Opinion Please

[Anonymous]

I just found this site. I am hoping to get some of your opinions on this issue.

I am 40. I was pregnant back in the summer of '08 but we had to terminate the pregnancy due to anencephaly. My OB put me on mega doses of folic acid. For the record, I had been taking folic before I got pregnant, but just the recommended dosage. We've been TTC again since October. I've had my hormones tested in April of '08 and January of '09. April test-FSH 6.1. LH 3.7 and thyroid normal. January test-FSH 4.7 LH 3.5 and thyroid normal. My periods have varied anywhere from 25 to 31 days. I have an OV watch that I just started using this month and it looks like we may have been off on the timing.

I got pregnant the last time after 6 months of trying. I had started doing some IF workup. I got pregnant two days after an HSG. I have an appointment for an evaluation with Dr. Rifka at Columbia. I will listen to what he has to say, but part of me just want to say, "Just give me another HSG and I'll get pregnant again." The radiologist said to me after the HSG, "Sometimes these things are theraputic" Sure enough . . .

Would you keep trying without assistance for a few more months if you had my numbers? I know an HSG is not a therapy for infertility, but there is a ton of anectdotal evidence that it is theraputic for many women who get pregnant right after the HSG. Would you ask for an HSG on the pretense that there might be scarring from the D&C?

I'm not unwilling to consider fertility treatment, but I would like to get pregnant the "old fashioned" way if possible. Also, I had been doing accupuncture before I got pregnant. I have no idea if it helped or not. I liked her but I don't think she specialized in IF. If anyone knows a good accupuncturist who specializes in IF in the area, I would welcome that name. DC preferred, but I'll go anywhere within the Beltway.

Thanks for your opinions.

[Anonymous]

I think it can't hurt to get another hsg -- they're pretty non-invasive. Your hormone levels look good. Did you get your actual thyroid numbers? There's some debate about what "normal" is. Most REs like to see tsh below 2 for ttc and some labs still consider up to 5 "normal". Have you read "Taking Charge of Your Fertility"? That's a must-read. Also, I would temp, so you REALLY know what your body is doing, in addition to the monitor. I really like my acupuncturist, but she's in Annapolis.

[Anonymous]

I wouldn't get another HSG, personally, since I found them to be quite uncomfortable.

Based on my experience with infertility, I would be wondering if your issue is that there is a male factor problem undetected by the regular sperm studies. Ask Dr. Rifka about this--he has a colleague Dr. Sherins who specializes in male factor infertility. Your numbers look fine. Remember 40 percent of the time it's a male issue and the sperm count, motility standard tests do not detect problems with sperm that cannot penetrate an egg, for example. Since you haven't done any ART, you are really just guessing about the helpfulness of an HSG.

If I were you, at age 40, I would not wait to conceive on my own, especially if it took you 6 months the first time. I had good numbers at age 40 and it still took us 6 months to conceive using ART--IUIs and then succeeded through IVF. I used to balk at IVF, but frankly, it was the best choice we made (I am now due any day....).

[Anonymous]

I wouldn't wait a single second to have a complete IF workup, pick a doctor, get on their schedule, etc. I don't mean to sound harsh, but past 40, nearly every second counts. Much of these initlal workups are covered by insurance, so keep trying, but get a back up plan.

[Anonymous]

I'm a huge fan of the OV Watch and preseed. We got pregnant with only 3 consistent months of using the watch and preseed (5 cycles total). But I agree that at 40 if you're not pregant with the watch/preseed in 1-3 cycles, and your hormone levels look good, it may be a male factor issue and ART may be the best method for you.

[Anonymous]

Sometimes life has a way of getting in the way of conceiving naturally. At 40 I would not wait to get help in getting pregnant. MOve on it quickly.

[Anonymous]

Hi All,

OP here. This is the first cycle I've used the OV Watch. At first, I thought that the thing didn't work because I didn't get a fertile day until day 14 of my cycle. Based on OPK's in the past, I usually ovulate early. According to the watch, I'm going to be ovulating tomorrow.

