Friday, May 29, 2015

Day 3 blood work

On a lark (and at Will's request), we did Day 3 blood work after our most recent one day work up in Denver.

I got the results today, and was surprised at the levels.

E2 = 58 (slightly elevated but not monstrously so, I think)

FSH = 6.8 (seriously? I know the E2 suppresses FSH, but this number still seems shockingly good)

LH = 6.4 (after years of fertility treatments, I still don't know what this number means)

AMH = 0.4 (OK, decidedly low, but my sister's AMH was 0.19 and she's six months pregnant, so it could be much worse). Nurse said this predicts how many eggs would be retrived (versus FSH is a proxy for quality)

My antral follicle count was five total (guess that explains the low AMH).

Will had had the idea that maybe we'd do one last fresh IVF cycle (ha ha!). So in my mind, these tests were basically to confirm that at age 43.5, the fresh cycle days are over. And well, hmm...now I don't know what to think.

I wonder what Will will make of these results and whether he'd want to endure the time and expense of cycling again with a fresh IVF.

Fellow amateur fertility specialists, what do you make of these numbers?

Mo

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25 comments:

  1. how many embryos do you have frozen again?
    The numbers are interesting....but to me age trumps the numbers. If you had fertility coverage or absolutely had to have another sibling at any cost, I would do it though.

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  2. It's been a long time... my AMH was .5ish when moved to DE. I generally had about 8-10 antral follicles but my only IVF that went to retrieval ended with 2 embryos.

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  3. Hmm. I'm a little rusty but I think the E2 is very slightly elevated--really not that much. So FSH looks wowsa good. AMH looks "could be worse". To me the antral count would be the most concerning in abstract but at 43.5 with the other numbers...hmmm.

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  4. I was told by Dr. Schoolie to always use your worst numbers (not the most recent) as the most accurate, especially when it comes to FSH.

    Good luck in your decision making. It's not easy deciding these things!

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    Replies
    1. I dunno. I had one bad FSH at 38--12--then at 41 it was 7 at ccrm (normal e2) and I had a fabulous cycle resulting in several normals. I wouldn't throw in the towel bc of one bad FSH.

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  5. Other than the AMH, your values read like that of say, a 39 year old. What should you make of it? as little as possible, because biology is effin insanely complicated, and these numbers, especially given your history, do not a full story tell. Heck, they may not be telling the full story in a host of other women, myself included. I had amazing, beautiful numbers-----and aneuploidy on aneuploidy at age 30.

    on the other hand, If you do indeed want to make something out of it, check it against your older number, and see if anything has changed, other than the slow expected decline in AFC and AMH.

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  6. Those are decent numbers, but I think your age is a far bigger player in the game. Statistics for normal embryos would be 1 in 10? Maybe less at that age. You should post it on SIRMs board and see what Dr. Sher thinks. Those numbers would have a different meaning if you were 33 I think. BUT people have babies at that age, so you never know. My grandma had my aunt when she was 44. She thought she was going through menopause, lol!
    Good luck making a decision. I'll be here rooting for you whatever you decide. :-)

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  7. ex-NewYorker (and Elvis baby)May 30, 2015 at 12:23 PM

    I tend to agree that age is the big factor here. Your numbers are pretty similar to mine when I started at CCRM 2 yrs ago - AMH 0.6, AFC 5, FSH 9 I think - at 41.5 After 4 ERs there, I wound up with 4 chromosomally normal embies on ice, average of 1 normal each time (though once I wound up with 2 and once 0.) Retrieved somewhere between 5 and 13 eggs each time I think. I was about on track for what stats would have predicted for me (but I did better than I had dared to hope for.) I'm *guessing* at 43.5 I might get a normal everyone one or two cycles now. BUT that cycle I had with 2 normals? That was my most recent one, last October. So who the heck knows. Good luck!

