Fertility specialist’s lecture shows couples their options

By Jessie Moniz Hardy

“You’re young, so keep trying” is the advice that many couples hear from well meaning medical practitioners when they are struggling to get pregnant.

A visiting fertility expert, Dr Matan Yemini, said that while some women may be young in age their ovaries might be functioning as though they are much older.

A simple blood test to check ovary function might mean the difference between more “trying” and skipping straight to Plan B, whatever that might be.

Dr Yemini is a specialist in reproductive endocrinology and infertility at the Diamond Institute in Millburn, New Jersey.

He gave a talk on infertility and alternative treatments such as in vitro fertilisation (IVF) to fertility support group Paperwhites on Thursday.

In IVF, this process of fertilisation happens outside the woman’s body.

A woman’s eggs are surgically removed and fertilised in a laboratory using sperm that has been given as a sperm sample.

Next, the fertilised egg, called an embryo, is surgically implanted into the woman’s womb.

Typically, one cycle of IVF takes between four and seven weeks.

“For the majority of patients, ‘go home and keep trying’ is the right answer, but for some patients it is the wrong answer,” said Dr Yemini. “It is simple enough to tell a woman who is 30, for example, to keep trying, but we also need to think for a moment.

“Is there anything in her medical history that would complicate things, such as pelvic surgery? Does she have endometriosis?”

Endometriosis is a condition resulting from the appearance of endometrial tissue outside the uterus and causing pelvic pain.

“Out of a hundred patients that I see over the course of a few months, at least 20 to 30 of them although young, their ovary function has declined,” said Dr Yemini.

A simple blood test to check a woman’s anti-mullerian hormone (AMH) level can shed light on how well a woman’s ovaries are functioning.

It is often among the first tests that Dr Yemini orders. AMH is produced only in small ovarian follicles, and is thought to reflect the size of a woman’s remaining oocyte (egg) supply — or “ovarian reserve.”

It, however, does not reflect the quality of the eggs she does have.

Women with many small follicles, such as those with polycystic ovaries have high AMH hormone values and women that have few remaining follicles and those that are close to menopause have low AMH levels.

Women with higher AMH values will tend to have better response to ovarian stimulation for IVF, with more eggs retrieved.

It has been documented that women with lower AMH produce a lower number of eggs.

“For some women, the AMH level is below zero,” said Dr Yemini. “In that case, you might say, you are young, but it doesn’t make sense to wait a year because your ovaries are older than your age.

“In that situation maybe we should be more proactive.”

Dr Yemini said if a couple is struggling to produce a child, it is also important to test the man’s sperm for problems such as low sperm count.

“The woman’s uterus and tubes also need to be tested,” he said. “If she had unexplained fertility, the worst they can do to her is say lets keep waiting. She needs to be treated. Time isn’t on her side.”

He said there is no perfect candidate for IVF. In the early years of IVF it was primarily used for women with problems with their Fallopian tubes, such as blockages.

Later, it was also used for couples with sperm problems.

“It is definitely becoming more and more for patients with miscarriage problems,” said Dr Yemini. “You might have a patient who is normal genetically, but keeps having a lot of miscarriages.

“In this situation, you might use IVF to control the situation a little better. You make sure the embryo is healthy before putting it back in the womb.”

He said IVF is also being done more and more for genetic reasons.

Some patients who carry certain genetic mutations might use IVF to make sure the embryo is not a carrier of the gene.

“The genetic part of IVF is becoming more and more available right now,” said Dr Yemini. “In the past, we could only test for some chromosomes.

“Today, we can check all the chromosomes of an embryo before we put it back.”

The success rate of IVF depends, partly, on the age of a patient.

It can be as high as 60 percent for women under 35 years old and can drop as low as 20 to 30 percent for some women who are 40 or 41.

He said checking the embryo’s chromosomes for genetic mutations raises the chances of a successful pregnancy.

For more information about the Diamond Institute see www.diamondinstitute.com/contact_us_Bermuda.html.

The Paperwhites infertility support group meets on the first Tuesday of every month from 6 to 7.30pm in the private room at Ten on Dundonald Street in the City of Hamilton. No need to call ahead.