Why it’s more important than ever to understand implantation testing, sperm testing and decreased ovarian reserve.
On the May 23rd Egg Whisperer Show, I took calls on some complicated fertility questions, mostly connected to older parents. The National Center for Health Statistics recently published a report that the fertility rate is the lowest it’s been in thirty years, which sounds very doom and gloom. But the reality is that the drop was only 2 percent. What’s more interesting is that the birth rate actually rose for the oldest group of women, those between the ages of 40 and 44. What this means is that society is changing, but our biology isn’t. I have no doubt that many of the women in this age group are needing to rely on some form of fertility treatment.
Society is changing, but our biology isn’t. It’s why it’s so important for everyone, no matter your age, to know about fertility screening.
It’s why it’s so important for everyone, no matter your age or whether you’re actively trying to get pregnant, to know about fertility screening. This is measuring your hormone levels to get ahead of your fertility, and maybe freezing your eggs. I also encourage families who are thinking about having more than one kid, and who are starting their family over the age 35, to considering freezing embryos for their future family.
Three callers told their stories and asked questions that are typical to older parents who are trying to conceive. A caller who was going through IVF asked about about implantation testing. Another asked about the importance of sperm DNA fragmentation testing, and another wanted to understand decreased ovarian reserve. I know that fertility treatments can sometimes get complicated and overwhelming, which is why I always try to offer clear and simple answers to your questions. If you missed the show, you can catch it here, or simply read some of my answers below to see if they apply to your situation.
What is Implantation Testing?
Your uterus is the house for the most important VIP guest of your life. So before you go through IVF, we want to make sure that you’ve done everything possible to prepare that house on the inside, but also think about what’s on the outside as well. If you’ve followed what I called the Egg Whisperer DIET, meaning you’ve figured out your Diagnosis, gone through IVF, done Endometrial testing, and then Transferred, there are two tests that can give you and your doctor more information about implantation success.
An Endometrial Receptivity Assay
I call it the evite to the embryo party. It’s a genetic test that tells you how many hours of progesterone that your body needs for implantation to occur, so it tells your doctor what time your embryo should show up in your uterus. When you do IVF, you’re doing something that is quite artificial: we are trying to mimic nature. Of course, there’s a lot of nature involved when you’re using science. But there are no two patients who are alike, and we have genes that are involved in implantation. Everyone’s implantation window is around twenty-four hours. The ERA test looks at gene expression related to receptivity and will tell me if your uterine lining is ready for your VIP guest embryo to show up to the party. (Read more about the ERA test here).
The Receptivadx Test
This test gives you a histologic score for something called BCL6, which is a protein that tends to get overexpressed in women with endometriosis. You get a level, which is either 1.4 or below, which is considered normal. It can be over 1.4, for example, it can be 2 or 2.5, which is considered mildly elevated. It can also be between 2.5 to 3.5, which I still consider to be mild to moderately elevated. Or it can be above 3.5, which is moderate to severely elevated. The test can tell the severity of endometriosis without having to do surgery.
These two tests together will help to guide your doctor’s protocol, and give them a sense of the best chances for implantation.
I also promote rest, relaxation and meditation to decrease inflammation in your body.
It’s also important to prepare your body outside of your uterus. I recommend a low inflammatory diet, a healthy BMI, and monitoring your blood pressure and blood sugar level. I also promote rest, relaxation and meditation to decrease inflammation in your body.
What is a DNA Fragmentation Sperm Test ?
This is part of my TUSHY Method. The S of the TUSHY Method is sperm health and part of the testing is DNA fragmentation on top of a semen analysis. Dr. Paul Turek, one of the most reknowned Urologists in the Bay Area has said about sperm: “You can’t judge a book by its cover.” This means you can’t tell the health of sperm by just how fast it moves or how it looks. We now have genetic tests for sperm, which I encourage everyone to do before they start trying to get pregnant. We can’t look at eggs under a microscope because women don’t have the luxury of being able to put them in a cup —but it’s so simple for men to test their sperm for DNA fragmentation, which is changes in or damage to the DNA that might cause abnormalities in the embryo, challenges with the transfer and miscarriages. The studies are robust about DNA fragmentation and it’s relationship between the increased risk of miscarriage as well as the decreased chance for a live birth.
You can’t tell the health of sperm by just how fast it moves or how it looks.
The Good News! Men Can Improve Their Sperm Health
The good news is that unlike women who are born with all the eggs that we’ll ever have, men have an opportunity to improve the DNA health of their sperm. Sperm has a lifecycle of around 70 days. I always ask guys to go through a fitness challenge to get their sperm in top shape. As soon as the sperm is healthy, it will increase the chances of having a health baby, and it’s much easier to freeze sperm than eggs if you want to wait or save the healthy sperm for a 2nd or 3rd baby. It’s important to see a urologist and make sure you or your partner has normal testosterone levels. Also try to decrease stress and heat exposure (i.e hot tubs) and make sure you or your partner have a healthy BMI and follow a low fat diet full of greens. Studies have shown that all of this together can potentially decrease the DNA fragmentation rate.
If I have a low ovarian reserve is there anything I can do to improve my egg quality?
A low ovarian reserve is something that happens with age, and it can happen with women who experience early menopause. It means you don’t have a lot of Antral follicles, which are the follicles in your ovaries that contain eggs. (For more information, watch my Egg Whisperer show, DOR: Decreased, NOT Depleted Ovarian Reserve)
I always recommend that women check their ovarian reserve and get their hormone levels checked every six months — even if you’re not actively thinking about getting pregnant. I offer an Egg Whisperer Fertility Awareness Panel, which involves a quick blood draw on the third day of your cycle. This can be done wherever you are in the world. The lab test analyzes three key hormones that paint the picture of your fertility health — Follicle Stimulating Hormone (FSH), Estradiol and Anti-Mullerian hormone. If you’re actively trying to get pregnant, these levels help to determine the best course of action. For example, if your ovarian reserve is low, my approach is to be as aggressive as you feel comfortable. It doesn’t always mean going straight to IVF. I may offer some pills that stimulate ovulation so you can keep trying at home or suggest trying a intrauterine insemination (IUI) in my office.
Trying to get pregnant older can be nerve-wracking — it can be at any age, but if you’re empowered with the diagnosis and best approach, you’ll feel more in control, and remember, I’m always here to help and answer your questions.