THINKING ABOUT IVF?
Before you head down the road of IVF, please make sure that you have checked off everything on this list.
I see many fertility clients in my clinic and their number 1 reason is “We are going to do IVF.” My question is why? Why do you need to go to IVF?
The recent recommendations regarding fertility are as follows:
Younger than 30 (both partners) if you have been trying for a year or more, without achieving a pregnancy – please see your Doctor.
If you are over 30 (both partners) – if you have been trying to conceive for 6 months or more – please see your Doctor.
Here is the thing that no one explains when we are talking about trying for a baby – you need to plant the soil. You need to nourish the soil and tend to it to make sure that it has enough nourishment, water and sunlight before any growth will occur.
It is the same for our bodies. We need to make sure that before trying to conceive, we are tending to our reproductive organs – for both males and females.
Have the following things been checked & ticked off?
Have you been given a diagnosis as to why you’re not falling pregnant naturally? If not, this is a huge RED FLAG. I see many women coming in for treatment having been told that they are too old, and/or that their egg quality is not good enough – yet they haven’t even had a Day 3 hormone panel test to see what there FSH levels are. You can’t just tell a woman that she is too old or her egg quality is not good without having evidence.
Therefore I ask all my clients for a hormone panel test. You need to have the following tested:
- Day 3 hormone panel – for FSH and oestrogen levels
- Day 21 hormone panel – for progesterone and luteinizing hormone.
For men – YOU MUST HAVE A SPERM TEST DONE!!!!!!!! I don’t care how awkward it is or how uncomfortable – if you are going to IVF your partner will be pumped full of hormones and other drugs that can affect her cycle and have other side effects. So, fellas, for 10 minutes of discomfort, please go and get a SPERM test.
Why do you ask? Well just like women, sperm begins to decline at 41 and as it takes two to create life, we want to see how your sperm are so that we can assist the best way can to achieve that bundle of joy in your arms.
So, let’s start with sperm, shall we! In 1980 the parameter set by WHO, the World Health Organisation for morphology was 80%. So, what is morphology? Well, morphology refers to the shape of the sperm, whether it looks normal, whether it’s got both a head, a body, and a tail. As opposed to just bits of heads & tails floating around. This is the most important part because if it doesn’t even have a head & tail how is it going to get anywhere?
In 1980 WHO’s parameter was 80% which in 1987 had dropped down to 50% & by 1999 it was down to 14%! (When I first started working in the lab, our parameter was 50% normal forms for sperm – I used to look at sperm under the microscope and do all the parameter testing, so I know what I’m talking about!)
In 2010 it dropped down further to 4% & I’ve seen in some labs 3% being acceptable which to me is beyond ridiculous. I’m not going to speculate as to why, you can draw your own conclusions. What I will ask is how is anyone meant to get pregnant with only 4 sperm out of every 100 sperm looking even? How can this be acceptable? I can’t tell you how many men who come in having been told they have super sperm with a morphology of 5%! Men, the low down is, if you have 4 out of every 100 being normal – unfortunately, natural conception will not occur.
The indication for natural conception to occur is that we need a minimum of 14% normal forms to achieve conception. So please if you are heading to IVF and you have been told that 4% is great, please hold off on your IVF treatment.
If you put this in further context with the other parameters, it just goes downhill from there. Let’s look at motility. Often overall motility will be looked at because it’s the highest number, so it looks most promising. However progressive motility is the only truly helpful percentage. Let me break it down for you. Motility is the percentage of sperm that are moving but progressive motility is the percentage that is moving in the right direction, the ones going for the egg. This means that if you have a motility of 60% & progressive of 35%, then 40% aren’t moving at all & 25% are Homer Simpson sperm, swimming in circles. It’s a bit deceiving right? And the frustrating thing is that there is a lot that can be done to improve the sperm quality, but conventional medicine isn’t talking about it.
Now that I’ve filled your mind with sperm values, let’s move on to the female side of things.
Have you had a tubal patency test & ultrasound to rule out any blockage in your Fallopian tubes, or to check the state of your ovaries? If not, I’d be asking why before going down the IVF track. If you have & you’ve been told you have PCOS & need drugs to get you to ovulate, I would say to you there are natural ways of getting you to ovulate & I would be trying these first. Surprise, surprise Acupuncture & Chinese herbal medicine is one of them!
This is something that I insist all of my fertility patients do. The BBT chart can give you an indication of whether you have hypothyroid issues (when the temperature is below 35.9 it can be an indicator), and it shows us when you’re ovulating, how well & if you’re producing enough progesterone for implantation to occur & pregnancy to hold. It’s a great tool & by far outweighs ovulation strips. Why? Well the trouble with ovulation strips especially for people with PCOS, is that it’s measuring the LH surge which happens before you ovulate but with PCOS you can have many surges as your body is trying to ovulate without success.
