Getting pregnant naturally with low amh
Chattycat78 · 06/10/2015 12:17
I was lucky enough to have a baby 8 months ago through ivf, which was recommended to us as I have low amh (2.8- probably less now I imagine).
However, although I know I have been mega lucky, I would like to try for a sibling. Ideally I would like to try naturally for a while before jumping on the ivf bandwagon again. Does anyone know if this is possible? Am I delusional?
My logic is that if I'm ovulating and I can improve egg quality theough supplements etc then surely there is a chance? I'm 36. Also I have been pregnant before naturally (after 4 months trying) but unfortunately it was a mmc. There are no other infertility issues- partners sperm is normal. Any thoughts from anyone?
Everhopeful76 · 27/10/2015 23:16
Shellster52...thank you. I ve also seen ubiquinol as being the same thing as COQ10 but the quality is better than COQ10?
I ve had a really hard time, had fertility MOT a year ago and this is when they found the endometriosis which was pretty severe. I then had to wait 5 months for the op, in a lot of pain. Anyway... am hoping the endo is dormant whilst I am on my baby journey.
Bit concerned about DHEA. I ve heard that it can make endo worse, and this is something to do with the oestrogen. I have taken steroids in the past for other health problems and haven't tolerated them well, but I probably need to do more research.
It seems like you ve had a difficult journey yourself. I hope everything is well and continues to be so.
Shellster52 · 30/10/2015 01:51
I had not read anything about DHEA making endo worse so I was not aware of that when I recommended it. I just read so many studies showing what significant improvements it made to IVF cycles, but can totally understand the hesitation in your case if DHEA makes endo worse.
Yes, now that you mention it, I do remember there being two forms of CoQ!0, but I can't remember the details. I just bought CoQ10 from the chemist and took that.
Very nice of you to be wishing me well amidst your own sagas. When I was going through IVF and would hear comments from others on here who had fallen pregnant, I would always think it was easy for them to dish out advice when their journey was over. So one part of me wonders if I should leave this infertility section alone to those still going through it. But after 11 IVF cycles, I know how awful the emotional roller coaster is and feel like I want to support the sisterhood of us with fertility struggles.
When does your actual IVF cycle start? Do you know the details of what dose of medications you will be taking, or have you had an ultrasound or AMH test to indicate how many eggs you are likely to produce?
Chattycat78 · 01/11/2015 18:59
UPDATE!! Ok obviously I have NO IDEA how this is going to turn out or how far it is going to go (im not naive enough to just think bfp definitely equals baby) but I got a bfp on Friday!!!!!!!!
I suppose the point is, it IS possible to conceive with low amh.
Saying that, of course I'm now worried that it could have been a rubbish egg, and is therefore doomed (which has happened to me before) but I guess there's nothing I can do about that now.
I thought about whether it was a good idea to post on here or not, but being superstitious isn't going to change anything, plus it might help others in a similar situation who are looking for hope that low AMH isn't necessarily the end of the world.
Good luck to everyone.
Shellster52 · 02/11/2015 01:58
Wow, wow, wow Chatty! I am absolutely thrilled for you - thrilled that you don't have to go through the torturous cycle of trying month after month, getting your hopes up, coming crashing down, then on to IVF.
I read in an infertility book that our fertility is higher within the first year after having a baby, and I wonder if that and the fact that you just stopped breastfeeding still has your fertility hormones on high.
I know exactly how you feel about being hesitant to post on here for fear that it will 'jinx' things. I was posting on another thread with failure after failure and I was too scared to post my IVF cycle updates towards the end as it felt like repeating the same steps would lead to the same failure - although logically there is no way that words I type on a keyboard could affect the outcome! But I totally understand.
Shellster52 · 03/11/2015 05:02
Yes, all is going well with my pregnancy (so far!) I thought I would get pregnant and all would be okay, but I was a bit of a nervous nellie as all I had know if IVF failure after failure, so just because this one got a bit further than the rest, I was just waiting to see when the wheels would fall off. I had a 7 week scan and that gave some reassurance, but I was still nervous going into the 12 week scan and was just waiting for her to tell me what was wrong. I thought once I hit 12 weeks, I would be okay, but my 20 week scan is coming up this Friday and I was starting to get anxious. Luckily, I had a doctors review last week and she happened to put a device on my stomach and I heard the heartbeat, so that gave me some reassurance instead of being worked up about this Friday. So now after hearing the heartbeat and knowing I've made it to 20 weeks, I am only now starting to think that this could be real.
