Karen, If the FSH was high, that might reflect a decrease in your available egg supply this month. When the ovaries don't respond right away, the brain responds by making more FSH than usual. Hopefully, that was a transient rise that will go back down. When a woman is in menopause (i.e. no eggs in the recruitable pool) then the FSH levels get very high. If you haven't checked, it may be good to measure your AMH level and to do an antral follicle count. If you are on estrogen therapy, then it can be hard to interpret the cervical mucous signs because one of the effects of estrogen is to increase cervical mucous. Interestingly, no one can look tell if a molecule is an estrogen by looking at its structure. We define estrogens as medications/molecules that have estrogenic effects, i.e. they thicken the lining of the uterus, increase cervical mucous, etc. You may not know if the changes are due to your own bodies estrogen or the estrogen that you are taking. It is good that you are in the hands of an RE to help you figure some of this out. I can get complicated and they have a lot more information than you are able to share with me. Sorry I couldn't be more help. Good luck! View Thread
Dear Baylee67, A good starting point may be to assess your ovarian reserve by getting a serum FSH and estradiol level between cycle days 2-4 and checking a serum AMH level. All women have a natural age-related decline in fertility that usually has little to do with how healthy they look or feel. Most women with unexplained infertility or an age-related decline believe in their heart that nothing is wrong until they have trouble conceiving. Your fertility at the age of 45 might be more like women that are younger but it is possible that you may not get pregnant with your own oocytes as well. Time is of the essence if you want to have a child. At the age of 45, the chances that a pregnancy will have trisomy 21 (Down's syndrome) has increased from about 1/300 at the age of 35 to 1/30 at the age of 45. If you don't conceive right away, you may want to do some soul searching about whether you are willing to consider donor oocytes or adoption to have a child together as a back up plan. Knowing what is an option or completely off of the table will help you in your discussions and a critical transition points. Good luck!View Thread
Dear Ready4Baby, Vaginal bleeding by itself is a sign that can result from many different conditions so you need to do a little more investigation. A late menstrual period can be a sign of a problem with ovulation, a miscarriage, an ectopic pregnancy, a normal pregnancy, etc. A pregnancy test is a great place to help you begin to narrow down the possibilities. If you are going to be overseas for very long, it may be worth your while to establish a relationship with an ob/gyn so that you have someone local to reach out to if you have a problem. Good luck! View Thread
Dear Curious, You are very insightful. Before we had pregnancy tests that detected the hormone hCG, doctors would give women progesterone and if they didn't have a menstrual period it was a sign that they might be pregnant. So checking a pregnancy test is a good starting place. If you are not pregnant, don't worry that happens some time. If you are trying to get pregnant and have to take the progestin every month then you probably still have a hormone imbalance that is preventing ovulation. Your doctor can do some tests to make sure that you have a correct diagnosis and then most likely he/she will prescribe something like letrozole, tamoxifen, clomid or another medication to help you start cycling (ovulating) on your own. Good luck! View Thread
The 0.025 mg patch should not be too much to interfere with your normal cycle. However, clearly something has changed. The patch may have nothing to do with the change in your cycles but you need to get evaluated by your gynecologist or reproductive endocrinologist to find out why you are no longer cycling. The cause of the arrest in your cycles will determine the best course of action. Until you start cycling again, the probability that you will get pregnant is very low. Good luck!View Thread
Dear Anxious & Confused, You are raising more than one issue that is worthy of discussion. First, it is important to know whether you truly had an ectopic pregnancy or was it a nonviable pregnancy of undetermined location. Years ago we used to diagnose an ectopic pregnancy by doing laparoscopy in seeing the pregnancy in the fallopian tube. Today, patients may be treated with methotrexate if we do not find the pregnancy in the uterine cavity and the hCG level does not fall. Some of these pregnancies are not ectopic pregnancies. The pregnancy might be in the uterus and we miss it with the D&C. If you have an ectopic pregnancy then you may have tubal disease and it may be important to evaluate your tubes with an HSG. Second, it is important to understand some basic principles about ovulation (i.e. releasing eggs). If you are not having regular predictable spontaneous menstrual periods without Provera then you are probably not ovulating, at least not on a regular basis. Your ovaries make estrogen during the first half of your menstrual cycle and they make estrogen and progesterone during the second half of your menstrual cycle (after you ovulate). If you are stuck in the first half of your menstrual cycle, i.e. not ovulating, then a menstrual period can be induced by simulating the second half of your menstrual cycle. This involves giving you the hormone that your ovaries are not making (Provera). It would be helpful for you to see your gynecologist again and talk about hormonal reasons that you might not be cycling and medications that may help you begin having regular predictable cycles again. The best news is that you are only 31 years old. As fertility specialists, we can correct many fertility problems but we can't (yet) make women younger. Good luck! View Thread
Having a tubal reversal is a big decision & I commend you for seeking advice first. If I were you I would seek the counsel of a reproductive endocrinologist or gynecologist that can help you assess your ovarian reserve & fertility potential. Our fertility potential changes silently over time. Second, I would investigate both tubal reversal and IVF as independent options. There are pros and cons to each. Tubal reversal allows you to conceive naturally. However, it is surgery and there is a recovery time. There is also the issue of having an increased risk of ectopic pregnancy and the possible need for reproductive assistance anyway. Also once you conceive you have the issue of contraception again. IVF has become much more successful in recent years & it does overcome some of the downsides of tubal reversal. The downside IVF is that your starting over if you don't get pregnant and use although oocytes that were retrieved. My advice would be to seek both personal and professional counsel. Good luck!View Thread
What you are describing is not that rare. There are two potential approaches:
#1 You can undergo an extensive evaluation and plan treatment that addresses all of the potential issues that are identified.
