Thursday, August 13, 2020

One Good Egg

“Based on your health history, there’s no reason why you and your husband shouldn’t be able to conceive naturally,” my new, unnaturally perky OBGYN said. With her megawatt smile and lightly freckled face, she was too pretty to be smart and too optimistic to be experienced, given the horrific things that can happen during pregnancy and birth.

But my insurance only had one OBGYN practice in-network that specialized in infertility, and the clinic only had one doctor taking new patients, so this is who I got. Not that I'm complaining. My new doctor, who we’ll call Dr. Baby-Maker, was the friendliest practitioner I had ever met; it was hard to believe anything could go wrong in her presence.

So when she told me that I should have no trouble conceiving after my husband’s vasectomy reversal, I believed her. She recommended six months of trying naturally before investing in any tests or procedures.

“But…if you want to test your AMH, we can,” she conceded.

AMH stands for Anti-Mullerian Hormone, which is produced by ovarian follicles. Women are born with all the eggs they’ll ever have, so their egg stashes (or ovarian reserve) decrease as they age. AMH level is indicative of ovarian reserve. A robust ovarian reserve means a woman may be able to get pregnant faster; diminished ovarian reserve (DOR) means it may take longer to get pregnant naturally, that IVF may be less effective, or that pregnancy with one’s own eggs may not be possible.

An AMH measurement is an inexpensive and non-invasive way to measure fertility. All it requires is a blood draw. So I surrendered my best vein to the lab tech, who told me the results would take up to two weeks to come back.

I wasn't worried. I’d had no problem getting pregnant in the past. Granted, my last pregnancy was 15 years prior. But I’d been studying up on all things baby-making with the massive tome Take Charge of Your Fertility. I was already familiar with charting my cycle, but this took basal body temperature monitoring to a whole ‘nother level. (For the uninitiated, a BBT is taken immediately upon waking with an extra-sensitive thermometer. Over the course of a month, temperature patterns can indicate various infertility issues.)

So far, I’d had several cycles that, on paper, looked perfectly normal. I also had the tell-tale egg-white cervical mucus for a day or two mid-cycle. All these things indicated I was ovulating. Now I just needed to confirm that I had enough eggs with the AMH test.

Ten days after the blood draw, I had a hunch that maybe the results were in but my clinic hadn’t gotten around to calling me yet. I logged into my online patient chart. I was right. There they were.

The median AMH for my age group was 2.03.

My AMH was 0.24.

In other words: abysmal. I had the ovarian reserve of a woman on the brink of menopause.

I called my husband – and started bawling.

“My dream is dead and we haven’t even started trying yet!” I wailed.

Ever the rock, he said I should hold off on freaking out until I’d spoken with Dr. Baby-Maker. I decided to go for a walk to calm down, and just as I set out, a nurse called.

“Dr. Baby-Maker says your AMH is lower than expected but it’s not predictive of whether or not you can get pregnant,” she said in a flat, affectless tone that indicated that this was one of many times she’d delivered disappointing news that day. “It’s a relatively new test and is more often used to measure whether IVF will be effective or not.”

Among fertility experts, there is some disagreement as to whether testing AMH is helpful. On the one hand, it can estimate your ovarian reserve; on the other hand, it cannot predict your chance of getting pregnant. As any infertility homeopath will tell you, ovarian reserve is not about quantity, it’s about quality. All you need is one good egg.

How do you improve egg quality? A whole lotta lifestyle changes. Eliminate alcohol, caffeine, sugar, and processed foods from your diet. Remove as many plastics as possible from your environment. Do acupuncture. Reduce stress. Supplement with royal jelly, CoQ10, and DHEA (but only under a doctor’s supervision because you could do serious damage to your body). Drink red raspberry leaf, nettle, or chaste berry tea.

In anticipation of baby-making, I had already given up caffeine. I had stopped taking my allergy and acne medications. I ate clean, drank the teas, and limited my sugar intake to a small serving of dark chocolate daily. I never drank alcohol. I was doing everything right, so why was my egg supply so low?

I did what I always do when distressed – I went on a Googling spree. The best thing about the internet is that if you click long enough, you can find success stories for anything. Sure enough, I found a message board where women with AMH levels even lower than mine had gotten pregnant – naturally and/or with IVF, some with twins. So there was a sliver of hope.

“Isn’t it possible that the doctors know nothing and we can just try?” my husband asked later.

I tended to glom onto whatever doctors said and treat it like irrefutable fact. But facts are not always the same thing as the truth. And only God knew what the truth about our baby-making potential was. In this matter, my husband had more faith than me, which was unusual.

“We have to be courageous,” he said.

“I’m trying,” I replied. “But you might have to keep the hope alive for both of us.”

“I don’t know any other way to be.”

Dr. Baby-Maker’s recommendation was to test my AMH again at the start of my next cycle in case the low level was a fluke. But I didn’t need to get bad news twice. No, it was time for the big guns (or huge needles, as it were).

We scheduled a second opinion at an IVF clinic...

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