difficulty falling pregnant

IVF test

What is IVF, ICSI & IUI? 

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What is IVF, ICSI & IUI?

IVF, ICSI and IUI are common procedures that can assist you to have a baby when natural conception is not working. They are all very different fertility treatments, and clients always wonder which would be the best option for them.

What are the differences between IVF, ICSI and IUI?

IVF In-Vitro Fertilisation

What is IVF treatment?

IVF involves using fertility drugs to gently stimulate the ovaries to produce good quality mature eggs, which are then retrieved and fertilised in the clinic’s laboratory with sperm from your partner (or a donor). The Sperm and eggs are placed together in a special dish and eggs monitored for signs of fertilisation.

The embryo of greatest quality is selected for transfer, where it is then placed into the uterus to implant and grow for pregnancy.

Advantages of IVF treatment

IVF maximises the chance of fertilisation by placing eggs with sperm. Your clinic can select the embryo with the highest potential for pregnancy. Many clinics have an advanced embryo selection method, which include time-lapse monitoring and Preimplantation Genetic Screening. If you have more than one good embryo from your cycle, you can also choose to freeze the remainder to use in future treatment cycles if you so wish.

Why IVF may be advised

IVF is intended to overcome issues that can prevent sperm from fertilising an egg, such as fallopian tube issues (scaring or blockages). It may also be advised in some cases of unexplained infertility, or in mild ‘male factor’ fertility cases.

ICSI Intracytoplasmic Sperm Injection

What is ICSI?

Instead of sperm being mixed with the egg in the laboratory, the best single, healthy sperm is extracted from the sample and injected directly into the egg to fertilise it.

Advantages of ICSI

ICSI can help achieve pregnancy when male factor fertility issues are seen. Due to the sperm being injected directly into the egg it bypasses the other stages of early fertilisation. Only the best quality sperm is used for fertilisation, which is identified by an embryologist.

Why ICSI may be advised

ICSI is designed to overcome male fertility issues, such as

  • low sperm count
  • poor sperm mobility,
  • surgically-retrieved sperm
  • High levels of DNA damage.

IUI Intrauterine Insemination

What is IUI?

It involves inserting sperm (or donor sperm) into your uterus at the time you are ovulating, in the hope the egg is fertilised for pregnancy. This is often referred to as artificial insemination.

Advantages of IUI

IUI can be carried out with natural cycles, without using fertility drugs, relying on the egg you naturally ovulate that month. However, as the outcome of IUI closely mimics natural conception, you may need more than one insemination attempt to achieve pregnancy.

Why IUI may be advised

Those who need donor sperm to conceive choose IUI as it can be a quick, simple way to try to achieve pregnancy.

For IUI to be successful, fallopian tubes must be clear, sperm must be healthy, and an egg must be mature to fertilise. If you have irregular ovulation, fertility drugs can be used in combination with IUI. Otherwise, IVF may be advised as an alternative.

IVF, ICSI or IUI: Which is best?

The results of your fertility tests will help your fertility clinic decide which type of fertility treatment is best for you. An individualised approach is vital to give you the highest chance of success.

The clinic will take into account factors such as your medical history, age, and response to any previous cycles of treatment you may have previously had.   

You may be given the option to try IUI, or they may recommend you go straight to IVF or ICSI, if your partner’s semen analysis test reveals a sperm abnormality.

IVF cost

The cost of private treatment can vary, but 1 cycle of IVF can cost up to £5,000 or more. There may be additional costs for medicines, consultations and tests.

All treatment decisions should be made in consultation with you, so you’re fully aware of what your treatment path involves and your likely outcome, along with transparent costs.

Remember that everyone’s fertility journey is different, and what may be advised for one person may not be right for you.

Finding a fertility doctor near me

If you are asking yourself ‘How do I find IVF near me that is trustworthy’? Use this reputable link to choose a fertility clinic service that’s right for you. If you’re an NHS patient, use it to research the clinic you’ll be having treatment at.

https://www.hfea.gov.uk/choose-a-clinic/clinic-search/

dutch-blog

So why do I recommend the DUTCH test?

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So why do I recommend the DUTCH test?

Firstly, what is a DUTCH test?

