Sunday, December 13, 2015

My acupuncturist's advice

I’ve been doing acupuncture with someone who specializes in infertility for a long time.  (I started when we cycled with our son.)  She has A LOT of opinions about fertility based both on her training as an acupuncturist and her experience with all of her many, many patients going through infertility / IVF.  Up until this point, I’ve really only relied on her for acupuncture.  But after my most recent failure, she wanted to sit down and talk about a two-month plan to build up my lining before the next cycle starts, and to discuss some ideas for what we should do now that we’re looking at our last two embryos. 

Basically, she thinks my lining is crap and we should be working on building it.  She knows that we’ve met the bare minimum threshold for my clinic, but definitely thinks a thicker lining is better (and science supports her:  I have to say, my period after our last failed cycle was SUPER light.  (Like, I definitely could have gotten away with just using panty liners.)  Again, a light period is nice from a lifestyle perspective, but not great for getting pregnant.

Here’s her thinking / advice both to build my lining and to use any hail Mary strategies:

Diet (build lining)
·        Red meat once a week (I basically do not eat red meat now)
·        Eat egg yolks a couple times a week
·        A glass of red wine 3-4 times a week until starting birth control is fine, but more alcohol than that is undesirable

Exercise (build lining)
·        Moderate exercise is fine, but no heavy sweating (hot yoga is out, running more than 2 miles is out)

Supplements (build lining)
·        Prenatal vitamin
·        Fish oil
·        Baby aspirin
·        She also suggested two kinds of herbs (stop when go in birth control)
o   Wen Jing Pian – 6 pills 2 times a day (
·        And I’m going to stay on my CoQ10 and super doses of folic acid

[As a side-note, following these protocols means I am taking THIRTY pills a day, some of them quite large in size: 1 prenatal, 1 fish oil, 1 CoQ10, 1 baby aspirin, 10 folic acid, 4 green dragon, and 12 wen jing pian.  To avoid having my liver poop out, I’ve cut my inositol for now.  I’ll start it when I start on birth control and drop the supplements.  I’m also thinking about taking Wobenzym N, but that’s a post for another day.]

Acupuncture (build lining)
·        Weekly until birth control starts
·        2x/wk acupuncture during cycle

We talked about how we know our last three fails were all female embryos, and now we have a decent quality boy and a poor quality girl remaining.  She suggested using the boy next time, as maybe there was something with the female embryos that was not right / my body did not like, and obviously we have a better chance of success with the better embryo.  She also suggested that, even at this point, she still would just put one in, because we know they are chromosomally normal. 

·        Heparin 
·        Prednisone 

We talked a fair bit about the last two bullets.  She’s not a medical doctor, but she said that in her 15 years of doing fertility acupuncture she’s had maybe five patients that met the standard of having a “clotting disorder,” but many more of her patients’ doctors chose to put them on heparin after multiple unexplained failures.  Same with prednisone—she actually knew A LOT about the drug (I happen to know a fair bit about it from my job, and her knowledge was dead-on) and acknowledged that it’s a dangerous and powerful drug, but said that at this point if it were her, she’d be having serious conversations with her doctor about it.  She also noted that a number of her repeat failure patients are on it.

Sooo, we have an appointment with our RE in January.  I’m going to generally follow her diet, exercise, supplement, and acupuncture recommendations.  I will talk more with my doctor (again) about the meds.  I need to read more about them first….

With respect to which embryo to use next, my husband and I are going to discuss, but I think she might be right.  As much as I would love to have a daughter, I’m not sure I’m meant to be the mom of a girl…. Or the mom of a second child.  (My heart broke a little the other night when my son asked me “when am I going to get a baby sister?”)

Saturday, December 12, 2015

Predicting success part 3: SART’s predictions of success

The Society for Assisted Reproductive Technology also has a simple chart for predicting success:

Based on my age, weight, height, prior pregnancies, full term birth, and diagnosis [unexplained], it suggests the following ism my chances of success for a live birth:

Probability of live birth after one cycle is 37%
Probability of live birth after two cycles is 56%
Probability of live birth after three cycles is 70%

One Cycle with One embryo:
Probability of live birth is 34%
Risk of multiple pregnancy is 1%

Two Cycles with One embryo:
Probability of live birth is 51%
Risk of multiple pregnancy is 2%

One Cycle with Two embryos:
Probability of live birth is 46%
Risk of multiple pregnancy is 31%

If I change my diagnosis from unexplained to tubal problem, my chances of success fall slightly.

Note that SART predictions are a little more optimistic than some of the other ones.

Tuesday, December 1, 2015

Predicting success part 2: blastocyst quality

No big surprise, the SART grading categories are highly correlated to success:

Good is considered AA or AB.  Fair is considered BA, BB, or BC.  Poor is considered CB or CC. 

In this article, over 60% of “good” embryos implanted, and over 50% resulted in a live birth.  Just under 50% of “fair” embryos implanted, with over 35% resulting in live birth.  They had few data points for the “poor,” but none of them worked.  (I’ve read some clinics will not freeze poor quality embryos because of their low chance of success.)  Now I’m re-thinking my guesses at what my embryos were rated.  My lab says it has at least an 18% pregnancy rates with B3s, which suggests B3s are better quality than CC.  Maybe BC.  (

Here’s another one that breaks it down further:

“From the results, the pregnancy rates of AA, BA, AB, and BB for patients <30 years of age were similar and there were no significant differences. The pregnancy rates of AA, BA, and AB tended to be higher than that of BB for patients 30-34 years of age, and this tendency was observed for the patients 35-39 years of age.”

“The pregnancy rates of blastocyst grading AA, BA, AB, and BB for the patients who were more than 40 years of age were 61.9, 54.5, 38.7, and 17.6%, respectively.”

So if you’re young, anything with an A or a B will do.  If you’re old, you definitely want As, and all Bs are bad news.

Okay, and here’s an article that suggests, unsurprisingly, that better-quality embryos were more likely to be chromosomally normal:

Blastocyst grade
Chromosomally normal

They also give you a chart regarding which one you should choose.  Basically AA = BA > AB > BB

I would be interested in knowing what my embryos would be considered rated using these standards.