Hope & Hopscotch

egg quality

THE 3 Books YOU SHOULD BE READing IF you're DOING IVF

ResearchSae1 Comment

There's a huge learning curve with IVF. I remember being at the very beginning of my journey and completely overwhelmed with all of the information. There were acronyms I didn't get, I wasn't sure what the best route for me was, what kind of things I should be doing or not doing... it was tough.

I'm not the kind of person who does well with not-knowing, or not feeling like I have a firm grasp of a situation. As there are so many factors in IVF you can't control, so I was very keen to educate myself and get a handle on what I *could* control. My kindle was filled with books about IVF. Some were better than others, I have to say. 

Here's my top three.

1. It Starts with the Egg. Rebecca Fett

During my first round when I was at my most determined to 'beat' infertility, this book was hands down the most helpful in terms of "what can I do right now?" help. All the advice is based on academic research (and studies are shared in the index).

It gives clear and easy to follow actions of things which will make a difference - the positive AND the negative of all sorts - supplements, lifestyle (think: cleaning and beauty products), diet. It also debunks a few myths (example - turns out there is no evidence to suggest that royal jelly improves egg quality or has a higher incidence of pregnancy).

Overall, pretty interesting and well worth a read for anyone TTC, whether you're starting out or you're three IVF rounds in.

(Available on amazon.com or amazon.co.uk). 

2. Get A Life: His and Hers Survival Guide to IVF. Rosie Bray and Richard Mackney

This is such a great book - it's essentially an IVF 101 guide, with what to expect at each stage of IVF and how best to handle it. It's written by a wife & husband duo who share their unique perspectives on their three rounds of IVF. For each chapter there is a guys and a girl perspective which helps get your head around how different the experience is for each person. This was super helpful for me with my guy - it took me a long time to understand we were processing at different rates. So when Zee  didn't want to talk about IVF, or would watch TV instead of fill out his forms - it wasn't that he uninterested in IVF. He hadn't processed yet. When I realised, I felt like a light bulb had gone off in my head.

They did a great job of highlighting the ups and downs of IVF. It was quite anecdotal but was very readable. There was just as many giggles as tears and you really felt for them. Their initial IVF experiences weren't too far from mine and it was comforting to know I wasn't alone. It also has a handy guide of things to ask at your first appointment. 

Well worth a read - especially if you haven't yet been through a round of IVF and would like to know what to expect. 

(Available on amazon.com or amazon.co.uk).

3. IVF: An Emotional Companion. Brigid Moss

Oh this book. It's the best example of how not alone we are. There are so many paths that lead to parenthood and this book covers the personal stories of large chunk of them - adoption, IVF, male factor infertility, single mums by choice, gay IVF/adoption, older couples, OHSS, diminished ovarian reserve, giving up on IVF, surrogacy... it shares the real life stories of people who have struggled their way through, and the decisions they've made.

It was pretty moving -  it was heartbreaking, uplifting and parts were even pretty gory. I realised how often I've read the side effects of IVF and dismissed it as if it couldn't happen it me. When I read the stories of women who it DID happen to I was shocked at how callous I had been. There were plenty of highs, but a lot of lows too. A very honest look at infertility.

It's a fantastic resource. Each section has a theme, an honest story and resources to find out more. 

(Available on amazon.com or amazon.co.uk)


Other mentions.

I read many and while I wouldn't put these in the top three, they were helpful in providing perspective.

The Complete Guide To IVF: An inside view of fertility clinics and treatment. Kate Bain.

This book has a good overview of the IVF process and a brief look at the various causes . It was a great behind the scenes look at how clinic's operate, and what happens outside of the rooms we typically get to see in. I also really enjoyed the technical breakdown of the processes (like ICSI) but wished it could have taken it a step or two further. I wouldn't call it a complete guide, as it discounts lifestyle choices (like diet) as irrelevant and not helpful. It didn't provide the tips or the details/studies I was looking for. Side note, it was published in 2010, so parts of it (like freezing) are a little out of date.

(Available on amazon.com and amazon.co.uk)

The Baby Making Bible. Emma Cannon.

This was a pretty interesting read. Essentially it talks through Eastern Medicine (think: Chinese herbs and philosophy with acupuncture, diet and visualisations) with Western Medicine. While it does have a few nods towards research studies, a lot of the supporting evidence was anecdotal. I enjoyed the 'look after yourself' message, as often when trying to conceive there is pressure on the 'conception' segment but very little thought given to the rest of your cycle. The idea is that you remove that pressure to conceive and spend some time building up your body. I'm not sure I understood the Chinese type casting and found it quite difficult to take in. I also got the impression that this book is essentially an ad for her clinic.

(Available on amazon.com and amazon.co.uk)

The Fertile Female. Julia Indichova

I... struggled with this book. I'm very scientifically driven and like data and research and studies. The Fertile Female is not like that - it's very spiritual. If IVF is about taking care of the medical side of things, this book provides insight into how to take care of your emotional/spiritual side. I found it difficult when I first approached IVF, because I wanted to know what I could do physically to improve my chances. It wasn't until much later (Round #3) that I cycled back to this book and gave it some proper thought. It encourages you to trust your body and advocate what is best for you. Our doctors often take a very medical approach and it's up to us to take care of our lifestyle approach.

The most telling for me is that I read this study about how visualising an exercise can make a significant difference. With that in mind, spending the time to visualise what was happening with my body seemed like a good use of time. 

(Available on amazon.com and amazon.co.uk)

The Essential Fertility Guide. Professor Robert Winston.

This is a good beginners book, if you're new to the world of infertility. He does a great breakdown of what to expect and what to ask, over several different types of infertility. I think the best bit is that Professor Robert Winston suggests you really understand what is happening with your body before you jump to IVF. He mentions the great costs (and thus potential profits) associated with IVF now that it's so commercialised and provides the information so you can advocate for yourself. 