The DUTCH (Dried Urine Test for Comprehensive Hormones) test is a comprehensive test to evaluate sex and stress hormones. In addition to measuring hormone levels, this test also takes into consideration metabolites (metabolites are breakdown products of these hormones) and specific nutrients (which are necessary for our body to use the hormones).  The importance of these groups of hormones is that they play a vital role in many aspects of our life that if left unbalanced, can leave us feeling anxious, moody, and fatigued, to name a few.

What does the DUTCH test measure?

  • Oestrogen (Oestradiol, oestriol, and oestrone)
  • Progesterone
  • Testosterone
  • Cortisol
  • Nutritional organic acids
  • Neurotransmitter metabolites
  • Melatonin
  • Hormone metabolites (the breakdown products of hormones that can tell us how your body is effectively, or ineffectively using the hormone – this may be the cause of one’s hormone imbalance).

The DUTCH test is beneficial for males and females. Various environmental factors, medical treatments, and age-related changes affect hormones in men and women.

Types of DUTCH testing

Depending on which test you take, you will either collect 4-5 strips of urine and/or 4-5 tubes of saliva that get sent into the laboratory. The results will be analysed to gain a comprehensive picture of what is going on in all those cells within the body.

In addition to your sex hormones (oestrogens, progesterone, and testosterone) and adrenal hormones (cortisol), the DUTCH test analyses hormonal metabolites which can be just as important as your hormone levels. Due to key nutrients being vital for optimal function, the test also measures nutritional organic acids, which are markers to show how much B6, B12, and glutathione your body has (or is lacking). Nutritional organic acids are not typically evaluated in standard medical hormone assessments. In order to have a comprehensive knowledge of your hormones, you need to know these other key factors. The additional benefit of these markers is that they show your risk of oxidative stress (or your potential for DNA damage) as well as your risk of oestrogen related issues.

The DUTCH test helps guide safe lifestyle and medical treatments to restore balance. For example, if you show higher or lower numbers in your organic acids that may be affecting your hormone breakdown and treatment may be as simple as saying, you need more B12 in your diet, versus you need hormone therapy. Or, if your cortisol levels are very high, mindfulness and meditation may be more important for someone’s treatment than compared to someone without high cortisol.

How does this test compare to other ways of evaluating your hormones?

Serum blood test

Most people are used to getting a blood test to assess hormones. There are many benefits of this test including convenience and it is inexpensive. However, the drawbacks are that it will only show you what is circulating in your blood at that moment in time. Hormones fluctuate throughout the month and throughout the day, so it may not capture as precisely as the DUTCH test would, especially for cortisol. A blood test cannot accurately determine what is going on with your cortisol levels. The DUTCH test has been studied and is comparable and as accurate as performing a blood test.

Saliva Testing

Saliva testing does have clinical value for cortisol especially if you do it over the course of a day, this is called a diurnal pattern which is the best way to measure cortisol but doesn’t necessarily give the full picture of what is going on in the body in regards to cortisol. Additionally, saliva testing is not the most accurate measure for sex hormones. The benefit of the DUTCH test is that it is one test that will measure both your cortisol and sex hormones accurately.

Standard 24-hour urine test

This test is another type of urine test for hormones and cortisol. Sex hormones and cortisol can be measured well in urine which is why the DUTCH test uses urine, but for cortisol, without a saliva comparison, it cannot be as accurately measured in that diurnal pattern. This test has a high error rate (40%) and can be messy (it is collected in containers throughout the day). The DUTCH test uses dried urine, not wet urine, and studies have shown that the accuracy is very comparable and just as accurate, but this is an easier method of collection and again, takes out the need for multiple tests.

Will I benefit from the DUTCH test?

The Dutch test is useful to help anyone wanting to get a better picture of overall hormone and metabolite balance. It helps you identify any lifestyle and dietary changes to better balance your hormones. We all get stressed, and we are all predisposed to dietary and environmental stressors that can affect our hormone levels. But beyond this, anyone that is dealing with symptoms of hormonal imbalance or chronic stress or disease – insomnia, obesity, weight gain, fatigue, pelvic pain, endometriosis, PCOS, infertility, mood changes, brain fog, etc can benefit from taking a closer look with the DUTCH test. This is a great test also for those that are experiencing symptoms of hormonal changes but their blood tests are coming back pretty normal.

Benefits

The DUTCH gives you a more complete picture and overview of the key components your body needs to both produce and utilize your hormones. It is a great compliment to a serum blood hormone profile, and it is good for both men and women as the results can help identify the root cause of issues you may be having.