I hope your first few weeks pass by quickly and that you can have a scan that shows all is well to hopefully provide you some reassurance too.
Chattycat78 · 03/11/2015 20:23
Hi shell- the nerves are totally understandable after what you have been through! However, I'm sure now you've made it this far, all will be ok!
I'm going to have an early scan too (if I get that far) - at the hospital if possible (nhs) or pay privately if they won't agree to it. There's no way I'm waiting for the official 12 week scan to find out if it's viable or not!
Shellster52 · 04/11/2015 00:21
Yes - 12 weeks must seem long a long time away to be anxiously waiting! Hope you can get an early scan organised to put your mind at ease.
Yes, now that I've made it this far, all should be okay with me and yes the nerves have gone, but somehow I still don't really believe that there is something in there even though I've seen it twice on ultrasound and heard it's heartbeat last week - just seems like too much of a miracle after 10 IVF failures. Think I won't truly believe it until I see it with my own eyes!
Everhopeful76 · 16/11/2015 22:21
I didn't get any notification that had a reply Shellster so sorry.
Was due to start ivf around about now with the Create Clinic in London. However I decided to get a second opinion from a local fertility specialist my Gynaecologist had recommended. Am glad I did this because straight away I felt more relaxed around her and the clinic environment. Unfortunately had a bit of false hope that my odds might be better, but more cysts have been found on my right ovary (not endometrial ones which is good at least) but it is obscuring the follicles I have on that side.
She decided to do the scan early in the cycle and oddly found an extra follicle on the left (so 4 in total) But I have none that can be seen on the right (although feel there are some) so therefore my odds are stacked. Been told that she would like me to lose a bit more weight and also take DHEA for 16 weeks prior to IVF. She was so so on COQ10 and its effectiveness.
So I have taken her advice that this supplement will be ok versus endo but she is recommending the long protocol regime and high dosage gonatrophins so pros and cons afoot, a natural form of IVF so kinder on the body but not really feeling 100% with the clinic, or feeling really relaxed about the clinic but being zapped with loads of drugs. The chances of conceiving are about the same. I am 99 pc sure I ll go with the clinic I felt really comfortable with. Best case scenario is that the common cysts will have dispersed so all follicles are showing, the DHEA make an impact and therefore I can start in Feb. If not I think I ll probably start the treatment and see how the follicles grow. I can get a chunk of the cash refunded if EC does not go ahead, then I guess I can try again, when DHEA might have made more of an impact.
Im pretty determined that I can get there somehow. The fertility show was so positive as well. Met a lady from Arizona who had actually had donor egg twins because she was told there was no other way. About 5 months after the birth she fell pregnant naturally. Other similar stories, against all odds. I ve been given an option of adopting donor embryos, which was a bit of a mind blow in the midst of ploughing ahead with my depleted eggs. Not least because I was never aware of this option. Knew about being put on a donor egg list but this was something new and something I would consider I think. I am seeing the consultant again in about 3 weeks
No problem with you posting your success story on this thread. It gives so much hope. You ve given your treatment some serious welly with so many attempts. I hope everything works out wonderfully well. He/she must be so cherished already, that she will never want for anything.
Shellster52 · 16/11/2015 23:14
Sorry to hear that more cysts were found on your right ovary hopeful. I would always have cysts if I had a day 2/3 scan the cycle following an IVF cycle - but never just during a regular cycle like you have. Curious as to how she can tell if they are endometrial cysts or not?? Or how she can tell they are cysts and not follicles that are growing for that cycle of which your body will select one to ovulate??
I can certainly understand you feeling the odds are stacked when she found 4 follicles on the right and none on the left (although obviously hoping some are there). I've had those disappointing scans before. I would keep trying to convince myself of the quality over quantity theory. I was so strict with my high protein low carb diet after being encouraged by the study that showed this increased the number of embryos that survived to blastocyst stage to a whopping 50%. And it certainly proved true in my case. I only got 4 eggs of which only two became embryos. Both were transferred on day 3 and one took - so just as the study promised, one out of two of my embryos (or 50%) did survive to blastocyst stage and is now 21 weeks. So I cannot recommend this diet highly enough.
