Navigating IVF/Fertility Treatments

Navigating the fertility world in BC is complex and I am here to help! As a fertility warrior I have worked with a few clinics in BC and can provide some resources to you. In today's blog I will go through how to see a fertility specialist (AKA a Reproductive Endocrinologist and Fertility Specialist). Often an REI will have trained in Obstetrics and Gynecology before continuing their fellowship to an REI program. These doctors have over 12 years of education and experience behind their belts - they learn the latest technology, techniques and so on to support fertility.

When to see a fertility specialist?

The general rule of thumb out there is if you have tried for 12 months and below the age of 35 then seek a referral to a specialist. If you are 35+ you can consider seeking guidance after 6 months. However, I always say more information is always better! I do not subscribe to the belief that you must wait these exact times to gather information. If you wish to understand your health status or any obstacles, I believe it is our right to ask and be given these tests. You can ask for these from your family doctor - you don't even need a fertility specialist!

Preliminary tests:

• Anti-Mullerian Hormone panel (AMH): this hormone is an indicator for our ovarian reserve. This level can show us if we have a high potential egg count, an average for our age or a low for our age. Remember, AMH doesn't mean you will not get pregnant! Its often the first worry women have when they see a lower than average number for their age. Remember we ovulate only 1 egg a cycle. Therefore, whether we have 50 eggs or 1 either way only 1 is ovulating that cycle anyhow. AMH becomes important in the context of planning your future fertility or for IVF. The less eggs we have the harder IVF can become and if we aren't ready for children but find out there is less eggs, this may prompt you to move the parenthood plans forward or consider egg freezing.

  
  

• Day 3 cycle labs: FSH, Estrogen, LH: these hormones are a good indicator for your fertility health and timeline! On day 3 of our cycles, our estrogen and LH should be low. As our cycle continues these levels will rise. FSH (Follicle Stimulating Hormone) is what drives the growth of the egg each cycle. You want to see an FSH below 10 IU/ml. When this number starts rising well above 10 this could indicate perimenopause. But further tests need to be run by your endocrinologist. FSH is the gas pedal to growing the eggs. Think of it like this, if our foot is already on the floor of the gas pedal (AKA very high FSH), we cannot press further on the gas to go faster. If FSH is too high it makes it challenging for the stimulation medicine to work. Having a low FSH is great for IVF because your pedal might be slightly tapped and as you take the stimulation meds or just wait for natural ovulation, the pedal is slowing bearing down for ovulation.

• Day 21 Progesterone: this is an important hormone to check! You want it to be above 20 to indicate your body has ovulated (or attempted to ovulate). According to Naturpathic Doctors, a 30+ is most ideal to indicate a strong ovulation and strong progesterone support for the luteal phase. However, many women have different ovulation dates/luteal phases so this is a good test to learn when you are really ovulating and do you need a bit of progesterone support (if you have a short luteal phase).

• Testosterone/DHEA/Sex Binding Hormones: this can help determine if you have too high of these levels or too low. Sometimes when they are too low it negatively impacts your follicle counts. Sometimes women with low AMH take DHEA or even androgel to boost these levels. However, for women with PCOS this is good to know in case your levels are too high and support is needed to regulate these hormones.

• Thyroid Panel: seek guidance from a naturopath! They are so well versed in TSH, T4, T3 and the full panel for optimizing thyroid. A general rule of thumb for fertility is to have TSH 2.5 or less. An ideal level is close to 1 for fertility. You may also ask about thyroid antibodies testing in case you are worried about Hashimoto's or Graves disease.

  
  

Making the move to an REI?

You will want to ask your GP/Family doctor to refer to one of the BC clinics (Olive Fertility, PCRM or Grace Fertility). You can also self refer but there is generally a fee of $200. If you do not have a GP/Family doctor, you can go to a walk in clinic and request this. Be prepared to advocate for yourself - that you have tried for X amount of time and need help.

Since there are only 3 clinics in BC right now, and millions of people, the waitlist can often take anywhere from 1-4 months based upon your history and urgency. I believe clinics often prioritize extremely low AMH patients or patients who have faced multiple miscarriages already. But either way you will be seen in short order.

While waiting for your initial appointment, focus on the things you can impact yourself.

• health and wellness: show up for yourself! Be your best you, whether that means starting your fitness plans, eating a little healthier or starting a mental health meditation practice

• limit alcohol (sperm and egg quality!)

• limit or stop any smoking. Smoking cannabis or cigarettes has been shown to decrease sperm and egg quality

• Look into supplements such as: Coq10, Vitamin D + K2 (we are all so deficient), Omega fish oils (anti inflammatory), NAC, NMN, Glycine, Resveratrol, Vitamin C, Vitamin E, Folic Acid, Prenatals. (Talk with your medical providers and do your own research before adding anything. These are just suggestions to look into)

• Mindset! This is a stressful time, but as we know stress is not helpful for our health. But its easier said than done and its also the most annoying comment to hear! "Just don't stress". Try and find a practice or support system - whether that means yoga, meditation, therapy or a mantra. Often reminding ourself that in this moment we cannot change what the future holds and to just focus on the here and now is all we can do to calm the system.

Final thoughts...

If you need any guidance or support during this time, please feel free to reach out to me! I am happy to share my experiences and recommendations and offer encouragement. Remember, that the best things in life often take some hard work. You are amazing <3