Drawbacks

The DUTCH test can seem costly and running the test requires restrictions during testing. Certain supplements and medications are recommended to be out of the system and for some women, it is necessary to take it at a specific time during your cycle.

If you are suffering from any of the issues mentioned in this blog, please get in touch to discuss whether the DUTCH test is right for you, I will take care of the rest.

 Contact Me

folate-blog

The importance of folate and vitamin B12 whilst trying to conceive

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Getting enough vitamin B12 and folate (vitamin B9) is important at all stages of life, but when you are trying to conceive or actually pregnant you have even more reason to include these vitamins to help ensure your little one grows as healthy as possible.

Folate and vitamin B12 deficiencies show a higher rate of infertility, miscarriages, and birth defects. This is because these vitamins are essential for red blood cell production, DNA synthesis, and nervous system development. These vitamins are not naturally produced in our bodies so it is important to include sources or supplements into our daily diets.

B12 deficiency is common in individuals who do not eat meat or dairy, and also who have been on medications like metformin. This is why it is common to see some ladies with PCOS to be deficient in B12 due to the years of hormonal birth control pills, metformin, and even some ladies who omit from consuming dairy. Do not fear though, most prenatal vitamins contain B12 and if you have been focusing on increasing protein for blood sugar balance, you likely are increasing this vitamin naturally with the animal products you are eating. Eggs, meat, and fish are sources of B12.

If you have low energy, not having enough of these vitamins may be to blame, so considering your diet, medication, and supplement history can help inform what type of prenatal or supplement to take in addition to what you’ll receive from foods.

Click here to view my programmes where I can guide you on the correct nutrition, supplementation, and lifestyle requirements to support your journey.

blood-test

When to have your lab tests done?

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Getting your blood drawn at the appropriate time in the day and in your cycle can be really helpful, to determine what’s really going on in your body.

Some lab tests you should be fasting for, others don’t really matter if you have eaten or not.

Some of the lab tests recommended should be taken in the morning after fasting overnight, such as: blood glucose, insulin, and am cortisol. The cortisol is more a timing issue of taking the lab sample within 30-60 minutes (or as close as) of waking and not so much because you need to have fasted.

LH and FSH are helpful to look at during the beginning of your cycle. Day 3 is optimal.

Male hormones don’t change too much depending on your cycle. If they are elevated, they are typically elevated, doesn’t matter if you are on your period, ovulating, or about to bleed.

You really only make an appreciable amount of progesterone if you have ovulated or are pregnant. So, if you have it tested early in your cycle before ovulation would take place, it won’t tell us much. Likewise, if you have a longer cycle, more than 35 days, getting a day 21 progesterone won’t tell you anything more than you didn’t ovulate “yet”. I always recommend women get progesterone tested seven days after ovulation. See my blog on ‘The power of ovulation’ and ‘Truth about getting pregnant on day 14’

Getting any other tests done like oestrogen, prolactin, AMH, SHBG, vitamin D or vitamin B12…. these are also tests you can have taken any time. Something like oestrogen is helpful to know what point of your cycle you were in during testing, and based on symptoms, your practitioner might request it to be drawn at a specific time.

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The power of Ovulation

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Ovarian hormones, oestrogen, and progesterone are beneficial for health. This indicates natural ovulatory menstrual cycles are beneficial for health because ovulation is how women make hormones.

Men make testosterone every day, so you might think women do something similar, but we don’t. Instead, women make hormones as a surge of oestradiol leading up to ovulation and an even bigger surge of progesterone after ovulation.

It’s an elegant system that sometimes results in a baby. Even when ovulation does not result in a baby, it’s still worth doing because regular ovulation delivers the beneficial hormones that the body absolutely expects to have.

Benefits of ovulation

Every monthly dose of oestradiol promotes muscle gain, insulin sensitivity, and the long-term health of bones, brain, and the cardiovascular system.

Every monthly dose of progesterone reduces inflammation, regulates immune function, and supports the thyroid, brain, bones, and breast tissue.

The benefits of ovarian hormones are both short-term by making women stronger, and long-term by building metabolic reserve and health.

Obstacles to ovulation

Hormonal birth control

Hormonal birth control stops ovulation, which is, of course, its purpose. It switches off ovarian hormones and replaces them with contraceptive drugs like ethinylestradiol and levonorgestrel which can cause hair loss and other side effects.

Tip: There’s no progesterone in any type of birth control.