For the record, I don't remember the exact TSH number but I am fairly certain it was 2 + a decimal, like 2.3 or 2.4, something like that.

I have some preseed but I haven't needed to use it. I guess all of you are saying that I should be using it regardless.

We'll start the workup but I seriously doubt that it is my husband. Both of us each had a college "accident" long before we met each other. The two of us had an accident before we were married about 8 years ago. (In the middle of switching birth control options, thought we were covered, obviously weren't) I terminated both of those pregnancies as did the girl my husband had been with in college. Then, we got pregnant less than a year ago. Unless fertility seriously declines with age for men too, I think the issue, if there is one, is with me.

Thanks for your opinions. I would welcome other ones here too. I hope I don't get flamed for admitting I've had abortions. I know DC is a very liberal place, but one never knows. I don't regret those decisions. It was absolutely the right decision for me/us at the time.

Also, if anyone knows an accupuncturist in the area that specializes in IF, I would love to get his/her name. Thanks.

[Anonymous]

I would try 1-3 well timed cycles with the OV watch and if you're not pregnant, get help asap.
Men's fertility does not change with age per say but it can ebb and flow over a lifetime. My husband had REALLY bad semen analyses (x 3) 3 years ago and now he was just retested and the results were fantastic. Apparently this is not uncommon.
Fertility in general is not static over time and just because you conceived a year ago and many years ago does not mean that you won't have issues now.

Try a few perfectly timed cycles now and then get to the RE ASAP. Natural conception is certainly very possible at 40 but should you need intervention, the chances of it working generally decreases rapidly after age 40. Older eggs simply are more fragile and don't like to go through the stress of manipulation.

Also, was your day 3 estradiol level normal? I don't think you mentioned it above. Sometimes in older women an elevated estradiol level can make an elevated FSH appear normal.

Good luck!

[Anonymous]

I'll also add this - just because you got pregnant after the HSG doesn't mean that is what did it. When I was TTC #1, the two times I got pregnant (miscarried once) were when DH and I were off of soy, so I attributed the soy to doing it. Second time around, we went off soy for months and months and nothing . . . .So much of it is random luck, as much as we want to believe it is something we do.

[Anonymous]

OP here. Thanks.

I have no idea what the levels of estradriol were. I am guessing that Dr. Rifka will do a complete workup on me and on my husband beginning next cycle provided I'm not pregnant.

The only reason I asked about the HSG is that there is some evidence that many pregnancies occur in the month following. The Columbia Fertility Associates even make reference to that in their website. I know you are right that it could just have been coincidence. I also think about the fact that we were taking a month off from trying the month I actually got pregnant.

I wish I knew what the answer was. I hear so many things. Do accupuncture. Stop coffee. Don't eat dairy, do eat dairy. You may be exercising too much. (I do the Seargent's Program every morning. It is intense, but it's only for an hour.) Believe me, I still have plenty of body fat to ovulate and to support a pregnancy.

Keep the opinions coming. Thanks.

[Anonymous]

I am going for my HSG tomorrow and secretly hoping I am become one of the anectdotal stories. We've been trying since October as well. I used the ov watch for three months -- didn't work. I mean it predicted ovulation, but we didn't get pregnant. I say have the work up done if you want it done. If you don't and can wait a bit then wait. 3 months won't kill you -- unless it will kill you, then you just go right ahead and start the tests. I will say that I have read a ton about strenuous exercise and especially anything that is high impact having a negative effect on fertility. So you might ease up on the working out and start spinning or walking - something that is less hard core. It's not about body fat but about stressing your system through high heart rate and the general effect exercise has on your hormones. Additionally, my RE told me that you want to avoid any jostling or jumping from ovulation on. It can effect implantation. But you are right - - there are a million answers and you never know which ones are right for you. This getting pregnant business is for the birds.

[Anonymous]

PP here -- I am cringing at my mispellings and typos and am high maintenance enough that I have to enter another post to point them out and ask you to overlook them. Sigh.....