#2 You can make some assumptions about the most likely cause of your problem and initiate therapy without a complete evaluation. This would require you to have a trusting relationship with a healthcare provider who understand your situation.
What you are describing is most consistent with what the World Health Organization calls a type II ovulation disorder. Many doctors and patients refer to it as Polycystic Ovarian Syndrome. A more informative way of describing it may be functional female hyperandrogenism resulting in estrogenic ovulatory dysfunction. This is a fancy way of saying that you have a hormone imbalance involving testosterone and estrogen. Approximately 5% of the adult female population has some symptoms of this disorder making it the most common endocrine problem that women have. Normally women's ovaries secrete estrogen for approximately 2 weeks followed by estrogen progesterone for approximately 2 weeks. Women with this problem often get stuck in the first half of their menstrual cycles and secrete estrogen continuously. Estrogen is a hormone that causes the uterine lining to grow. Over a period of approximately 10 years this unopposed growth can lead to the development of uterine cancer , which you describe. This is often a fairly treatable cancer using high-dose progesterone under the care of a gynecologic oncologist if a woman wants to conceive.
In the absence of cancer, this progesterone-deficiency disorder can be treated with birth control pills, other progestins or ovulation induction to help your body naturally produce progesterone. This latter therapy would increase the chances that you would be able to conceive. There are a number of relatively inexpensive oral medications that can be used to try to induce ovulation if this diagnosis is correct.
Three medications that are commonly used for this purpose are clomiphene citrate, tamoxifen and letrozole. I would recommend that you develop a relationship with a healthcare provider that understand your personal circumstances and is willing to work with you within your resources.
The dose of estrogen that you are on should not prevent you from getting pregnant. However if you are not having regular predictable cycles with a positive ovulation predictor test at the right time, you may have a problem with ovulation that needs to be treated. I am currently treating a patient of mine with estrogen patches while I am also giving her ovulation induction medications to increase her chances of getting pregnant because she does not make estrogen on her own. You should see a gynecologist or a reproductive endocrinologist to help you evaluate your cycles, ovarian reserve, other endocrine factors, etc. Good luck!View Thread
I was almost afraid to respond to this question. However, it's a fun topic to ponder even though it might be opening a can of worms. The simple answer is no. However, experts from a variety of fields could organize an entire medical conference to discuss this question.
Identical twins provide a natural experiment to give us some insights into this question. Identical twins share the same DNA but develop into completely unique individuals. Why? One reason is that we do not express all of our genes. Some genes are turned on and some are turned off. This process is dynamic and appears to start shortly after fertilization and continues through our adult lives. In a sense, our environment influences expression of our genes. This is called epigenetics. Some environmental exposures increase our risk of developing cancer and others may lower our risk of developing heart disease.
This is an exciting area of research because it may be possible in the not-too-distant future to individually tailor medical therapies to individuals based on their known genetic code. For couples who contemplate using eggs from donors, it may also be reassuring to know that the maternal environment may influence the development of their unborn children.
I'm not sure what sparked this question, but it certainly gives us an opportunity to discuss some interesting ideas. Looking forward to see what follows.View Thread