Wow. I’m definitely tagging this post ‘emotional rollercoaster’. I thought my next post was going to be a list of the reasons that I’m fine with our child-free lifestyle, but right now I’m excited to be contemplating assisted reproduction as an option for the first time ever. All due to a fairly amazing article that was published this week. I managed to get a full-text copy of the article today and just finished reading the whole thing right now. Hopefully I can quickly get all of my swirling thoughts down in this blog post, because my head is buzzing right now!
First, let’s just back-track to over a year ago when I first got my AMH (anti-mullerian hormone) tested. We’d been ‘trying to conceive’ or at least not worrying about contraception for a while, so we suspected something was not quite right. I was reluctant to bother with a specialist. In the end my curiosity got the better of me. I was soon hit with the ‘whammy’ of an undetectable AMH result*, with my doctor concluding that I was very unlikely to have my own kids, although donor eggs may be an option (something I had never considered, or even thought about in general). Along the way I’ve had various feelings about the way that that piece of news was broken to me. These have ranged from disappointment to some degree of respect for the doctor’s professionalism. The one thing I wouldn’t want would be false hope.
In the mean time I’ve done lots and lots of learning, trying to understand what my own personal situation might be. There have not been many answers. There have certainly been times when I’ve thought my efforts have been for very little gain. There is a mountain of material to sort through and I kept reading and I kept coming back to the same conclusion: “Well, I don’t know why my ovaries are inactive, it could be various reasons, I don’t have any of the proven causes, but I know that this is not menopause and that there is the potential of a healthy egg developing”. I know that I’ve learnt more than my doctor about this particular situation. That’s a politically contentious thing to say right there, but it’s true that sometimes patients can be their own advocates. Anyway her attitude was that I should consider my ovaries done and dusted. During my learning I’ve constantly reminded myself that this may be the case (even though I still have the occasional period). I also didn’t want to be too cynical and just assume that I was turned away from the clinic so as not to harm their success rates.
Therefore, reading the new article from Seifer et al. was somewhat of a revelation. They looked at women with ultralow AMH results (what used to be classed as ‘undetectable’), just like me. And found that the success of a live birth from an ART cycle (using Assisted Reproductive Technology, such as IVF), was 9.5%. What?!? The authors state this is a surprising finding, and on the one hand I am surprised and on the other hand I am not at all surprised.
9.5% is a favourable number. Right now it seems like a huge number to me. Perhaps after I let this all sink in I’ll feel differently. But this is the comparison that should be made: These results (from the US) are from 2012-2013. In 2012 the comparable success rate for ANY woman in my age range (35-39) in Australia or New Zealand undergoing ART was 17%. I’d been led to believe that my chances were much much lower than other women (with normal AMH levels), but in fact they might be a little more than half of the normal success rate. It seems to come down to clinics thinking ‘more eggs are better’. Seifer et al. confirm that women like me have pretty unresponsive ovaries and if we try to stimulate them we’d be lucky to get one or two eggs out. More than a third of the cycles (38.6%) that they looked at were cancelled prior to retrieval. In other words, follicles did not grow to a big enough size to suspect that a mature egg was available. This is certainly much more likely to happen to women like me. And because not many eggs are produced from women like me, not many of the women had ‘spare’ embryos available to freeze for future transfer attempts. But when some women did continue cycles with frozen embryos the success rates were totally comparable to women of a similar age. This point was not surprising to me, but it provides evidence that our problem is spitting out enough eggs, and not anything else (eg. our eggs are not ‘aged’). And historically there has been an emphasis on ‘the more eggs the better’. Thankfully the message is now shifting to ‘you only need one’.
Next steps: I need to get a new appointment with my doctor and she what she thinks of all this. If I get any funny answers I’m getting a second opinion. Some people have urged me to get one before now, but I’ve known that good data to show I have a chance has not been available (till now!). Then I need to confirm the costing side of things. Yes, the money aspect is important to me, but no, I don’t think it’s shallow or selfish.
What do you think? Is an almost 1 in 10 shot worth it? Oh, and one kind of funny thing that I noticed in the article: Of the cycles that resulted in live births (they had a baby!) those women were, on average, 36.8 years old. Age has always been known to be the most important indicator of success. My birthday is a little less than two months away, so I’m just over 36.8 years old 🙂
Side-note: clinics in Australia are not obliged to make their success rates public. If you check the websites of the major clinics here they’ll proudly claim their success rates, but beware!, they usually state ‘chances of clinical pregnancy/live birth per transfer’. The success rates I have quoted above are per cycle start. This captures the data on how successful the stimulation part of the procedure is. There are many types of stimulation routines these days, and some will work for some women and not others. My chance of success ‘per transfer’ would be similar to a woman of my age with unexplained subfertility/normal AMH levels.
*To recap; ‘undetectable AMH’ used to refer to < 0.16 ng/mL (unit of measurement used in the US) or < 1 pmol (unit of measurement used in the UK, Australia and elsewhere, also written as pmole/L). The conversion between the two units is about 7.14, i.e. 0.16 ng/mL = 1.14 pmol. Now there are more sensitive assays that measure lower amounts of AMH in your blood, but anything below the old limits of detection is very very low (unless you are over 50, in which case it’s totally normal).