It’s getting close to game time. Next week, on the 24th, I begin my IVF protocol. It starts with a baseline ultrasound to see what’s happening in my ovaries. To get a sense of the potential. I’ll also be doing a blood draw to check hormone levels, which will be closely monitored over the next two weeks. That day I will also start injecting myself with medications to stimulate my ovaries into maturing more eggs under carefully controlled conditions so that my body doesn’t go rogue and ovulate them before the doctor can surgically collect them.

The plan is to do ICSI, which is where they inject a healthy looking sperm directly into the egg to fertilize. Then biopsying for Pre-implantation Genetic Screening (PGS), cryogenically freezing the embryos (every time I say that I feel like I’m talking about a science fiction story), and waiting for PGS results. If we have at least one normal embryo we will likely be doing the ERA test (endometrial receptivity analysis) to determine the optimal time for a frozen embryo transfer. And then, finally, we will put that little baby back where he or she belongs!

I’m nervous about my potential for producing eggs – quantity and quality. A while back I got my AMH (Anti-Mullerian Hormone) results. This test tells me about my ovarian reserve. The last time I did IVF, in 2013, it was 1.3 ng/ml, which was on the low side for my age. My breath caught when my nurse told me it’s now 0.66. Lower is worse. I really wasn’t expecting that much of a drop. I did some research and found a nice chart from the Center For Human Reproduction’s website. They are a leader in infertility treatment for women of advanced maternal age, as well as managing diminished ovarian reserve in all aged women. Their article on AMH can be found here. They give age-specific AMH levels, which is more meaningful than non-age related averages. Here’s their cart, which includes FSH levels too (unfortunately I didn’t get my FSH level this time):

Age Specific Baseline FSH and AMH Levels
< 33 Years < 7.0 mIU/mL 2.1 ng/mL
33-37 Years < 7.9 mIU/mL 1.7 ng/mL
38-40 Years < 8.4 mIU/mL 1.1 ng/mL
41+ Years  8.5 mIU/mL 0.5 ng/mL

(Note: The US uses ng/ml as the units of measurement, other countries vary.)

At age 36, the first time I did IVF, I was about 0.4 under the AMH level for my age group. This time around, at age 39, I’m 0.44 under for my age group. Well at least I’m consistent. So this means that once again I will be on the max dose protocol for stimulation. This also means that I may get fewer eggs this time around than last time. Last time I had 8 mature eggs retrieved, 7 fertilized, 4 made it to day 5. Of those 4, one was really lagging behind so they watched it another day to see if it would catch up. It didn’t, so we lost that one. The other 3 were also a little slow but looked decent. My RE recommended transferring all 3 due to their quality, my age, and the condition of my uterus. Transferring 3 was a shock to us because I never even considered that, but we were given a very low chance of all 3 sticking. At my first ultrasound shortly thereafter we found that one of those little embryos implanted and grew into my beautiful daughter. So this basically means that from 8 eggs, 1 was healthy.

With an even lower AMH this time, I’m scared. I know AMH isn’t the end all, be all, and I could have even more eggs than last time. But I could also have less. I keep reminding myself that it only takes one healthy egg. I’ve been diligently taking my doctor-recommended supplements to support healthy egg development. But it’s easy for me to slip into fear. Fear that I won’t have many eggs. Fear that they won’t be found “normal” on PGS testing. I recently had my genetic counseling appointment, which was a requirement before PGS. The counselor told me that for my age group, about 60% of the eggs come back abnormal. I realize that statistic is an average and any one woman could have more or less. But it’s hard to not think that my chances would be better if I had more eggs retrieved. Every time I start to fall into that fearful mindset, I focus on two words: trust and faith.

You see, I have this vision. A vision of my husband and I. He’s holding our toddler and I’m holding our new baby. As crazy as it sounds, I feel like I already know this baby. I feel like it’s part of the Divine plan for us. Against all odds, I just know this is going to work. Now, like I said,  it’s really easy for me to lose touch with that sense. Especially when my logical left brain takes over. But that’s when I come back to those two words that give me solstice. Trust. Faith. I trust my intuition. I trust that my body can do this. I have faith in Goddess. Faith in the bigger picture. These words mean many things to me. So they are my mantra. And I’ll be repeating them silently to myself all morning on the 24th. Hold on. This is going to be a wild ride.