Our RE just made me feel like we are "barren"...completely shocked and a little lost

[deojames]

We finally finished all of the initial testing for our RE. He said everything looked normal besides my husband's relatively low morphology level and my relatively low AMH level (1.7 at almost 33 years old). Basically, he told us it was pointless to do anything other than IVF.

I only went in to see him because of my irregular cycles post covid vaccine, but now we're here. Would you get a second opinion, or are most REs just IVF pushers? I'd really appreciate hearing the experience of others, as I plan to reach out to my actual OBGyn, but am in such a daze right now.

EDIT: My bloods:

AMH: 1.7
FSH: 6.01 miu/mL
TSH: 0.740 (currently on meds for hypothyroidism)
LH: 12.1
Estradiol: 50.9 pg/mL
Vitamin D: 30.7 ng/mL
Testosterone: 12.5 ng/dL
Progesterone: 12.9 ng/mL
Free T4: 0.844 ng/dL

Hubby SA

Volume: 2.8 mL
Concentration: 14 million/mL
Motility: 70.5 % million/mL
Forward progression: 2+
Total count: 39.2

Ph: 8.3
Viscosity value: 2+
Motility rate: 2+
Concentration: 9.87
Total count: 27.64

Strict Morphology: 1

 

[bornagain54]

@deojames I can tell you that as someone who has been seeing an RE for 3 years, our RE has never pushed IVF on us until we were ready. My RE did a great job making sure we knew how hard it would be.

I don't think this is normal and I'm sorry that was your experience. There are cases where REs do expedite IVF for other factors such as DOR.

As a side note, I'm surprised you were able to get into an RE so quickly. I had to wait several months for my first initial appointment even after being referred to them.

 

[ahcadvocacy]

@deojames Given your age, duration trying, irregular cycles and test results, I disagree with your RE and believe you have a good chance of spontaneous conception. REs have a very limited tool set - the most effective, fast, and expensive of which is IVF. Pushy is not unheard of, especially because willingness to treat people who are likely to have good outcomes can inflate your SART scores and leave your good reviews. Wah wah. In my humble opinion, a better RE might have told you to come back for testing at 6 months or a year.

When did you come off hormonal birth control? I ask because irregular cycles are very normal common of hormonal birth control, and while there is little evidence that it suppresses AMH in the long term there is a bit of evidence (https://www.ajog.org/article/S0002-9378(21)00685-2/fulltext) it can interfere while you're on it.

Also, does your husband have any lifestyle risk factors that could be hurting his sperm? Smoking, steroids, working in a hot place, etc?

I am not an embryologist. I'm just a filthy infertile who does a lot of homework.

Linking relevant wiki stuff.

How long does it take to get pregnant?

And this one, very surprised nobody linked it, at least for the crowd who is now freaking out about AMH. Fertility testing and 'answers'

 

[deojames]

@ahcadvocacy Thanks for your reply! I had been off of hbc for about 6 months when things went wonky. I got the COVID vaccine, didn't get a normal period again until fall, when I was also put on meds for hypothyroidism. I think the reason I was sent to RE is because there were a lot of complicating factors at play. I truly wasn't expecting the conclusion to be IVF or bust

 

[ahcadvocacy]

@deojames The immune response from vaccination can cause an odd cycle, but, hypothyroidism explains it better. It can take awhile for thyroid meds to work, but given that you ovulated this cycle and your husband's SA is middling I would not be ruling out spontaneous conception.

 

[deojames]

@ahcadvocacy Do we think it's possible that RE essentially ruled out spontaneous conception due to the fact that they only found 13 follicles? Thanks again for all the info!

 

[ahcadvocacy]

@deojames No. Because an AFC of 13 follicles is entirely average and doesn't say much about your odds of spontaneous conception. It's more predictive of response to stims (since you're trying to grow the entire base cohort of follicles at the same time), and ovarian reserve (An AFC of 13 would not indicate any issues).

Can I ask again what you mean by irregular cycles? Do you have charts?

 

[deojames]

@ahcadvocacy Basically, my predictable, "normal" periods with a 28 day cycle turned into a 27-35 day cycle with breakthrough bleeding upon getting the vaccine. Obviously hypothyroidism (undiagnosed until a few months ago) could be at play also. I did have 1 month from 4/21-10/21 where I had no period at all. Currently, i have a 31 day cycle, but only with a 30% regularity since August.

Some months, I'd only have spotting for a couple days. Other months, I'd spot for 2 weeks before having any semblance of a "real" period. I do have charts, but they're across several different apps that I tried prior to TTC.

 

[commissionerfd1]

@deojames Having a cycle every 27-35 days is not irregular cycling. Even if you usually have a 28 day cycle, having one cycle be 27, one be 30, one be 34, etc. is within the realm of normal. The follicular phase can vary, so you can ovulate on day 14 one cycle and than day 18 the next. This is normal.

I agree, it was best to get the breakthrough bleeding checked out, because that can have a number of different causes. Again, hypothyroidism is the likely culprit.