The physiological difference between our actual hormones and the contraceptive drugs of birth control affects every system in the body. Compared to women who cycle, women who take contraceptive drugs have altered brain structure and a greater risk of depression and autoimmune disease.

Undereating (to include carbohydrates)

Losing ovulation and periods because of undereating is called hypothalamic amenorrhea. It’s not a disorder, but rather a smart, adaptive decision by the brain to pause reproduction when there’s not enough food to safely make a baby.

Polycystic ovary syndrome (PCOS)

The hormonal state of excess androgens or testosterone can cause anovulatory cycles (cycles with no ovulation) and is usually associated with insulin resistance. Reversing insulin resistance with diet, exercise, and natural supplements such as inositol can help to restore ovulation.

Tip: Before you embark on any kind of calorie-restricted or carb-restricted diet for PCOS, take care that your diagnosis was not based solely on an ultrasound or an AMH blood test. Those tests are not reliable and may have resulted in you being told you have PCOS when you actually have hypothalamic amenorrhea.

In conclusion, ovulation is so important for women of childbearing age, but not just to make a baby.

menstrual-cycle

The truth about getting pregnant on cycle day 14

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You do not need to ovulate on day 14 to get pregnant.

Only 10% of the population of women with a 28-day cycle even ovulate on day 14, this means a 21-day progesterone blood sample is likely to be misleading for many of us.

If you are ovulating you are likely doing so 10-14 days before the end of your cycle when your next period would start. That means if you have a 40-day cycle length, ovulation is most likely to occur between days 26 -30. If you have a 60-day cycle then it would be days 46 – 50. If you average 35 days, then you are likely to ovulate from day 21-25. See my blog on ‘Ovulation is what makes progesterone’.

I have seen plenty of women conceive when they ovulated late into a long cycle. If you have been told you don’t ovulate because your cycle is longer, then you were told something based on incomplete data. If you were told you don’t ovulate because they drew progesterone levels on day 21 of a longer cycle, the same thing applies.

So how can you tell if you are ovulating?

Many women move straight to ovulation predictor kits – also known as OPKs. This isn’t recommended for a few reasons, but especially for PCOS, where you can see a lot of false positives. I recommend instead learning what cervical mucus is and investing in a basal body temperature thermometer. Starting to collect data on the mucus your body makes and when your temps go up and down can literally tell us not only “if” you are ovulating, but also “when”.

You can ovulate with PCOS. Many of us can do so with a simple diet, lifestyle, and supplement tweaks. Many of us, it’s that simple to go from “infertile” to “fertile”, just getting us to ovulate. Then there are other things to learn, like how to time intercourse, how to support progesterone levels, and so on. But, be assured, you can get pregnant at different points in your cycle. Remember, it is possible to be a mum even if you have PCOS – I’m living proof and would love to support you on your journey.

maximising-fertility

Maximising my fertility

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Whether you want to get pregnant tomorrow or in a year, there are some actionable steps I can guide you with to maximize your fertility potential.

Lab work

It is never too soon to make sure your thyroid function is on point, inflammation is well managed, nutrients look good, hormones are in a healthy range, glucose is normal. This I can guide you through via your GP and functional testing.

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Start tracking your menstrual cycle

Depending on your goals, this could mean anything from tracking your cycle in an app to collecting all the information with basal body temperature and ovulation predictor kits. The more familiar you are with your unique patterns, the easier it will be to determine if something is off, and the quicker we will be able to zone in your fertile window. See my blog on ‘Do you know when you’re ovulating?’. ⠀⠀⠀⠀⠀⠀⠀⠀⠀

Focus on nutrient density

I can guide you each step of the way. As a rule, eating a rainbow of fruits and vegetables is the best way to ensure broad-spectrum antioxidants, phytochemicals, and micronutrients. A Mediterranean-style food plan that is antioxidant-rich, anti-inflammatory, and full of healthy fats is a good choice for many people. During a 3 month programme, we will create a food plan together which is specifically tailored to you.

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Supporting your emotional mindset

You are deserving. You are capable. You are full enough to give to another. This journey can seem such an emotional rollercoaster, your note alone, I’ve been there and completely understand your pain. It doesn’t have to be this way, let me support you, as a Freedom Fertility Formula Specialist I am trained to support you with the emotional aspect of your journey. Freedom Formula Specialist

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Clean up your cleaners and beauty products.