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  8. I'm going with what Jay said. My numbers were always SO crappy (FSH of 24) that my insurance fought me tooth and nail about paying for any IVF I did manage to squeeze out one good egg but that was it. Good luck whatever you decide

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  9. I hate to be pessimistic, but IMO, your age and history are the overriding factors. Will has always been more glass half full about fresh cycles. I'm assuming you'd do this in Denver. Not easy. 😕

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  10. Yes, the age and past experiences are what do it for me. Also, assuming everything miraculously went to plan, is it safe for you to have another one at your age? Seems like Magpie will be doing the fair share of household duties after you get up in age - is that fair? Do you really *need* another child? Seems a bit Narcissistic

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    1. 43 is not that old, based on US life expectations, women live to about 80. Women are having children much later, and with advanced medical age comes more tests for mother and baby's safety. It also seems a big leap to assume Magpie or her sibling will be saddled with extra chores. I know for me I'll be happy to help out my parents (they had me at 35) when they need help, and if it's too much for them, they'd get a housekeeper!

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    2. Safe? Really? I had a perfectly normal pregnancy at age 45/46. Gave birth to a full term baby at 46. I will turn 52 on my daughter's last day of kindergarten. As for fair, that's not for anyone to judge. Not to mention your name calling!

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  11. I just typed a long, somewhat well thought out comment, and then I lost it because I have never commented here and didn't know how to log in, so now I am going to try to recreate it by commenting anonymously since I don't have another way to do so.

    The gist of the comment was a response to the previous anonymous comment, posted at 6:33 p.m. It deeply saddened me to read your response, and although I have never commented here before, I felt compelled to do so, on behalf of Mo and perhaps, on behalf of myself.

    I truly hope that you did not intend for your comments to overstep and be as judgmental and insensitive as they were, but I also hope that upon reflection, you can realize why they were and why they were so inappropriate. Mo asked for thoughts on her numbers with regard to a fresh vs. frozen cycle. She did not ask for criticism of the very personal decision that she and her husband are making about trying to add to their family, but this is precisely what was given. Many readers and supporters expressed the very real concern of age in this discussion, but suggesting that this decision to try to conceive comes from selfishness and narcissism is heartbreaking. Have you been following Mo's story these many years? I can't think of a less selfish, narcissistic member of this blog community.

    Speaking for myself, only, I chose to try to conceive a second child after 40 precisely out of love for my daughter. I could have been satisfied with my one well-fought for beautiful child, but the thought of one day leaving her alone in the world broke my heart. I wanted her to grow up with someone to complain about me to and keep secrets from me with and to cry with and laugh with and be intimately, forever connected to when I was gone. This is not to say that wanting another child purely for myself would have been any less justified. It's just to point out that there are many "motives" for wanting to add to one's family, even in less than ideal circumstances, be it financial, health, age, etc, and in the end, only those directly involved in the making of that decision know which variables trump which. The rest of the world can and will judge, but I would hope that members of this community would do their best to refrain from making such judgmental, inaccurate, and hurtful comments.

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  12. Bless you anonymous at 8:56 pm

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  13. Perhaps it's my age (34) that makes me feel differently than most of the commenters here, but I think with numbers like those - which are better than mine were at 33 with diminshed ovarian reserve - if you can comfortably afford another fresh cycle, I would say do it. So much of managing infertility for me is being able to say I have "no regrets" - knowing that I did everything in my power to make my dreams come true. For what it's worth, after three IVF attempts cancelled for poor response, we pushed forward on attempt four with only four mature eggs. All four fertilized and made it to day three - transferred two (froze two on day three) and I am now 30 weeks pregnant. It only takes one good one, right? :-) -Polly

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  14. I'm 33 with stage 4 endo, DOR and E2 levels bordering on menopausal...we did a fresh cycle in Jan that failed and just did a fet from that cycle in april. I'm cautiously expecting a singleton and your numbers are far better than mine. If financially you can and emotionally you are willing, I'm all about no regrets or what ifs. Best of luck in making your decision and weathering the process Mo.

