When you first start working with a fertility clinic, cycle monitoring is done as it determines when you’re ovulating so your fertility doctor can figure out the best time for insemination or have sex – to ultimately increase your chance of a pregnancy.

Cycle monitoring is done for:

• Natural cycles
• IUI, where ovulation timing is determined
• IVF, to measure the number and size of the follicles
• Donor cycles, where uterine lining is determined in the recipient

Monitoring is typically done in the mornings to get the best glimpse of your hormones, and to determine how you are responding to any drugs you may be taking.

When does cycle monitoring start?

Cycle monitoring takes place in the first half of your menstrual cycle. It begins when you start your period, and are experiencing substantial flow, not spotting. You will usually need to visit your fertility clinic around days 2-4 of your period where blood testing and ultrasounds will be done.

What does cycle monitoring monitor?

Blood work measures estrogen levels, a hormone that’s necessary for follicular growth as well as development of the uterine lining. Your ovarian reserve is also measured because your doctor will be looking for 6 to 10 follicles that will continue to grow in the next few days.

Ultrasounds are also done to visualize the progressive growth of the follicles and lining. Right before ovulation happens, a dominant follicle should be about 20 to 24mm in diameter. This, along with hormones (estrogen and LH), will indicate that ovulation will happen.

What happens after ovulation?

At ovulation, the dominant follicle is released, and is basically waiting for sperm to fertilize it. Your doctor may give you a trigger shot of hCG to facilitate ovulation.

At this point, you will be told to have sex or an insemination is done once (or twice) to fertilize your egg.

Depending on the type of cycle you have, you might go back to the clinic in the luteal phase to measure your progesterone levels, or and ultimately determine if you are pregnant.

Final Thoughts

Cycle monitoring can be particularly stressful because of the frequency of visits, as well as feeling anxious about how your hormones and follicles are doing.

Because you have a lot on the line – time, money, hope, there’s a desire to get everything right. Do the best you possibly can to get the outcomes you want. Expanding your health team, potentially including a naturopathic doctor, may support and enhance these treatments.

It’s no secret that infertility is on the rise. Women often delay parenthood to pursue higher education, advance their career and attain financial security. Because of this, as their age increases, as does their use of assisted reproductive technologies (ART) to become pregnant.

Acupuncture and IVF

When someone is on the IVF journey, they often use acupuncture as an adjunctive treatment as it has been shown to help with IVF success. Acupuncture is helpful in a couple of ways as it:

• Promotes and increases blood flow to your ovaries and uterus
• Causes the release of neurotransmitters to your brain which increases ovulation, menstrual regularity and overall fertility 
• Reduces stress and anxiety associated with IVF
• Decreases chances of miscarriage
• Decreases side effects of medications

In fresh, non-donor cycles, studies show that using acupuncture was associated with more live births and fewer biochemical pregnancies (compared to IVF alone). In fresh donor cycles, adding acupuncture was associated with more live births.

In the previous study, they use more than just a defined set of acupuncture points. Treatment may also include herbs, dietary and lifestyle recommendations, as well as vitamins or minerals. This serves as a reminder that individualized medicine is important, and can result in the effects that you want (aka. a live birth). 

When should you start acupuncture?

Unfortunately, having acupuncture done before and after your embryo transfer only isn’t good enough. Yes, it helps to reduce stress (which is incredibly important, because IVF is stressful), but it’s not sufficient to improve birth outcomes.

If you can, it’s best to begin weekly acupuncture treatments at least 3 cycles before you begin IVF as this increases your chance of live birth. Definitely consider starting when you are in the down regulation phase (ie. taking lupron or birth control).

Next Steps

(Unsurprisingly) a Naturopathic Doctor can help you as you tackle IVF! Not only can we help you with acupuncture, but we also take the time to go over your diet, lifestyle habits, and any herbs and vitamins that you might be taking.

References

Prior, Eugenie et al. “Fertility Facts, Figures And Future Plans: An Online Survey Of University Students”. Human Fertility, 2018, pp. 1-8. Informa UK Limited, doi:10.1080/14647273.2018.1482569.

Hullender Rubin, Lee E. et al. “Impact Of Whole Systems Traditional Chinese Medicine On In-Vitro Fertilization Outcomes”. Reproductive Biomedicine Online, vol 30, no. 6, 2015, pp. 602-612. Elsevier BV, doi:10.1016/j.rbmo.2015.02.005.

