Pregnant over 35 – Fertility Q&A
Welcome to Fertility TV. I’m Dr. Marc Sklar, also known as the fertility expert. I’ve been working with couples for over 19 years through my online coaching programs and here in San Diego at my clinic.
Today’s episode of Fertility TV is going to be a fun one. It’s going to be a Q&A. That’s right. I’m going to be answering your questions live, and these are questions that you have posted as comments to some of my recent videos, which I asked you to do. So thank you very much. The last time we did this, the feedback was awesome, you all loved it, which is exactly why I’m doing it again. So let’s get into it right now.
Before I start with the first question, which I’ll get into in just a moment, I do want to give a quick reminder to all of you that I am doing a free live training in December. This is going to be an awesome training. The last one I just did was amazing. We got great feedback, which is why I’m doing it again right before the holidays.
So if you want more information on how you can improve your fertility and what next steps you can be taking to do that, then you need to join me for this free training. Use the link in the description below to register, because that’s how you get the link on the day of the training.
Okay, so let’s get to our first question. I really like this one. So we’re going to start with this one. She says, “Hi, doc. Thanks for the video, but I have a question. What happens if you are a poor responder to your stimulation injections? Does this mean that your IVF success is low? I am kind of worried because my first stimulation didn’t respond to my body, and I had three days stimulation, but only produced one embryo. My doctor has scheduled me for another appointment, but I am just worried.”
I think some of the information she shared here is a bit off, because you’re not going to have three days of stimulation. That’s just not something that we do or see. But I think the general premise of what she’s asking here is really an important one, because we often hear, are you a good responder or are you a poor responder to IVF? What does that mean for my outcomes?
Well, obviously if we just take it black and white and we say good and bad, then that tells you what it means, that if you’re a bad responder, that we’re not going to have much success on our IVF procedures. But I think there’s a lot of nuance and details to this.
So much is dependent on, first, your condition and your hormone levels to the protocol that is being given to you and how much preparation work you’ve done. So if you’ve had the proper understanding and found the root cause of your situation, then you should have a plan in place to support that and make those changes. That’s probably going to take about two, three, four months, depending on what the circumstances are.
If you’ve done that, then I do think you’ve set yourself up in a good way to be successful, hopefully, to conceive naturally. But if you’re going through IVF, to be successful in your IVF protocol and retrieval. But your protocol trumps everything.
So if the protocol that was chosen for you was not the right protocol for you, which, unfortunately, sometimes we just don’t know until you do it and we see how you respond, then if we’re just going to continue to do the same protocol, then obviously you’re probably going to respond the same way.
So my hope is that both you and your physician have learned from that protocol, have learned what could be done and what needs to be changed, and that this next cycle is going to be a little bit different so that you respond differently. If we keep doing the same thing over and over, we can’t expect different results. So let’s change things up, let’s be proactive, and let’s see different results in your situation.
All right, question number two. So how will you help someone in her 40s with fibroids, or I’m assuming she says … Maybe it’s just 40, but I’m translating to 40s, with fibroid to get pregnant naturally?
So fibroid in and of itself is not going to prevent you from getting pregnant. We need to understand so much more than that. So the first thing obviously is your age. The second thing would be what are the rest of your hormones? What are those hormones? What do they tell us? Have you had a complete assessment?
You are so much more than just one diagnosis and one value. So having fibroids and being 40 doesn’t necessarily tell me if you can or can’t conceive naturally or what path you need to take. So we do need a lot more information.
Being 40 doesn’t scare me in any way, as long as you’re having a regular cycle, your hormones look good, and everything is on point. Then we need to find out what other issues are at play that are either hindering your issues or contributing to the fibroid. Once we have that information, we can create a plan around that, then I do think you can have some success.
The other piece to the fibroid is how big is it? Where is it located? These are important details. Is it inside the uterus or is it outside the uterus? Where in the uterus is it located and how big is it?
I’ve seen many women with large fibroids, like the size of a grapefruit, but it was on the outside. They conceived naturally, had healthy pregnancies, no problem. I’ve seen others, because of the size and the location of it, have issues, and those issues needed to be addressed, like partially or totally removing that fibroid.