    Melissa

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    1. My understanding from my RE (as someone with DOR in her 30s, too) is that egg/embryo quality is largely determined by genetic age. Not hormone levels.

      But Mo, however you go about it--fresh, frozen, DE, adoption, surrogacy, whatever--Magpie will be one lucky kid to have a sibling! Best wishes to you.

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  15. Go for a fresh cycle! I'm rooting for you. I'm 45 and my 13 month old is sleeping next to me as I type this. As for ANONYMOUS, bad health and death don't just prey on the old. None of us know what tomorrow will bring.

    Wishing you the very best!

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  16. As a former (well, undoubtedly still, but no longer ttc) high FSHer, I can tell you that by the end of my ttc journey (I was 41.5, that IVF produced 2 lovely and one less-so embryos and no PG), the RE told me they "no longer" though FSH mattered much, they though maternal age was pretty much the only/best useful predictor (I think at that point AMH was just coming into use). Her point was that FSH can predict response but age is a better predictor of actual cycle outcome and not, of course, a good one in your case (or mine). So ... yeah, I'd go with that. I do know that the technology has improved a bit WRT what they can offer older women/poor responders, so take that with a grain of salt, but yeah.

    I'll also agree with the "bless anonymous @ 8:56 pm" sentiment expressed above.

    Final thought, the one question (as I think I've commented here before) that guided me (effectively) through the whole treatment process was, "If I try this and it doesn't work, will I regret having tried." So if your answer to that question is no, well -- maybe that's your answer (i.e. to try it).

    No! Wait! My real final thought is to express my delight that your sister is 6 months pregnant! What wonderful news! Congratulations to her and of course to her baby's aunt- uncle- and cousin-to-be.

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  17. I say you do whatever the two of you decide together! God bless the anon that apparently has NO clue about reality. Either way, I'm rooting for you!

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  18. Hi. If you have the money and emotional bandwidth to cycle again, why not? But if you think going down the IVF rabbit hole is going to limit your ability to consider other family building options (DE, adoption), if those are avenues you might consider, then I wouldn't gamble with another fresh cycle. I did multiple cycles at CRMI with good hormone levels and follicle counts at 43; always had decent cycles but nothing stuck.I went DE after that for my second child and never looked back.

    I'm very interested to hear what Schoolie thinks!

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  19. I don't agree that numbers don't matter bc you're older. I certainly never got that message in any way from ccrm when I cycled there at 41.5 in 2010. If anything I would think it would be even less the case today. It seems most of those who posted on this issue had bad numbers. And I've read a lot of blogs over the years and I don't recall too many situations where someone in their early 40s had good numbers but got no normals. I think perhaps a lot of the posters here didn't do CCS testing and their docs didn't have much to go on so they fell back on "you're old". Not to say that you absolutely should go for it. But I wanted to dispel the notion that only age matters. Of course usually as you age your numbers get worse. But for those lucky few of which I'm one, who have good numbers in their 40s, not all hope is lost. For Mo and anyone else reading.

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  20. Sometimes, the hormones (specifically HCG) produced during pregnancy can improve quality of the remaining ovarian reserves. This is why the final shot you give yourself before retrieval is HCG. It matures the eggs so they can move away from the inside wall of the follicle and into the fluid to be extracted. There is a school of thought which believes this is why some people are able to get pregnant spontaneously after a successful fertility treatment. Egg quality improves after exposure to nine months of HCG. Perhaps your numbers look better because they are better after pregnancy. Do the FET first, see the outcome BUT don't rule out a fresh cycle. Wouldn't you rather try a fresh cycle and know the outcome than wonder what would have happened if you had tried. On a positive note - this could all be moot, the FET could very well work. I know it hasn't worked in the past but you have some excellently cute evidence that tells you it can work.

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  21. There are many studies which show that FSH doesn't equal bad quality. It is correlated with lower quantity usually.

    Check out this study
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729851/

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