Your newfound fertility specialist sounds very up with the latest research, knowing all about CoQ10 and DHEA. The three fertility specialists I spoke to throughout my cycles knew nothing about the benefits of these. Again, I have not done research on DHEA and endo as it was not my issue, but I certainly read several studies that all showed very convincingly how DHEA increased both follicle count and embryo quality so I hope it does that for you and you are elated when your next scan shows more follicles.
Donor eggs was somehow just not personally for me. It's not a common thing here in Australia, so perhaps that's why I am not as comfortable with the idea as someone who knows about it and has it in the back of their mind as a plan B. Foster care was my plan B. So I am glad you have a plan B that can swim around in the back of your mind as you work towards your IVF in Feb.
Thank you for your well wishes with regards to my pregnancy. Very lovely of you to be wishing me well amidst your own IVF saga. I am so glad this Dr has left you feeling strong and determined. Now we just count down to February to see how you get on!
Everhopeful76 · 17/11/2015 18:10
The cysts she said were completely black which signified common cysts (had 1 of 2cm on a previous scan, this then grew an extra cm and another appeared behind it which was about 2 cm) Having viewed the huge endometrial cyst I had before, it certainly looks very different, but they could disperse and am hoping they will. My Consultant feels that more follicles appear in the early part of the cycle and this gives the fullest picture, am now wondering if cysts are more prominent then as well. So good to see I have more than expected follicles on the left, but doesn’t give any sort of pic on the right. So frustrating.
Its very interesting you say about the high protein diet. I have read plenty on Endo diets, and it tends to say avoid wheat and heavy carbs so infact my diet is more protein based than anything else. Hard to know the exact ratio. I ve got this theory about dairy products and endo as they are oestrogen sensitive.At the fertility show I attended they were also saying about getting 50/50 ratio of omega 3 and 6. It is a MINEFIELD!!!
In terms of the low carbing, were you avoiding obvious carbs such as bread, pasta, potatoes or just cutting right down? Do you have a link to the study, would be very interested in seeing it?. I have read people taking the COQ10 and DHEA, miraculously suddenly producing follicles out of the woodwork, but then I guess it’s the quality/quantity debate as well isn’t it. You can think there are less but the quality has improved from taking the supplements so you get your 50% embryos, rather than you have twice as many but the quality may not be so great.
The donor embryo option sounded almost like less of a hurdle and much higher odds which could potentially mean I could have a baby by the end of next year. Obviously want to try my own eggs first but then I guess I have the option of trying again using OE when the supplements have been rattling for longer or just opting for donor embryos. Am still waiting for my DHEA purchase to get here, so the time is ticking. My understanding had been that finding an egg donor was the only way forward but ready made embryos are also an option. Am a aspiring single parent so an embryo would work in my case. I would also be interested in fostering and had thought this could also be a vocation for me, rather than the work I am currently doing.
Shellster52 · 17/11/2015 21:03
}}http://www.medscape.com/viewarticle/803821 here}} is studies online showing that a high protein low carb diet significantly increases IVF success. I don't think this particular article specifically states this, but the study showed that when protein was increased to greater than 25$, the pregnancy rate rose to 66.6%. When carbs were also reduced to below 40%, the pregnancy rate shot up to 80%. I had been vegetarian since I was 14 but it was impossible to meet these criteria so I re-added fish to my diet. I would have a protein shake for breakky (home made from pea protein with almond milk and things like chia seeds and flaxseed and super greens powder for extra nutrition then half a banana to make it palatable, a tin of tuna and salad for lunch, then another piece of fish (I would regularly have salmon for the good fats) with vegies for dinner. Nuts and eggs were regularly on the menu. Glad the high protein diet is coincidentally what is also suitable for endo!
Yes, hard to know about the quality/quantity debate. I also remember reading that the first to mature eggs should not be allowed to over-mature for the sake of allowing a few of the smaller follicles to grow in the hope of getting a couple more, as the the first to mature follicles are the ones that contain the best egg. That made sense to me as they are the ones that your body is naturally selecting as the most viable eggs for that cycle that your body would ovulate were it a natural cycle. And I had one IVF cycle where I had two larger follicles and three smaller ones. After having read that article, I even emailed my fertility specialist asking to go ahead with egg collection rather than wait for the smaller ones to catch up. She decided to make me wait over the weekend. The result was that I got 5 eggs but two broke apart with the ICSI process. Another fertilised abnormally, another did not fertilise and the last did fertilise but died before transfer. When I saw my FS for follow up, she said that the two which broke apart were probably the two larger ones as this is what happens to over mature eggs. So I really felt I lost my two best eggs and my chance for that cycle.
