Older Mom - if not IVF, then what?

[Anonymous]

I am 42 and TTC #2. #1 was conceived when I was 37 without any difficulties (after 1 m/c). We've been trying for 4 months now, without success. I understand IVF is not too successful in women my age, but do I have any other options? I don't think my OB/GYN is a helpful resource here. We haven't even thought of an RE yet, and I am not even sure DH wants to go that route (his doubts about having a second are why it's taken us this long to try again). I am trying not to be too obvious in the "trying" but want to be prepared to propose a next step.

Thanks.

[Anonymous]

Go for an appointment with an RE. The diagnostic work they will do will give you a lot of information upon which to base your next decision. For example, the bloodwork could show reduced ovarian reserve (not uncommon at 42), which could lead you in the direction of adoption or donor egg, or the diagnostics could show you to still have a decent shot at IVF. They also do a diagnostic test to determine if your fallopian tubes are clear, and many women who have been having trouble conceiving go on to conceive naturally following that test (which has the effect of roto-rootering your tubes).

[Anonymous]

The other thing to keep in mind that as we get older, 4 months is really not that long to have been trying. I can't remember what the average is for age 40, but I'm fairly certain it is more than 6 months.

I agree with PP to go for testing -- the more information you have sooner, the better position you will be in to have more choices and make decisions. I just went through IVF and although it was a tough few months (with all the shots, appointments etc) we had a successful first cycle after TTC for 2 years. If you conceived naturally just a few years ago, my guess is that you'll have success with a little help! IVF can certainly be successful with 'older' women, it's more about what the issue is.

[Anonymous]

Well...I would say, that if you aren't SURE about whether you want to have any intervention...you should think twice about going to an RE.

Because, to me, it would be difficult to go through fertility treatments of ANY kind if you weren't (both members of the couple) fully committed to the process.

It is NOT an easy road...

[Anonymous]

You may also want to consult with an acupuncturist. Acupuncturists who specialize in fertility can prescribe herbs that assist in nourishing the ovaries. They also to actual acupuncture to assist in straightening out the cycles too. I've been seeing an acupuncturist in connection with an RE. I was unable to take the herbs for the prescribed period. (It had nothing to do with the herbs and due to something else)

I am 41 and beginning IVF. I don't have an kids. I saw an acupuncturist when I was 39 and got pregnant with no intervention but had to terminate due to a condition "not compatible with life."

I have a good FSH level at 41, 7.0. It has varied between 4.7 and 7.7 in the past 2 years. The most recent was the 7.0.

If you are averse to going to see and RE right away, try acupuncture. It is non-invasive and gentle.

[Anonymous]

OP here. Thank you for the thoughtful answers. If you have an accupuncturist recommendation, I'd appreciate it. I am not opposed to an RE, just curious what else an RE can do besides IVF. Is it possible to find an RE not associated with a big IVF shop like Shady Grove? What else can an RE do (and thanks for the HSG rec)? At 6 months of trying, should I be calling my OB/GYN or going straight to an RE? I know the ovaries are still functioning based on a sonogram in July looking for a cyst. I actually need to go for a follow up sono for the cyst.

[Anonymous]

Well...IVF isn't necessarily the only option...
I did 2 rounds of IUI with injects. It upped the number of targets, and for some who have gotten pg in the past...this might be a good option.

[Anonymous]

PP here. I go to Kerri Westhauser and she is wonderful. I was referred to her by my RE. She has offices in DC, Bethesda and Falls Church. Her number is [phone].

Here is what an RE can do short of IVF. I was diagnosed with a luteal phase defect. Supposedly, it is easy to correct with injectables. You could try that with timed intercourse or IUI. It didn't work for me but it doesn't mean it wouldn't work for you. The drugs and the monitoring were all covered by my insurance. (BCBS Fed) I go to Columbia Fertility. From what I've read on this board, SG does not do injectibles with TI, they will only do injectibles with IUI. I think the stats for IUI and TI are roughly the same so CFA allows the TI. You are monitored so closely so you won't become the Octomom if it works.

I would go directly to an RE. He/She will do a complete workup, which includes an HSG, an endometrial biopsy, blood work etc. It could be something simple. They may recommend going directly to IVF. You don't have to take their advice. At least you will be more informed. Also, I know most federal plans cover all the diagnostics. I can't speak to other insurance plans.

[Anonymous]

The other thing that an RE workup will do is sperm analysis. There might be issues with your DH, OP. A semen analysis tests for how many little swimmers your DH is producing, looks at how fast they're swimming and what shape the little guys are. Some over the counter cold medications can actually affect shape---and shape effects how likely they are to penetrate an egg for fertilization. And older eggs are sometimes more difficult to penetrate.

A good RE starts out with diagnostics and then recommends the least invasive approach that will get you a good result.

I also think an acupuncturist is a good recommendation. I had a much better IVF result re egg production and fertilization after going to the acupuncturist for 5 months.

[Anonymous]

GW has a small IF clinic that offers very individualized care. They also work a lot with older women. There are 3 RE's there. I LOVE Dr Frankfurter, Dr Gindoff has a strange bedside manner, but has a good reputation. The other RE is younger and a woman and seemed good too. My accupuncturist is Lisa Eaves (www.heal-from-within.com) her office is right near the Tentleytown metro. Good luck!!!

[Anonymous]

OP again. I am very interested in the location and comments about Dr. Frankfurter. I see he is with GW MFA. Does that mean I'd be doing all my testing and referrals internal to GW MFA. It's one reason I stopped seeing other doctors in that organization years ago.

[Anonymous]

I'm the PP who used to see Dr Frankfurter. His office is in the GW MFA bulding. I had my initial testing done at another RE's office (I initially saw Dr F for a second opinion before switching to him). But if you are starting with him, I assume he or another RE in that practice would do your initial testing (usually teh only test other than blood work is the HSG test and sperm analysis for DH). If you want to have someone else do your HSG, I assume they'd be fine with that. Bloodwork is either done in their office or in the general bloodwork area in the basement of the building (depending on the type of bloodwork). Once you are in treatment, you only see the REs there, no other doctors. When you are pregnant and released to an OB, I assume you can see whoever you want. Does that make sense?

Dr F is great, I highly recommend him. He has an amazing bedside manner for someone who is so widely published.

[Anonymous]

Anonymous wrote:GW has a small IF clinic that offers very individualized care. They also work a lot with older women. There are 3 RE's there. I LOVE Dr Frankfurter, Dr Gindoff has a strange bedside manner, but has a good reputation. The other RE is younger and a woman and seemed good too. My accupuncturist is Lisa Eaves (www.heal-from-within.com) her office is right near the Tentleytown metro. Good luck!!!

I second the comment about Dr. Gindoff. We used him for IUI and found him quite strange. He really pushed IVF too, even though I told him we did not feel comfortable with that. I appreciate that he tried to allay some moral concerns I had, but we (including my husband, who does not share my moral concerns about IVF) still thought he was very pushy with it. And he seemed very dismissive of adoption, which was the path we ended up taking. Granted, his whole business is making women pregnant, not creating a family through any means, but still...total turnoff. I really liked the nurses there though.