(Available on amazon.com and amazon.co.uk)

How to Improve Egg Quality: The Smart Way to Get Pregnant. Darja Wagna. 

I really wanted to like this book. I did. It seemed great at first - clear and concise actions you can take to improve egg quality. However there wasn't enough scientific evidence to back up what she was sharing and I found that parts of what she was suggesting didn't go into enough detail. An example would be call to take the supplement CoQ10. Yes, you absolutely should take it, but the book didn't mention that you should be taking the form ubiquinol (and NOT ubiquinone, which is the cheaper and more widely available).  I found it difficult to trust what was being advised.  

(Available on amazon.com and amazon.co.uk)

The Four Hour Body. Tim Ferris. 

This book has nothing specifically to do with fertility. It's more about about understanding the relationship you body has with food in a weight loss context. Bonus, the low carb diet is pretty IVF friendly, too - because there are some pretty strong correlations between BMI and fertility. I thought it might be relevant. I lost 15kg with the four hour body method, and found it relatively easy to stick to. Essentially, you cut out carbs, dairy and sugar (easier than it sounds, promise!) for 6 days out of 7. .

(Available here on amazon.com and amazon.co.uk)


book2.png
book1.png
book3.png

Why should worry about Egg Quality if you're doing IVF

ResearchSaeComment

 

There’s a lot of speculation that fertilisation is the crux of getting pregnant. Take one good swimmer plus an egg and boom - nature will take it's course and produce a healthy little baby. So to fall pregnant all you need to do is introduce an egg to the sperm, right? 

Often when trying to conceive there is a huge focus on fertilisation. There are some complicated ovulation prediction methods to help get the timing right. Like temperature charting and OPKs - peeing on sticks to compare the lines from previous days. The hope is having sex at the right time, the sperm and egg will meet and fertilise. 

Turns out it's a bit more complicated than that. Truth is,  Fertilisation is only a small part the equation. Only around a third of fertilised embryos will survive and grow in a healthy baby (1). 

Let’s take a moment to process that. Miscarriages are more common than we think, occurring in about 10-15% recognised pregnancies (2). The important part there is "recognised pregnancies". Most miscarriages happen before you even realise you’re pregnant (3).  In fact, it’s thought that up to 70% of pregnancies end in miscarriage (1).

So despite getting past fertilisation a large number of pregnancies won't grow to term. It's been found that the key to getting pregnant (and staying pregnant) is egg quality. That is, whether your egg has the right number of chromosomes or not.  

Each egg starts with four sets of chromosomes. Shortly before ovulation (4) your egg will go through a process of aligning two sets of chromosomes.  Once matched, your egg will dispose of the extra set. It does this twice and if all goes as planned your egg ends up with one copy of each chromosome, ready to ovulate. This process is called meiosis.

Meiosis will define whether your egg will have the right number of chromosomes. This is important, because an egg with the wrong number of chromosomes could result in a miscarriage, or even have difficulty fertilising. If a chromosomal abnormal embryo does grow to term it's likely to have a genetic disorder. Down’s Syndrome, or Turners for example. 

Chromosomal abnormalities are surprisingly common. In women over 40, it’s thought that more than half her eggs may be abnormal (5), possibly even as high as 70%-80% (6). For women under 35, in one study it was found that up to a quarter of her eggs will have an abnormal number of chromosomes (6).

Putting that in context: for every month that a woman under 35 ovulates hoping to become pregnant, one month of four  it’s unlikely she’ll be able to conceive. If she does, she’s likely to miscarry.

During IVF there is an optional process called PGS - Pre-Genetic Screening. Once fertilised embryos reach blastocyst level they can be screened to check the number of chromosomes. Only chromosomal normal embryos will be transferred back for implantation.

It’s a heartbreaking decision to make. With PGS there is a possibility all the embryos may be abnormal. There may no-viable embryos to transfer. If that’s the case it’s likely even without PGS the outcome would not result in a healthy pregnancy.

There have been several interesting studies (7, 8, 9) on the impact of using PGS with IVF. The most interesting - pregnancy rates increase dramatically when using PGS screened eggs. Embryos that have been checked and are chromosomal normal are more likely to produce a successful pregnancy. 

In one study, the successful implantation rate for ladies between 40-43 years old went from 19.0% to 45.5% when using only screened embryos. The number of ladies in that age bracket who became mothers more than doubled. (7).

Another study repeated in both Beijing and LA found that 69% of IVF patients who used PGS screening and selected only chromosomal normal eggs became pregnant. In the control group (who did not use PGS to select chromosomal normal eggs) had only 41% of IVF patients fall pregnant. (9)

It’s clear that having chromosomal normal eggs - good quality eggs - is fundamental in having a successful pregnancy, and a happy healthy baby, more so than fertilisation. To put it simply: Egg Quality is everything.

The question then becomes, can Egg Quality be changed? If so, how?  Stay tuned for more posts. :)

References
1 - http://www.ncbi.nlm.nih.gov/pubmed/14532867
2 - http://humrep.oxfordjournals.org/content/27/8/2297.full
3 - http://humrep.oxfordjournals.org/content/27/12/3583.full
4 - http://www.nature.com/nrg/journal/v13/n7/full/nrg3245.html
5 - http://www.rbmojournal.com/article/S1472-6483(10)00571-7/fulltext
6 - http://molehr.oxfordjournals.org/content/17/5/286.full
7 - http://www.ncbi.nlm.nih.gov/pubmed/25578536
8 - http://www.ncbi.nlm.nih.gov/pubmed/19939370
9 - http://www.molecularcytogenetics.org/content/5/1/24


egg.png
eggquality.png