I guess all we can do is try everything - supplements and diet for quality and quantity and then we have given it our best shot and can have peace that we did so. But hopefully more than having peace, we really are according to that protein study, significantly increasing our chance of success.
Everhopeful76 · 17/11/2015 21:46
Thanks so much I will check the link out.
I think I should probably eat more fish. I also decided to stop meat when I was trying to improve fertility- was also convinced it wasn't doing my digestion any good
I tend to make up breakfast smoothies with almond butter, almond milk, banana, cinnamon or vanilla powder and date nectar and sometimes hurl in superfood powders and maca (Peruvian fertility aid so am told) although then it is really quite bitter. Has recently put me off, might just swig the maca in water so I can enjoy the shake!!
I find this all fascinating but I think apart from making a few minor amendments I am probably on about the right ratio - live on eggs, beans, lentils, nuts and nut butters, seeds and veg mostly. I do still eat chicken but could do with upping the oily fish. Eat very little bread, no wheat pasta (sometimes alternatives) and maybe cut back on potatoes.
Its really useful to know about the follicles that become larger are probably your front runner eggs so to speak. FS did say that I could decide to wait to see if more came up to size. Am doing mine as a one off cycle so may put this to her based on your exp. Thanks so much
Shellster52 · 20/11/2015 06:05
Sounds like you're already really healthy and naturally doing a diet that the studies say ups the success of IVF anyway.
So what is your next step from here? Do you have any future appointment dates set, or do you have to phone and make an appointment when you've taken the supplements for a period of time?
Everhopeful76 · 20/11/2015 11:44
I have an appointment early next month in readiness to start ivf in January. Then I think the process is I will be re scanned in early Jan and if the cysts have dispersed FC will suggest starting the cycle at end of Feb or March to allow for a bit of further weight loss and the DHEA to have been taken for over 3 months.
If its much the same picture with the cysts then I think I will then be making a decision on whether to go ahead with own eggs with 3/4 follicles present in January when will have only taken the dhea for about 6 weeks at this stage, or risking the cysts growing further and my egg reserve to become lower each and every month I don't try.
Or trying the donor embryo route to better ensure a pregnancy.
Its going to be a very tough call with IVF and also with the alternative solution. Obviously the best possible scenario is that the cysts have gone, and therefore more follicles appear, and I can start in February as even if reserve has dropped (supposing the supplements don't work). I suppose with the IVF start options, one is only marginally better than the other as they may, I suppose find no follicles on the right, even if the cysts are gone.
Trying to stay calm and collected. I have since been speaking with people about fostering and heard anecdotal stories of people struggling to be approved or having kids being taken away at very short notice into other foster homes, due to the authorities not liking a foster carers opinion. Even that option seems less than straightforward.
If you got through all that, I congratulate you. Have a great weekend
Shellster52 · 20/11/2015 19:01
That's what I found when I did my research - fostering was not the perfect solution. My parents in law do foster care, and they are regularly taking him to his mother for visiting rights as well as constantly having to report back to the authorities with his progress and having to get permission to do things like take him interstate or change his school. And yes, they can legally take him away at any time if the mother gets off the drugs and they feel the mother would be a better fit. Although I must say, since I've sparked this idea in my mind from when I was struggling to conceive, the idea does appeal to me more now that I actually am pregnant and am not wanting to do it as a replacement for the child I couldn't have.and I would just be helping another child, but definitely not the same as an alternative to the donor egg/embryo option.
Is there anything practical you can do to help the cysts go away, or are they just something that goes along with having endo and nothing you can do anything about? For me, they always just appeared after the drugs of an IVF cycle, but you're were just there in the middle of a random cycle so it seems it is something you regularly have. Do you have regular cycles as when ever I had cysts, my cycles were out of whack also?
I truly hope the cysts have gone. Jan must feel like a long time for your next scan to wait and find out. Or even if you still have a cyst, I hope the DHEA has done it's job for there to be a few more follicles on the other side for you to consider it worthwhile to still go ahead. You don't mention anything about the endo so I assume that was still dormant at your last scan?
