QuestionQUESTION: What are my chances to get pregnant?
Age factor = 40
Day 2 FSH =checked four months 5 - 7 range with one high month at 9.2
Day 2 Estradiol = 47
LH = 3.9
AMH = 1.1
Antral Follicle counts are low - range between 3 - 9 each month
Day 21 Progesterone = range between 15.6 - 30.4 (high)
27 - 28 day cycle always regular, 14 day luteal phase.
2-3 days of blood flow medium to light (always been this length).
Other health cholesterol, thyroid, blood pressure etc all very good.
no endometriosis, open tubes, normal uterus
3-4 days of (plenty of) fertile cervical fluid at / prior to ovulation.
feel "ovulation pain" and can tell which ovary - left side seems to be dominant.
one issue i have noticed in bbt charting is that I get an LH surge (using OPK) on day 12 - but it is for a very short time, only 6 hours. I have to test twice a day to catch it on the test. I get a temp dip on day 13. It then takes a slow rise over 6 days for me to reach a high temperature. On 7 dpo I test for progesterone and it is high - so corpus luteum is functioning. I cannot find a reason for this slow rise - except two references.
Traditional chinese medicine attributes this to poorer egg quality issues. Western medicine reference possible low progesterone / short luteal phase problem - which does not seem to be the case with me. I would like to know if this could mean I am having a short / weak LH surge, causing slower degradation of follicle surface and egg is releasing from the ovary too slowly - instead of "bursting" out it is seeping out, possibly being more than 12 hours old by the time it emerges and diminishing chances of conception. Is this a possibility? Would getting a trigger shot for ovulation with monitoring be able to help with this?
Would you say that such a slow rise in temp after ovulation indicates problem at ovulation?
I greatly appreciate your thoughts on this.
ANSWER: Hello Cara from the U.S.,
Thanks for providing all the information. It all looks very good and shows that your ovaries are functioning normally. That part does not seem to be the problem, and I doubt that you have a "luteal phase" defect. I don't think that monitoring or an HCG trigger shot will increase your chances in any way.
The major problem that I see is your age. At 40 years old, your eggs have now aged 40 years which means that they have slowly degraded in quality. We call that the "age related egg factor". Therefore, the majority of eggs that you are ovulating are going to be abnormal/poor quality. We know through IVF embryo testing that at age 37, only 20% of embryos produced are genetically normal. It is worst at 40. So even if your body does everything properly and physiologically normal, as you have been, you will have a decreased chance of pregnancy due to egg quality. Because of this, your natural chances of pregnancy is approximately 10% per year (<1% per month). With IVF the chances will rise to 44-50% per attempt because IVF will allow you to recruit, and extract, more that one egg at a time thereby increasing the chances of finding a good egg in the pile. It's just increased statistical chance. If you were my patient, that is what I would recommend as your best treatment option. The alternative would be to do IUI with superovulation i.e. using fertility medications to get you to ovulate 3-5 eggs per cycle, using the ultrasound to time ovulation and injecting the sperm preceding ovulation.
Checking your cervical mucous and BBT are of no real value since you are so regular. Remember, the physiology is not the problem. Your ovaries and reproductive system are doing what they are supposed to do. It's just a matter of getting a good egg.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
---------- FOLLOW-UP ----------
QUESTION: Thank you! I can see that I packed a few questions into one message so I appreciate your directness!
IVF does seem to offer the most options for the goal of getting pregnant, especially to try to assess embryo quality.
But still not much greater pregnancy rates -
I have found rates < 5% chance of natural pregnancy at 40 yo, and finding success rates between < 6 - 12% statistical avg for 40 yo age group with IVF.
(unless doing ivf with a donor egg).
As far as statistics go, I was very much hoping that my overall good health (late menarche start date and late menopause in my family) would give me slightly better chances of being in that 5% group, but i cannot seem to find any proof that this can help me.
I have now also noted some tests comparing rates of natural LH surge to HCG shot induced ovulation, with no clear determination that triggering ovulation increases success rates - so thank you on that answer as well.
Meanwhile, I am still looking for answers to this discrepancy I am noting at my ovulation - I began doing the BBT charting because I noticed that the OPK test timing and my sense of ovulation seemed to span a whole week. The BBt chart seems to confirm this "grey" area - I still cannot find any information on why I can get a weak or short LH surge on day 12 but not a full temp rise until day 20. So there seems to be some unexplained delay happening around ovulation - I just don't have the knowledge how to find the answer. I would like to learn an answer for this so I can better understand my body regardless of whether I go now to IVF (or Clomid et al).
This will be my fourth month TTC, and of course I wish I had learned about this much sooner, but it has been a fascinating education all the same. Thank you if you have any light to shed on this particular issue regarding ovulation. And thank you for making yourself available to answer questions online!
AnswerHello Again,
The problem with trying to evaluate your ovulation with OPK vs BBT is that neither of these tests confirm ovulation exactly. That is, the OPK measures the LH surge but ovulation can be delayed for up to 52 hours. The BBT measures the progesterone rise, but again does not show when ovulation occurred. Therefore, no conclusions can be drawn from their comparison.
Pregnancy rates of 5-12% is very low now-a-days. If you look up the CDC results (the latest is from 2007), based on the age of 40 years old, it shows the pregnancy rate to be 24.6% and live birth rate at 17.1%. The Society for Assisted Reproductive Technologies shows more current rates from 2008, and for 40 year olds it is 30.3% PR and 28.2% LB. So you should look for a clinic that at the very least, meets these thresholds.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
