Trying to Conceive at 42 and Sustain a Pregnancy

by Barbara S
(Toronto, Ontario)

Hi Amelia,
My husband and I were trying to conceive for 5 years before getting pregnant. I was taking my BBT (although I admit I wasn't sure what I was doing) and we made love every other day. In January 2008 I got pregnant which ended in a miscarriage 6 weeks 2 days later.

We decided to see a RE. After blood work, a sperm analysis and a sonohysterogram, we were diagnosed with unexplained fertility. The RE prescribed Letrazole 2.5 mg Day 3 to Day 7 and timed intercourse the first cycle which ended with a BFN. The second cycle I was prescribed Letrazole again (same dose) and an IUI which turned out positive. I was 39 and gave birth to a healthy baby boy at 2 months shy of my 40 the birthday. I had a c section.

Anxious for another we went back to the RE for #2 when our son was 8 months old. We went straight to Letrazole and Puregon injectables 75iu. The second IUI was positive although I miscarried 6 weeks 6 days later (May 2011). Still desperate for a second child we went back for a 6 more IUIs, which all failed. The RE said the next step is IVF but we can not afford this treatment.

My husband and I decided to try naturally so I looked at my lifestyle and made changes: I started to take and record my BBT with assistance from Fertility Friend. I lost 26 lbs, since January 2012,

I started to see an acupuncturist specializing in fertility weekly since April. He was able to reduce my period from 34 days to 30 and it is now a bright healthy red colour, little or no clotting and not as heavy as it was prior. It lasts 4 days vs before it lasted 6 days. I no longer have brown spotting at the beginning of my period and my cramping has gone done. I reduced my coffee intake to one cup a day from 5 and started taking herbs and supplements.

We went back to my RE and asked to do more treatments, so last month we completed another IUI with Letrazole, Puregon 150iu and menopur 75 ml and the ovidrel trigger .... all which resulted in a BFN. My follicles on Day 11 were right : 2.5, 2.2; 2.0 and left: 2.9, 2.5, 1.5. Also I am not confident that IVF will work as the sonohysterograph resulted in no polyps, fibroids and my tubes are open. The sonohysterogram also stated my uterus in anteverted and possible adenomyosis. In September my Day 3 stats were FSH was 10, e2 was 84. I also had my AMH tested in December 2011 and it was 1.1.

I would like your professional opinion do you think IVF is the right treatment for us?

Thank you,
Barbara

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Trying to Conceive at 42
by: Amelia Hirota

Hi Barbara,
You're at the cusp with trying to conceive at 42. We know that your body was able to conceive relatively recently, so that is positive news. However, between the recent pregnancy, the c-section and the repeated fertility cycles, I'm concerned that your body may be overwhelmed.

While the size of the follicles were very good in the cycle you detailed, we don't know the quality of these follicles and that's what's important. Fertility drugs can force out large follicles, but are all of the necessary components of the follicle in good, working order? That's why we're made to just ovulate 1 egg per cycle optimally. The body is relatively confident that it can get it right for 1 egg at a time.

The results that you're getting with your acupuncturist and your lifestyle changes are phenomenal. Very impressive!

It's hard for me to make a blanket statement as to whether or not IVF is the right treatment for you. I'm concerned about the amount of fertility treatments that you've already undergone. You just had a fantastic IUI cycle and didn't get pregnant.

I don't think that your body is currently making great follicles on the meds. You did get lucky with your first IUI, when you conceived your son. However, you've had multiple cycles with meds since then without conceiving. These drugs are not benign substances, so being mindful of this is important.

Also, you mention that you can't really afford IVF, which is another concern. It's very stressful to throw money that you don't have at a super expensive procedure, where there is no guarantee of a healthy pregnancy. I lean towards adoption in these situations, as at least there is more of a guarantee.

Studies show that women over 40 have a better chance conceiving naturally, than with fertility drugs. Maybe doing some salivary hormonal testing with your acupuncturist will yield some answers as to how your hormones are performing and what are your chances of conceiving naturally.

Lastly, I'm wondering about the sperm, since you didn't conceive in 5 years of TTC with BD every other day after getting married. Your first cycle on meds was timed intercourse and your second cycle on meds was with an IUI and that's the cycle you conceived. This makes me curious about the sperm. I realize that you just did an IUI and didn't conceive, but this is only 1 cycle and it's hard to draw firm conclusions from 1 cycle.

I'm sorry that these complex questions often don't lend themselves to crystal clear answers. It's a tough call when you're longing for another child. I know. Write back with your sperm numbers if you like and I'd be happy to discuss this further with you.

Sending Lots of Babydust Your Way,
Amelia

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Sperm counts
by: Barbara S.

Thank you for the informative reply. I did forget to mention my husband's sperm count: in the last IUI in September the prewash count was 55 million, the post wash count was 84 million, the progression is 3+ and the motility is 3+. This is one of the lower counts my husband has produced. Although my RE stated 20 million is considered adequate.

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