So it really just depends on those variables. If you can find out those variables and then we can create a plan around that, then I do think we have opportunity to be successful naturally.
All right, so this third question is actually a two part question, because we went back and forth a little bit in the comments section when she posted this. So it says, “Doc, do you think everyone should start with IUI before considering IVF?” My response at the time was, “I believe you should first make sure the reason why you are not getting pregnant naturally.” She responded, which I appreciated, she says, “Our case is that my husband has low count and motility. The fertility doctor in Cancun said best to just go straight for IVF. However, that isn’t covered by our insurance. So I was wondering about IUI, just to give it a go or not.”
So first I think I’m going to say the piece that I need more information on is what are the actual numbers on the semen analysis? What does the count actually look like and what are the numbers for the motility? Because depending on what those numbers look like, that might influence my decision.
So if your count is really, really low and motility’s really, really low, then, yes, I think probably your best option is to go towards IVF first. But if we’re just a little bit off, so we’d like to have … I mean the normal range for concentration or count is going to be 15 million. I’d like to see that be at least 15 million or a little bit higher. But let’s just say you’re just at 10 and your motility is, let’s say, 30% instead of 40%. Then I do think that trying IUI in those circumstances could be beneficial and fruitful.
That’s actually why IUI was initially started was to help with mail factor fertility. So I do think that could be a first step in the process. If not, then obviously we would go towards IVF.
The other benefit of doing IUI first is that, on the ovarian side of things, you also see how your body, your ovaries are going to respond to the medication. It allows the physician to see how your body’s going to respond to those medications, to see if there’s anything that could be adjusted.
IVF and IUI are somewhat of an experiment because we don’t know exactly how you’re going to respond to certain protocols. And so, if they could do some of that beforehand and see how you’re going to respond, that can help them change and manipulate the protocol when you do have to go through IVF, and doing IUI is much less expensive, or, in your case, maybe even covered by insurance, then IVF would be … So that might be a good way to utilize that as well.
All right, I love these. Hopefully you are enjoying these questions and my answers as well. Please let me know in the comments what you think about them, what your thoughts are, and if you have any questions. I’m going to keep answering some additional questions. I got a few more, okay?
So this next one is multi-part as well, and it says, “I have very low AMH,” although she doesn’t tell me what the AMH is, “for my age, and I tested high for FSH, above 11. I tried DHEA protocol, not a very high dose, for two months. After three months from my last test, I tested again, AMH was lower, but FSH became half of its value, from 11.5 to 5.5. I think it’s because DHEA stimulates estrogen production.”
So the first part to that question is this. So I’ll stop there. Yes, DHEA can stimulate higher estrogen levels, but I also don’t know what the estrogen levels are. I don’t know what they were the first time. I don’t know what they are now. So it’s hard for me to also give feedback on this. But having a complete picture, because all of these hormones impact one another, is going to be important in assessing this situation.
I am very careful with DHEA use, and what I would’ve appreciated is if when she did her first round of testing with FSH and AMH, if she also tested DHEA, because then we would’ve also known if she needed it and how much to use and potentially for how long, and also to retest it the second time.
So I would be very careful with DHEA. I have a whole video or two just on DHEA and why it’s important to be careful, but we do need to be mindful of it. In her case, I would’ve hoped that she would’ve tested before and after as well. I would’ve also liked a little bit more information on the entire picture.
She then goes on to ask also a question, “Does TSH,” which is your thyroid-stimulating hormone, “need to be below 2.5 for good fertility or not necessarily?” Thank you.” Ideally, yes, it should be below 2.5. A perfect range is between one and two. I have tons of videos on this topic as well. You can learn more about thyroid and fertility in some of those videos if you haven’t already.
Okay. This next question’s really interesting. I put it in here because I do think it’s a question I’ve never had anyone ask me before. But it’s an interesting question, so let’s get into it.
She says, “Dr. Sklar, is there any way hormonal or alternative medicine, to not ovulate every month, but to menstruate just a few times per year in order to not prematurely finish up the ovarian reserve?” She’s clearly concerned about using up her eggs and wants to preserve them. “I know that a monthly cycle is a sign of good function, but every month is an extra lamentable loss when you are single.”