 

[deojames]

@commissionerfd1 Thanks, that's helpful. So, I shouldn't be concerned that my cycles are often different lengths, with varying days of bleeding? My periods were 28 days with 5 days of bleeding without any breakthrough my entire life until COVID vaccine in April 2021 (hypothyroidism undiagnosed for unknown amount of time).

For example:

7/21: 26 day cycle
8/21: no period
9/21: 35 day cycle
10/21: 27 day cycle
11/21: 31 day cycle
12/21: 31 day cycle
01/22: 30 day cycle

days bleeding : 1-5
Luteal phase: varies drastically
Breakthrough bleeding: every month from July - present

Some months I bleed/spot for 2 weeks

Thanks again for your thoughts!

 

[commissionerfd1]

@deojames As you are new to this, I think reading the wiki could be very helpful.

No, I wouldn't be worried about cycles of different lengths with varying days of bleeding (within reason). Flow can vary from cycle to cycle.

I think you're a bit mixed up about how to label cycles...? The 1st day of a cycle is the 1st day of your period, so if you "missed" a period, you must have had a 50-60 day cycle in there somewhere? For example, my period started on Jan. 1st, I don't get a period in Feb. but then it comes again on 1st of March--that's a 59 day cycle.

Your luteal phase does not vary drastically. The luteal phase is more or less the same every cycle. It can vary woman to woman, as in I typically have a 14 day LP and you typically have a 10 day one, but you won't have a 10 day LP followed by a 17 day one. If you think your LP is varying drastically, then you aren't properly identifying day of ovulation. How do you track? OPKs? Temp?

 

[deojames]

@commissionerfd1 Thanks again. I know what you mean, I was confused about this myself...the numbers I gave were just the stats listed in FF. I'm wondering if a day of spotting confused the app and it assumed that was a period.

I've only been able to confidently confirm ovulation a couple times since my numbers have felt all over the place. I've been temping and using OPKs, however my sleep is completely erratic, so I bought a Tempdrop a couple months ago. I did get positive and peak OPK readings even on months where my Temps weren't reliable.

 

[commissionerfd1]

@deojames Correlation does not imply causation--just because you started having irregular cycles around the time you received the vaccine does not mean that the vaccine caused the cycle issues. There is no evidence that the vaccine causes prolonged effects on the menstrual cycle.

Hypothyroidism can cause irregular cycling--heavy periods, infrequent periods, or no periods at all. The fact that your period returned once you started medication points to hypothyroidism as the cause.

 

[deojames]

@commissionerfd1 Right. It could just be that the hypothyroidism happened to start messing with my cycle immediately after the COVID vaccine, despite having symptoms of hypothyroidism for almost a year at that point. Don't get me wrong, I'm pro-vaccine for COVID 100%! My doctors have said there are links and a lot of anecdotal suggestions that the vaccine and getting actual COVID can mess with your cycle a bit.

Even though I've been on meds for hypothyroidism, I still get breakthrough bleeding, something I never experienced until after the vaccine.

The truth is, I'll never know. I still got periods after the vaccine (with the exception of 1 month) but they were very short/scant, which was unlike my previously consistent periods. There's a lot of factors at play, which is the REASON my OBgyn referred me to an RE despite being early on in the TTC process.

 

[rmakolomi]

@deojames Low AMH is frequently used to push people into IVF. I would say get a second opinion.

I was told I have low AMH (considerably lower than yours) and I have conceived twice. There are lots of factors that can make your AMH low as well (like vitamin d). There are also lots of other labs they can do to see whether your ovarian reserve or quality is truly low. Did they draw and fsh?

 

[deojames]

@rmakolomi Thanks for the ray of hope! I edited the post to include all of the results, but FSH was 6.01.

 

[dusgfmo]

@deojames Did they also do a water ultrasound around 5 days are your period started to double check? That is what mine did, and confirmed it. In my case IVF isn't even an option though. We are trying IUI with hormones just to give it a try.

 

[deojames]

@dusgfmo I think the water ultrasound might be one of the only diagnostics that they didn't try! We did the HSG, but they never mentioned a water ultrasound.

Out of curiosity, what made them think that you might be a better candidate for IUI as opposed to IVF? My doctor blew off the suggestion of a medicated IUI or medication TI, and basically said "You can give IUI a whirl, but IVF is the "better" treatment ". Needless to say, I don't love this doctor lol

 

[dusgfmo]

@deojames We have conceived naturally several times, just our daughter passed away and then I had 2 miscarriages in a row, so I can get pregnant. We actually wanted to go straight to IVF, But I only have 1 follicle in each side, so IVF isn't an option. I think the idea is that hormones could help my egg develop better and my hubby had a low sperm count, so getting them in there closer could help with conception. We are going to give it a try and if it doesn't work we will get an egg donor.
If you don't like your dr though, I would recommend trying to find a new one if you can. It's an emotional and invasive process, it wood be a much better process for you if you are comfortable with your dr.