The other reason I like BBT charting is that the only other way to confirm when someone is ovulating is either through an ultrasound or a day 21 progesterone test, both of which are not realistic to be doing monthly. The day 21 progesterone test also only works if you’ve ovulated on day 14 otherwise it’s going to give you a false reading & chances are if you’re doing one in the first place it’s because you’re unsure when you’re ovulating, so how does that one work!
If you read our blog on the menstrual cycle – not everyone ovulates on day 14. From the BBT chart, we can see where ovulation has occurred and how long each part of the cycle is. Therefore we can assist you to time sex correctly! How awesome is that!
When I first started working in the lab – it was via a blood test every day – and we used to call them “tracking” patients. This was good as it did measure the hormones day to day around their predicted ovulation days – yet it also removes vital blood from the body. You may also know the BBT chart as part of the rhythm method (which is how our grandparents used to conceive and used it for contraception). Another thing – it’s FREE.
Let’s move on to blood tests. I’ll start with the day 3 hormone panel which includes estrogen(E2), FSH, LH, Testosterone, SHBG, prolactin & DHEA. I won’t get into huge detail here. However, testing these on day three of your period can give us a lot of information on the state of your hormones, how they’re performing & in many cases how well people will respond to the IVF drugs. So, if this hasn’t been done, how is the specialist determining the dosage of your drugs? Educated guess? Because going off your AMH is not accurate.
Side note – AMH only measures your egg reserve for the next 4 months not your primordial pool of follicles. This number can change.
While we’re about blood tests let’s look at iron & thyroid. For fertility, we want a TSH (Thyroid-stimulating hormone) reading of no higher than 2.5 as during pregnancy baby takes a lot of T4 (the storage form of thyroid hormone) & if there’s not enough this can lead to miscarriage & birth defects. For more on thyroid & what all the blood tests mean, my blog on thyroid will get you up to speed.
Iron & ferritin (your iron stores) is an interesting one, because in the clinic we see iron deficiency as a big factor in not falling pregnant, as well as poor responders to the IVF drugs. Let me put it to you like this. If you imagine you’re lacking in iron, your body is going to prioritise blood flow to your brain, your heart, all the organs necessary for you to stay alive.
As important as your ovaries are in fertility, for your daily functioning they are low on the list. Unfortunately, it’s as simple as that. So, in order to get the blood flow your ovaries need to do their thing, we need to make sure you have good levels. So what level am I after? For iron at least 15 if not higher. For ferritin, if the reference range on your blood test is 30 – 200 I want it to be close to 100. If you’re below 30 you should be asking for an iron infusion. Unfortunately, as women it’s common for us to be low in iron & ferritin due to menstruation and if you are coeliac as well. I think because of this fact some practitioners get desensitised to how low a patients iron is because it’s low across the board. However, if you think that at below 30 you qualify for an iron infusion, it’s crazy to me that a patient with a reading of 36 may be told they are fine.
Which brings me to the most important part & why I wrote this.
Which is that YOU must be your own advocate.
Especially for fertility & IVF where many people are thrust in & can easily get blind sighted.
You need to do your research & make sure whoever you’re working with has ticked off all the boxes before jumping in.
The feedback I’ve had from patients is that it can be a very clinical and mechanical journey undergoing IVF. My hope is that by doing some of these things first you will have better outcomes undergoing the IVF process because your specialist will be clearer on what’s going on, or that you fall pregnant naturally.
Pre IVF checklist:
- Have you been given a diagnosis as to why you can’t get pregnant?
- Females – have you had a:
– Hormone panel test done
– Day 3 and day 21 hormone test
- Vitamin D and iron studies
- Thyroid function test – TSH, free T3, Free T4 and thyroid antibodies.
- Tubal patency test and ultrasound.
Males – have you tested
- SPERM!!!!!!!!!!!!!!!!!! This is the major test that I need to see.
- FBC, Iron studies, Thyroid studies, Vit D
- Hormone panel – FSH, LH, SHBG, Testosterone, progesterone
- Another question to ask is – do you have a history of undescended testicles, any accidents to the groin or testes, any previous torsions – as these can all affect sperm.
My wish is for everyone to achieve their bundle of joy in their arms and to assist all couples, to achieve their dream of a family. My hope is that in writing this checklist, that you stop and think before just being told that IVF is the only way.
I have had men with sperm at 4% and we have treated them alongside their partner and what do you know, without IVF, they conceived naturally. It is possible and using acupuncture and Chinese Herbal medicine and Diet therapy we can assist your body to function better and we can assist to balance hormones, regulate the cycle, along with BBT chart assist with timing sex and overall we improve your health and wellbeing along the way.
If you or someone you know is struggling with fertility, please share this article so that we can help them.
If you would also like to book a consultation where I can give you a holistic treatment plan which includes guiding and supporting you through the above steps, please give us a call – 9431 5505 to book your appointment or book it online here.
Written by Dr Julia Bartrop (TCM)