So I think the first thing I want to say here is let’s think about this a little bit differently. I think the belief is that once we hit menopause, we don’t have any eggs left. And so, we want to hold on to as many as we can. Well, I can appreciate that, but I want you to all know that odds are that when you go into menopause, you still have plenty of eggs around. It’s that, hormonally, from your endocrine system, you’ve transitioned and you’re not going to use those eggs in the same way that you have before. So it doesn’t mean you’re ever going to get to zero, literally zero eggs. So hopefully that gives you a little bit of peace of mind.
The second thing here is, this is a really interesting question, like can I prevent ovulation to hold on to my eggs so I don’t use them up unnecessarily? I can appreciate that. It’s not my favorite approach to things. I really would’ve preferred that everything is functioning optimally, that you are ovulating and menstruating regularly every month. That is an ideal situation.
I would never do anything, naturally or through alternative medicine, to prevent a normal healthy ovulation and menstrual cycle. However, that’s exactly what birth control can do. So if you decided to go on birth control, it will prevent you from ovulating, and when you come off and you’re on the sugar pill or that last week of non-hormonal medication, so to speak, the placebo, then that’s when you’ll have your cycle after that. So you’ll still have a cycle, but you won’t lose those eggs.
Again, that is a way to do it. It’s not my favorite way. I don’t promote it. I’m not saying this is what you should be doing. I would prefer that you have regular cycles and that we just focus on taking care of yourself, taking care of your egg quality, and not focusing on the potential amount that you’re losing every month. But this was a fascinating and interesting question, which is why I put it in there.
What did you think? Did you find this interesting? I mean I’m curious to know. Comment below and let me know.
All right, so let’s get into the next question. It says, “Thanks for the information. I have done several tests with my husband, but can’t find anything wrong with both of us, and I’ve lost four pregnancies.”
So here’s what I’ll tell you, first and foremost. I will tell you that more often than not, when someone says, “I’ve done all the tests. Everything looks fine. I can’t find anything wrong,” I’ll tell you there’s a couple different variables. One is they haven’t done all the testing, things have been missed or, two, you’re interpreting that information in a different way, or someone’s interpreting it as being good but maybe it’s not.
I think the former is the more likely situation, is that you think you’ve done all the labs and you actually haven’t. For instance, with your husband, you say, “Oh, nothing’s wrong. We’ve done all the tests,” but has he done a DNA fragmentation test? That’s the first thing I think of when you say you’ve had four losses and you’ve probably just done a regular semen analysis.
Additionally for you, have you dove deeper into your labs and looked at autoimmune issues, blood clotting variables? Have we looked at any issues going on inside the uterus that might be impacting implantation? These are all things that I look at on a regular basis and invariably always find that they are missing. These are the things that I coach and support couples on in my coaching program so that they can get the right information they need to make the best choices on their fertility journey.
These are some of the things that actually I’ll be talking about in my upcoming free training. It’s the last one of the year, absolutely, because it’s December. It’s happening in the early part of December. If you want to join me for that, I highly recommend it. The last one was great. You do have to register. Just use the link in the description below.
So hopefully this was helpful for you. I really enjoyed it. I did this before. I forgot how much I enjoyed it. I’m going to do it again. So if you have questions that you want answered in this style, just like I just did, then go ahead and make sure you leave your questions in the comments of my videos, and hopefully the next time, I’ll pick one of your questions to answer live in this video or in a video similar to that.
I did mention my coaching program and how I work with couples in that coaching program. Hopefully you can see some of my perspective and understanding and how I view these questions and how I guide you and support you. If you want my eyes on your case and a personalized plan to help you get pregnant, then I want to invite you to apply to join my Hope Coaching Program. You can use the link in the description below.
Before we go, a quick reminder, December 9th is my live free training. I want to see you there. Come and join me. Use the link in the description below. If you like this video, give me a thumbs up. If you’re not already a subscriber to my YouTube channel, you should be. So hit that bell to subscribe and get notified when I put out a new video for all of you.
Until the next video, everyone, stay fertile, and a quick happy Thanksgiving to all of you. Hopefully you have a very happy, thankful, grateful Thanksgiving and you spend it with those people that you love. See you in the next video.