Your fertility questions answered part 3: case by case Featured

Hi Elphas!

In the third and final post of the three-part series, we’re answering your questions about different conditions or treatments that may or may not affect your fertility.

We want to give a special thanks to these Elphas who have shared their deeply personal experiences with us – know that you are not alone as your questions represent other women’s lived experiences, so we appreciate you opening up the conversation on these topics.

If you missed the first two parts, don’t worry, you can find them here: part 1 and part 2.

Q from @Kamala177: What age would you recommend to start with this kind of treatment if you suffer from endometriosis?

A: Endometriosis is a condition that affects many different systems. Oftentimes, women with endometriosis have trouble getting pregnant but can achieve a pregnancy with IVF rather than donor eggs or gestational surrogacy. Interestingly, pregnancy actually improves symptoms of endometriosis.

In general, treatment of patients with endometriosis should try to maintain estrogen levels as low as possible to avoid increasing inflammation associated with endometriosis.

Q from @AudreyRochas: What is your recommendation for someone who is 45, doesn't respond to stimulation, has adenomyosis, and has tried IVF with an egg donor thrice with no result? Is there anything that should be investigated?

A: I’m sorry you are going through this. Yours is a difficult situation that requires a complete review of your past cycles, embryo grading, and transfer protocols and lining development. If you are with the same clinic and physician, I would recommend a fresh set of eyes to review your case. Getting a second opinion doesn’t mean you need to change physician, it just allows everyone to get a new perspective.

Q from @Belle: I've come across a lot of contradictory information regarding conception and pregnancy with a bicornuate uterus. My doctor didn't give me much information about this when they diagnosed me with it, but I know of women who've had to go through IVF to conceive with a bicornuate uterus. I'm 29 and hadn't planned on having kids just yet, but now I'm concerned it's going to be more difficult to conceive. I'm not sure if this is in the same area as fertility issues, but thought I'd ask!

A: It may be worth speaking with a maternal-fetal medicine physician or fertility specialist with the MRI images in order to review your specific situation and risk. From a fertility standpoint, the risks are not around conceiving but more centered on risk of preterm delivery. In general, women with bicornuate uteri have smaller uterine cavities and there is less room for a pregnancy to grow, which can increase the risk for a preterm delivery or pregnancy loss.

Q from @Una74: I've been on an anti-inflammatory diet and hormone balancing path for several months. I haven't started TTC yet but I know being 38 almost 39, age is definitely a consideration. Whenever I think of ART/IVF, I envision so many needles because of the hormone shots! After coming off contraception and working very intentionally to balance hormones, I'm not so thrilled about then taking hormone shots to potentially throw off the balance of my hormones. Are there any "gentle" ART options available? Will ART always require taking hormones in some way?

A: ART does typically involve hormone modulations, although some patients may be better suited for a minimal stimulation or natural approach. Hopefully, your journey is easier and does not require aggressive hormone modifications or shots. Good luck!

Q from @Karen2: What do we know about the effects of a COVID infection on egg and sperm quality during the preconception phase? Is there a way to test for this? I’m just recovering from a mild case of COVID but my husband had a rough time with it last summer - sick for nearly a month. I’m nervous now about trying for a baby soon.

A: So far, data on covid infection and fertility is reassuring. Having covid in pregnancy does put you at increased risk of a pregnancy loss, so we do encourage everyone to get vaccinated.

Q from @Mistie8: Would you recommend the supplementation of DHEA even in cases where the ovarian response to IVF is not too bad (10 eggs retrieved, 6 blastocysts, of which (after PGT-A) two normal, two mixed and two abnormal - age 38)? Considering that currently both DHEA and total testosterone (according to blood tests) are both on the lower end of the recommended range (2.53 mcmol/l and 0.8 nmol/l respectively)? Is there any further warning/recommendation that you would like to give in relation to DHEA supplements?

A: The data around DHEA are mixed. In general, we do not advising supplementation unless there is a deficiency. These hormones are not static, which is why there are normal ranges. If you are within normal range, none of us recommend supplementing.