Everhopeful76 · 20/11/2015 19:28
the cysts aren't endo at all actually, but once you have the condition, the chances are its just dormant, waiting to explode at some stage.
The common cysts are a new thing, well in last few months, so its possible that they may disappear. My cycles are way out but I did have a run of them being either 25 or 27 days which was brilliant for me - then following that what tends to happen is I ll get a long cycle and then a short, which throws me completely out and then I find I ovulate really early the next month immediately after the short one. Trying to get the luteal phase at at least 10 days, which hasn't always occurred either.
I am a bit concerned about the side effects of dhea. I ve taken it only since yesterday and some major stomach disturbances going on, although sudden huge levels of energy which is a new thing.
Just wondered did you find that Shellster? Or anyone else? I guess I can handle it, if its just to begin with. I ve got the ultra micronized version 25mg per day. had it shipped from the States, but also got another type which wasn't quite so hardcore, so I guess I can take that instead but then I ve heard from others that it has to be micronized? My Consultant did not specify this though
Bizarrely my eyes look less tired and am wondering is this the coq10 wonder drug. My acupuncturist seems to think its doing nothing for me.
I would still foster alongside my own I think. I guess people have stories, and will depend on the social worker assigned to your case. It hasn't put me off..but would have to go into with my eyes wide open
Shellster52 · 21/11/2015 03:54
So the cysts are completely unrelated to the endo - you just got lucky enough to get endo and now get an entirely seperate fertility condition of cysts on your ovaries! Interesting about your cycles being long then short. I remember when I had cysts one time after an IVF cycle, I had a really long cycle of 43 days and then the next cycle was short at 18 days. So perhaps the 25-27 day cycles that you had were when your ovaries did not have cysts and were working normally. Would be fantastic if that could happen now and then see no cysts on your Jan scan - you'll have to give your ovaries a talking to! I wonder if a naturopath could help in that department? Or is that just an added cost to the already expensive game of IVF?
Before my son, my cycles were all over the place. I was blissfully ignorant back then and miraculously conceived him. So when I started trying for baby number two, I saw a naturopath who prescribed me Vitex. I took it for a several months and then stopped because it wasn't helping me conceive (turned out hubby's sperm had gone downhill), but my cycles were regular from the time I took it. My cousin also had very irregular cycles and has some fertility condition that made her think she couldn't conceive to the point that when she met her now ex husband, she told him she couldn't have kids. She saw a naturopath for something entirely unrelated, but the topic of her periods (or lack of) came up, and the naturopath prescribed her Vitex. She then wasn't feeling well and got the shock of her life when the Dr diagnosed her as being prgnant. So I really stand by Vitex and perhaps it is something you might like to research if a naturopath is too expensive.
I personally did not notice any side effects whatsoever from either the CoQ10 or the DHEA. A lady on another thread also mentioned noticable increased energy from the CoQ10. As for the DHEA, I know I got my blood levels tested before and during it, and the DHEA definitely increased my DHEA and testosterone levels so it was obviously doing something, but no side effects at all. I don't remember if mine was called Micronised or not - I don't have the bottles any more to check. Perhaps you could start a new thread titled something like 'side effects or imrproved IVF outcome of DHEA' and see if others can share their stories, as it just seems to be you and me here. Have you googled the studies about DHEA? Every single one of them shows really positive outcomes for us 'maternally aged' ladies, so that convinced me to take it.
Everhopeful76 · 21/11/2015 17:47
Yeah am not sure how you can continue to have endo with none of it obviously present from scans, all it shows is I currently have no endo present on either ovary. However when I had the op they found scar tissue on bladder, but it was described as adhesiolysis or something such so was most likely endo tissues pushing onto bladder from stomach. For fun I also have a diverticula on the bowel, but that is totally unrelated and am told shouldn't cause a problem unless it becomes diverticulitis. So going back to the bladder issues that's why I was told I could never have IUI, 1) because I was 38 at the point of the investigations and it wasn't recommended for anyone over that age, and 2) because this tissue would cause a problem for that procedure. What that would be am not too sure.
The cysts I have I think are extremely common and most people probably have them present but its only when they cause a problem ie size, pain or in my case at the moment obscuring follicles.
