NIAW: IUI and IVF
In this post, I wanted to talk a little bit about fertility treatments. My husband is completely clueless when I start using all these acronyms. I'm talking about my LH and my BBT, making an appointment with the fertility specialist who is likely going to perform IUI first, then maybe IVF, but I'm not really sure yet because of COVID-19. I already posted about LH and BBT. So in brief, LH is luteinizing hormone. Women need an LH surge in order to have ovulation. No LH surge, no ovulation. This LH peak is measured by urine strips in kits called ovulation prediction kits (OPK). The BBT is the basal body temperature. This is the body temperature measured first thing in the morning before any activity. After ovulation, the rise in progesterone causes an increase in a woman's BBT. This is a way to confirm ovulation and determine the length of a woman's luteal phase. When I start talking to my husband about fertility treatment, he says what is IUI. IUI is intrauterine insemination. Intrauterine insemination (IUI): A thin tube (catheter) carries sperm directly into a woman's womb (uterus) through the vagina. Often, the woman must take fertility drugs to help her ovaries produce one or more eggs. This procedure can be done with sperm from a partner or donor (when the male is infertile or when the female is single or has a same sex partner). Depending on what your fertility specialist thinks, after diagnostic testing, they may start with IUI before moving on to the more intensive IVF. What is IVF? IVF is in vitro fertilization. The production of an embryo in a petri dish. The eggs (oocytes) are harvested from the woman, and assessed for healthy appearance, then placed in a petri dish with the man's sperm - voilà - making embryos. It's not an easy process though. I can tell from my experience during my Master's work in cattle. Our retrieval rate was about 60% (if there were 20 follicles total, then you retrieved 12 eggs). The retrieval rate in women is different than cows, and depends on the skill of the practitioner, and the balance of risks associated with aspiration. The rate of retrieval is different than the antral follicular count (AFC). The AFC is dependent on the women's ovarian reserve with AFC decreasing with increasing maternal age. AFC is also positively correlated with AMH (anti-Müllerian hormone). Which is a simple test of ovarian reserve that a woman can get. If you think about it this way, the lower your AMH is the closer you are to menopause. Another thing in the reproductive lab that is important is the blastocyst rate - that is the number of embryos that develop to the blastocyst stage - the stage where you can transfer the embryo to the womb for implantation. The blastocyst rate is also multifactorial - both from the skills of the laboratory technician, the genetics of the woman and the man. Women below the age of 40 may have a blastocyst rate of about 40%, while women over 40 have about half that. If you can recall from my previous post where I talk about the fertilization of the egg, and that you need a blastocyst in order to have implantation? If your embryos are not healthy, they will not develop to the blastocyst stage. You will have fewer transferable embryos. It is a lot of work and a lot of stress leading up to that date. I personally have not experienced it, but I know women who have. Women of an older age are more likely to get a successful pregnancy if they can get a donor egg from a women who is younger. It's just a fact of science. Some women who are career driven will prepare in advance and get their eggs harvested while they are young, frozen in the laboratory and stored until they are older and ready for a family. However, this is also costly, and not something that is covered by your provincial health - unless you have a medical condition like ovarian cancer. One of my colleagues and I were discussing this years ago, both of us in our early-mid 30's. At the age of 36 would you want your 32-year-old eggs? Being in a working group of theriogenologists - reproductive experts - they thought at 36 you may still be ok. Now, if you were 38 - then you are going to want your 32-year-old eggs. So that begs the question - To Freeze or Not to Freeze?? If I had the money at 31 before going to vet school - I would have frozen my eggs. But vet school is expensive. So, I'm stuck! Only time will tell whether or not we are successful.