LH hey hey! Hope married life is treating you well?
My two penneth for what it’s worth on your q’s (with my extensive ‘I’ve read some internet medical training’ - ie take ANYTHING I say with a pinch of salt as I have zero qualifications whatsoever and this is just the ramblings of some random on t’internet)
1. Clearly at 40 with low AMH the number of eggs we can collect will be limited - but I should just let the Lister give me the best protocol they can, probably same as last time, and hope for the best. And of course ICSI this time too. Would you agree?
Yes. I’d trust Lister with the protocol. Might be worth asking them about estrogen priming, as it’s something they mention here that they do for poor responders, but they know their stuff ivf.org.uk/images/downloads/Lister-Fertility-Clinic-low-ovarian-reserve.pdf
2. Everything or anything I can do to improve egg quality myself has already been done (I.e Ubiquinol is my main one; DHEA really dos NOT agree with me). And eating and drinking and exercising well. Is this correct - is there anything else I should be doing in the last few weeks?
Sounds like you’re doing everything you possibly can! Quality will be primarily determined by age and the ovarian environment created by the stims - we can’t do anything about the former and you’re in terrific hands with the Lister with the latter.
3. I have always had a short and light period, with very short cycle. I had a Mirena coil in for ten years, and didn't have any periods with that. When I had my son (got pregnant easily) my cycle was about 22 days long, and period lasted about 3 days. It is now more like 24 days, and wondered if this change was more likely to be down to my increasing age (bad sign) or impact of Ubiquinol (good sign?). Any views?
If you’ve always had short cycles this doesn’t sound like anything to worry about. Cycles getting shorter (ie ov getting earlier and earlier) is more of a concern - sounds like all good with your cycles
4. In the last few months my period has become even lighter - truthfully I am talking one day of bright red heavy bleeding (with some bright red stringy bits - sorry gross), then one day of light red bleeding. Day three is no more than brown stringy bits. Nothing actually coming out. Then couple days of brown spotting.
Is such a short period ALWAYS a sign of lining issues, and as I approach my next round of IVF is there anything I should be doing NOW to assist?
My Dr said scanty periods definitely weren’t always a sign of lining issues in and of themselves. I don’t know about changing consistency of bleeds, but I’d ask your Dr. The only thing that can diagnose lining issues is a mid-cycle ultrasound in a natural cycle (to see if it’s growing as it should) and a saline ultrasound (to see if there’s any indication of adhesions)
5. I had a D&C about 15 months ago now, but this very short period only started about 3 or 4 months ago. if that D&C had caused Ashermans adhesions, would the very scanty period have not started immediately after the D&C? Is the much lighter period more likely to be an indicator of my advancing age - and if so, what can be done about this during IVF?
Don't know about the D&C - what you say makes sense to me. I'd ask your Dr. A saline ultrasound can confirm if there's any indication of adhesions post D&C if you're worried. If your lining thickens up appropriately during your cycle that’s all that matters. And if it’s not thickening up quite on track, they can give you oestrogen pills or patches
6. Clearly as I want to do IVF now, I don't want to lose a month having an HSG or hysteroscopy, but if this round is unsuccessful after transfer, should I certainly get one of these done?
They can do a saline ultrasound at the start of the cycle. Many IVF clinics insist on it to check for polyps or adhesions. Takes 30 mins.
7. Could someone (Banana?) give me a brief overview of what happens to a TYPICAL IVFer to support and sustain implantation, and then what else can be done for someone known to have lining issues?
I have read this thread many times now but I still don't understand all the drugs and pessary choices available, when and how they are used, and who is suited to which regimen best?
Normally in a typical IVF er the growing follicles produce oestrogen which thickens up the lining before EC - same as in a natural cycle before ovulation (the proliferative phase). In a natural cycle, progesterone is produced by the corpus luteum - this makes the lining receptive to implantation (the secretory phase). The retrieval process interferes with natural progesterone production, so in IVF we take supplementary progesterone. This is usually in the form of vaginal progesterone pessaries - brand names include Crinone, Cyclogest or Utrogestan. If your Dr decides you would benefit from additional progesterone, this can be in the form of injections (Gestone or Lubion)
In a medicated FET you replicate the first half of this cycle with oestrogen tablets or patches instead of natural oestrogen from the growing follicles. This oestrogen is basically what’s given to menopausal women for HRT: brand names include Progynova or Climival for pills, Evorel for patches, Vagifem for pessaries.
You are doing a fresh cycle so yours will be pretty straightforward, unless you have any lining issues identified in your tracking scans. You’ll just take progesterone pessaries (I believe Lister uses Cyclogest) from the day after EC.
For someone with thin lining the issues are with the first half of the cycle - getting the lining to the right thickness. You want the lining to be an absolute minimum of 7mm+, preferably 8mm+, ideally 9mm+ and have a triple line appearance.
For most people with thin lining the problem can be solved with additional oestrogen. For my 2nd IVF cycle, where I did get pregnant, my lining was thin, but thickened up with oestrogen tablets.
For some of us, very rarely, FET can be problematic, because we don’t respond to artificial oestrogen, but do to our body’s own natural oestrogen. Just giving increasing amounts of oestrogen tablets or patches doesn’t help the few of us who have treatment resistent lining.
The problem can also be blood flow related, hence why acupuncture helps some people. It’s why all the supposed lining friendly foods and associated woo therapies can help
My uterine blood flow is great, but for some of us with treatment resistent lining we have to bring out the very experimental big-guns like G-CSF washes, vaginal viagra pessaries or Trental. You really, really don’t need to worry about these unless you’re having FET cycles cancelled due to non responsive lining.
8. At what stage during my IVF cycle will the Lister nurses realise whether my lining is not thick enough (or not triple line), and will there still be time in this cycle to do something about it?
They will monitor your progress - you’re aiming for 7mm by trigger, some clinics will take early intervention, but many will wait till after EC to give any additional oestrogen if needed. You can’t take it till after the Cetrotide is started - I think in my second cycle I started the Progynova the day before trigger. Most clinics seem to wait till after EC to start any additional oestrogen. I also think you may well be worrying about nothing. Most people don’t have lining issues. And unless the clinic mentioned anything about your lining looking particularly thin last time, I think it’s very very unlikely you will have any concerns
9. I always thought it was the egg / embryo quality that becomes limited as the mother gets older, but the age of the uterus is not a limiting factor. But it seems that uterus linings DO become less welcoming with age?
Not true. The uterus doesn’t get less welcoming with age. It’s why success rates with donor eggs in women in their 40s and 50s are the same as success rates for women with own eggs in their 20s and early 30s. It’s the age of the egg, not the age of the woman, that determines the likelihood of success. Some women have crap lining, but that’s relatively unusual, and not related to age.
10. Am I worrying far too much about something which may not be an issue? I know that I sustained a pregnancy naturally just 2.5 years ago, but I keep reading here about light periods and the effect of adhesions etc and feeling very nervous that I could be facing a whole new set of problems. I thought getting healthy embryos to blastocyst stage was going to be my greatest challenge at nearly 41, but I am now seriously concerned about my 'soil as well as my seed' (stolen from Banana).
Yes. Yes you are. The soil is unlikely to be an issue. Stop worrying about it. You’re extrapolating issues from a very small number of people who’ve congregated around a thread because they share this unusual issue - confirmation bias. You’re worrying about something that you are very unlikely to need to worry about.
Good luck!!