One hormone that is very relevant to reproductive health is oestrogen and some chemicals (xenoestrogens), or foods and plants (phytoestrogens), mimic the action of oestrogen produced in cells and can alter hormonal activity.

Hormone disruptors get into our bodies when we breathe, eat, drink and have skin contact with them.  There is no way to avoid them entirely, but reducing your exposure to them to the extent that it is within your control should help.  Some of the worst offenders when it comes to hormone disruption are:

  • BPA Plastics- Bisphenol A (BPA) is commonly used in some plastic products such a food storage containers, plastic drinks bottles and linings of canned food, and
    Phthalates – used in cosmetics, fragrances and other personal products.

Emphasize non-toxic products – you are what you eat, breathe, and absorb.

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Supplementation

Nutrition is the key to laying down the foundations for the health of your conception, pregnancy and baby. Nutrients play an essential role in creating and maintaining healthy eggs and sperm that will go on to fertilise, implant and grow a healthy baby. There is so much conflicting advice around diet and supplements when trying for a baby naturally, together we can develop a personalised and targeted nutritional plan which includes supplementation that is right for you.

Together we can work towards nourishing that new life

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The four types of PCOS

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What is PCOS?

Polycystic Ovary Syndrome (PCOS) is best defined as high levels of androgens (male hormones) when all other causes of androgen excess have been ruled out. 

This may lead to unpleasant symptoms such as weight gain, irregular or absent periods, difficulty falling pregnant, oily skin and/or acne, hair loss or thinning hair on the head, and unwanted body hair growth.

Despite the name, you do not actually have cysts if you have PCOS. The ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs. Although it’s a condition that affects our hormones, PCOS has roots in metabolic health, inflammation, and adrenal function.

The four types of PCOS

1. Insulin resistance PCOS

This is the most common type of PCOS and is the result of high levels of insulin in the body, also known as metabolic syndrome or pre-diabetes.

 

Insulin resistance is what happens when the cells in your muscles, fat and liver stop responding well to insulin, which increases blood sugar levels and forces your pancreas to release even more insulin.

Higher levels of circulating insulin increase the production of androgens in women which interferes with ovulation and leads to symptoms of high androgens, resulting in PCOS symptoms noted above. 

How will I know if this is me?

In addition to signs of androgen excess, insulin-resistant PCOS may also cause fatigue, brain fog, frequent thirst and urination, and weight gain around the middle. Having a test to measure insulin levels is recommended.

2. Post-pill PCOS 

If symptoms of PCOS started a few months after coming off oral contraception, it may be a temporary state related to a surge of androgens that are produced as your ovaries kick back into gear.

Oral contraceptives contain an androgen-suppressing form of progestin. Even though it’s more of a temporary hormonal state, some women are given a PCOS diagnosis during this time.

 

How will I know if this is me?

You may be dealing with post-pill PCOS if you have ruled out insulin resistance, and started experiencing signs of higher androgens within 6 months of coming off hormonal contraceptives.

Fortunately, post-pill PCOS may heal within a few months to a year when supported with the right nutritional and lifestyle input. 

3. Inflammatory PCOS

This is where chronic inflammation in the body is the primary driver of elevated androgens.

High-level inflammation stemming from an overactive immune system can stimulate the ovaries to make too many androgen hormones, which can interfere with ovulation and lead to irregular periods.

 

How will I know if this is me?

If you have inflammatory PCOS you will not experience insulin resistance or be in the temporary post-pill phase. However, you may experience other signs related to high levels of inflammation, such as:

  • Persistent fatigue that isn’t remedied with sleep;
  • IBS-type bowel irregularities
  • Headaches
  • Joint pain
  • Skin conditions such as eczema, hives or psoriasis

4. Adrenal PCOS

The final type of PCOS is not driven by insulin resistance, hormonal contraceptive use, or inflammation, but rather the body’s response to stress.

With Adrenal PCOS you will either experience high levels of stress, or your body is reacting abnormally to stress. In either case, you will have high levels of DHEA (an androgen produced in the adrenal glands) and normal levels of other androgens produced in the ovaries (such as testosterone and androstenedione).

How will I know if this is me?

If you have ruled out insulin resistance, and testing shows only your DHEAS is elevated and not your other androgens, then you are most likely dealing with adrenal PCOS.

If you feel you may be affected by PCOS and would like some further guidance, please feel free to get in touch, I am here to support you as this can be an overwhelming journey.  Contact Me

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