’d still say that that was okay. So in my mind, that’s nothing to worry about, but that doesn’t answer her second question, which is if we have abnormal sperm, can that lead to a miscarriage? And it can. It can absolutely lead to a miscarriage and we don’t often talk about that, but it absolutely can. So we do like to look at that, but I’m not concerned about her partner’s parameters at this moment, given what I am seeing and what I’m assuming based on the information she gave me.
All right, the fifth question. And this one has a lot of detail. So stick with me on this one. It says, “I have low ovarian reserve, endometriosis and underactive thyroid,” which is another way for saying hypothyroid. “Age is 40. Miscarriage one year ago and haven’t been able to get pregnant naturally since. We had our first IVF cycle in March. We got three mature eggs and two embryos classed as grade one. We transferred the two embryos, but unfortunately they didn’t take. Am I wasting my time with doing another cycle or should I move to donor egg?”
There’s nothing in your history that tells me you need to move to donor egg. Low ovarian reserve does not tell me that you have poor egg quality, two different things. Now you might have low ovarian reserve, but you still got three mature eggs, and two of those that were graded well for your transfer. So I’m not concerned about that. Is the endometriosis a variable? Absolutely it is, and that can absolutely impact implantation and a successful pregnancy. So that needs to be supported and addressed. And also the hypothyroidism. You did say you have an underactive thyroid, but you didn’t tell me if it was medicated or if there was being supported in some fashion. And that absolutely needs to be supported properly.
All those variables, especially those two, endometriosis and thyroid, can lead to a miscarriage or a pregnancy loss. It can also impact implantation on an IVF cycle. So nothing you’ve told me makes you feel like you cannot get pregnant with your own eggs at this time. And I don’t feel like it’s time for you to move forward with a donor egg. And you always have that option in six months or a year. That option will still be the same and your success rates will probably be about the same. So I don’t think you need to rush into that at all.
But one of the things here that we do need to talk about and I’m looking for it in here, is that she said that they transferred the two embryos and it wasn’t successful. So first things first is I like to suggest transferring single embryos versus two at a time or more. I just like to hedge my bet that way. Not to mention that there’s a lot of complications that can happen from having multiples during a pregnancy, both for the babies and for you. And two is sometimes IVF just doesn’t work. It’s not 100% successful. Often those success rates are actually relatively low, well under 40 to 30%, if not lower, depending on the clinic you’re at. So don’t take this as a sign that something is wrong with you. It just might mean that you need to do another cycle to be successful. So I want you to stay positive, stay hopeful and stick with it. And I do believe that you can get pregnant with your own eggs.
I hope this was helpful for all of you. I know that it was a lot of fun for me and I forgot how fun doing these Q&A sessions here was. So I’m going to do more of these. And if you’ve got questions for me, please post them in the comment section. Again, I’ll do my best to answer them now, but if not, I am going to do more of these and I will look for more questions to answer in future Q&A sessions that we do right here on Fertility TV.
If you’ve been trying for longer than you like, if you’ve been going through things and you’ve got a lot of questions, you don’t understand what’s going on, and you really want guidance and support to push you through in the right direction and get the results that you deserve, then I want to invite you to join my Hope Fertility Coaching program. All you have to do to apply is use the link in the description below, and we could be your fertility coaches.
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