Hullender Rubin, Lee E et al. “Acupuncture And In Vitro Fertilisation Research: Current And Future Directions”. Acupuncture In Medicine, vol 36, no. 2, 2018, pp. 117-122. BMJ, doi:10.1136/acupmed-2016-011352.

Did you know that tests exist to tell you how fertile you are?

It’s true!

Your ability to become pregnant depends on your chronological age and biological age.

Your chronological age reflects your current age, while your biological age is in reference to your ovarian reserve (the quantity of and quality of oocytes at a certain time point). Chronological age increases year after year, while biological age decreases year after year until menopause.

Fertility Testing

When women are undergoing infertility evaluation, a flurry of testing is usually done. This may includes particular tests like:

• Anti-müllerian hormone (AMH)
• Follicle stimulation hormone (FSH)

AMH and Fertility

AMH is produced by developing follicles, and serves as an indicator of ovarian function. An AMH greater than 0.8-1.0 ng/mL is suggestive of a normal ovarian reserve (the ability of your ovaries to provide eggs that are capable of being fertilized and resulting in a pregnancy).

Your AMH levels will gradually decrease after peaking at around 25. Around 5 years before menopause, AMH levels decrease below the detectable limit.

Studies have also shown that low AMH is associated with increased risk of miscarriage. Women with an AMH of 0.4% had over twice the risk of miscarriage, with the increased risk primarily associated with clinical pregnancy loss.

AMH does not tell you how many eggs you have left or give you information about your egg quality. Ideally it should be run with other markers (like FSH and estradiol).

FSH and Fertility

FSH is a hormone produced in the pituitary and stimulates ovarian follicles to grow and develop. In some women, the pituitary secretes a lot of FSH to get the ovary to respond. This usually happens when your ovarian reserve starts to decline. When FSH is over 10mIU/mL, it’s suggestive that ovarian reserve is in decline.

Overall, AMH decreases as you age and FSH increases as you age.

Testing AMH and FSH

If you are sent for testing to better understand your fertility, most of the tests will be done on day 3 of your period (ex. 3 days after you start your period).

FSH needs to be tested on Day 3, whereas AMH remains stable throughout your period. It’s independent of any other hormones (ex. FSH, LH and estradiol are usually tested together). AMH is also more predictive of hyper-response and ovarian hyperstimulation syndrome risk during IVF than FSH.

Next Steps

Getting your AMH tested may sound frightening especially as it tells you about your ovarian reserve – and this can cause a lot of undue stress in people hoping to achieve fertility. Nevertheless, this is something that your Naturopathic Doctor can test for you (and should be done with other tests to get a more representative picture of what’s going on).

Moreover, if you’re worried about your chances at a successful pregnancy, working with a ND may be worthwhile as we take a look at your diet and lifestyle habits, lab work, and more!

References

Iwase, Akira et al. “Clinical Application Of Serum Anti-Müllerian Hormone As An Ovarian Reserve Marker: A Review Of Recent Studies”. Journal Of Obstetrics And Gynaecology Research, vol 44, no. 6, 2018, pp. 998-1006. Wiley, doi:10.1111/jog.13633. 

Wang, Shunping et al. “Discordant Anti-Müllerian Hormone (AMH) And Follicle Stimulating Hormone (FSH) Among Women Undergoing In Vitro Fertilization (IVF): Which One Is The Better Predictor For Live Birth?”. Journal Of Ovarian Research, vol 11, no. 1, 2018. Springer Nature, doi:10.1186/s13048-018-0430-z. Accessed 13 Jan 2019.

Zamah, A. Musa, and Mary D. Stephenson. “Antimüllerian Hormone And Miscarriage: Fifty Shades Of Gray…”. Fertility And Sterility, vol 109, no. 6, 2018, pp. 1008-1009. Elsevier BV, doi:10.1016/j.fertnstert.2018.02.140. 

Zhu, Jieru et al. “Chronological Age Vs Biological Age: A Retrospective Analysis On Age-Specific Serum Anti-Müllerian Hormone Levels For 3280 Females In Reproductive Center Clinic”. Gynecological Endocrinology, vol 34, no. 10, 2018, pp. 890-894. Informa UK Limited, doi:10.1080/09513590.2018.1462317.