Elias Tsakos, FRCOG
Medical Director , Embryoclinic
Category:
Low Ovarian Reserve, Success Stories
I see couples who’ve had multiple IVFs, multiple failures, and they have adverse factors that have been undiagnosed from the simple stuff like low vitamin D levels, normal vitamin D levels have been associated with a lot of health issues positively, so we do need to optimize as much as we can. We don’t need to go over the top, we shouldn’t try to look for rare diseases, but we should ensure that harmonically the female and the male are properly checked. Checking the thyroid, having a breast assessment to eliminate any pre-existing breast cancer, which is becoming more and more common in women in their 40s or even before that. It’s also about ensuring that you’re up to date with smears, focusing not only on the ovaries, but also on the uterus to exclude any pathology of the tubes. I cannot emphasize enough the importance of pre-IVF tests.Low AMH and having lower ovarian reserve don’t mean that you’re sub-fertile unless you’ve tried and haven’t succeeded. It doesn’t have a huge relation with a spontaneous natural pregnancy, so if everything is normal and after 6 months or 1 year at the normal age of mid-thirties, you find low ovarian reserve, don’t be alarmed, it doesn’t mean that you’re subfertile, it may be important if you end up having IVF, but by itself, it’s not a factor of infertility, and it doesn’t hugely natural conception provided that everything else is normal. When you identify seriously abnormal AMH at a young age, it’s essential to proceed with further investigations, there can be an autoimmune disease associated with that. You need to try to eliminate any other associated factors related to low AMH. Checking autoimmune diseases like thyroid disease or other autoimmune conditions and it’s not over the top to request a karyotype testing, DNA genetic testing to ensure that the structure of the DNA is normal. It’s very essential to sit down with your doctors when they design the stimulation protocol for you based not only on your AMH but also on your antral follicle count, which most likely will be aligned with your AMH levels but also with your age, your weight, previous performance and stimulation, and by defining the successful outcome of stimulation, you get more confidence in the overall procedure and the outcome.
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