I have never tried naturopath or Vitex. I am having weekly acupuncture sessions, and healing sessions and not sure I can fund anything else at the moment but will definitely look into the Vitex. Thank you x
Currently reading the "it starts with the egg" book. Fascinating it is. The research papers have to gear myself up for the ride hehe
I sometimes wonder on blissful ignorance..... if I d just tried with a donor thru a shared parenting site I may have fallen pregnant miraculously too, knowledge is power but at the same time its caused an absolutely hideous stress level at times, and has felt devastating.
I may do a thread for DHEA etc but its not too bad now and the side effects having looked them up do say stomach disturbances.
Everhopeful76 · 21/11/2015 23:14
oh have just looked up vitex, which is the same as agnus castas I think. I was taking that infrequently, was advised that it helped the luteal phase ( a friend of a friend swore by this supplement) and that I should take day 1 to 14 of my cycle (normally its used as a pmt supplement I think). 2 cycles ago, I didn't really have a period and wondered whether to hang on as cycle would be late, then I was aware from test that I had ovulated (damn it, so then realised the virtual non existent bleeding was my period), and last cycle, came on early, was away from home and didn't have the supplement with me when I needed it. So next time will most likely retry it.
Shellster52 · 22/11/2015 22:47
That is at least one promising thing that the endo is dormant.
I too did acupuncture. I am more into facts and figures, while a friend was doing things such as meditation, yoga and acupuncture. I couldn't see how putting a needle in my skin was going to improve my egg quality but she persuaded me to do acupuncture. Being the more factual person that I am, I found this study showing that women who did acupuncture on the day of embryo transfer had 39% preg rate, compared to 26% for patients that did not. That seemed statistically significant and I paid a bucket load for the acupuncture clinic just down the road from the IVF clinic to do this for my last two transfers as they spedcialise. And I did have success the last two transfers (the second last transfer ending in early m/c). So that turned me into more of a believer.
Yes, Vitex is the same as Angus Castus. It is known for helping with PMT symtoms, but I never had any PMT symptoms and took it just to regulate my cycle. Not sure why you would take it only days 1-14. Both naturopaths who recommended it to me had me take it the whole way through. Although I did not take it during an IVF cycle since this herb is known to help normalise your hormones levels, and the IVF meds are trying to ramp up your FSH so it made sense to me to stop it during IVF.
I totally agree that knowing the facts can be stressful as opposed to blissful ignorance. But I also totally agree with you that knowledge is power and I truly believe that I never would have gotten pregnant if I did not do all the research that I did which led me to doing things like
- Taking CoQ10 and DHEA for egg quality, after my first IVF's were a dismal failure
- Me selecting the estrogen priming protocol which studies show produces more eggs for poor responders like me, and also better quality.
- Doing acupuncture on transfer day
- Asking the clinic to do HA sperm selection for hubby's abnormal sperm
and I truly believe these things helped create my miracle baby.
I've read about that book 'it all starts with an egg'. It sounded fantastic and very factual, which was right up my alley. But I was broke from IVF and couldn't afford it, so I got a woman on Mumsnet to summarise any main points for me! Hope you're finding it useful.
lucieloos · 23/11/2015 12:09
Hi hope you don't mind me joining in! Shell I noticed you said you did the estrogen priming protocol which I am also interested in. Would you mind explaining what it all involved and were the outcomes any better with numbers, quality etc from previous attempts?
Everhopeful76 · 23/11/2015 17:20
No not at all Lucieloos, all welcome!!
I am quite interested in this estrogen priming protocol regime also, but don't think it will be offered to me. What is it Shell?
Acupuncture on transfer day has not been suggested to me, I think it was for the day before and after and then leave everything alone for a while
And yes am very puzzled by only taking the AC from days 1-14. It was a friend of a friend who is a journalist and was very thorough in her research That said, have not seen the paper that recommended this. My cycles are still erratic so maybe I ll see if this can work until January.
I have been doing meditation more to encourage positive thinking because I am struggling with this emotionally, and that's before IVF!!! I am quite spiritual but also a bit of a controller on things that I really want, and feel I cant live without - bit of a difficult combo.
Did I read on another thread Shell, that you didn't have too many problems hormonally from the IVF drugs? I guess it may have been the estrogen priming protocol was less drugs? They are planning on putting me on high dose, but I will have the options explained more thoroughly on the 3rd, which I cant believe is only about 10 days away now.
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