# 40+ don't know where to go from here...



## Elsi0553 (Sep 1, 2014)

Hi,

I'm new to this site but having trawled the internet for answers, I found this site so here I am.  My DH and I have been TTC for the last year and I've found out I have low AMH = 1.5.  My FSH is 8. I don't think I ovulate but am seeing a fertility reflexologist and taking angus castus plus other vitamins. We are just starting the IVF journey but I have so many questions, should I try DHEA first?  Is it worth it as I've read the side effects are bad.  My clinic were very cold and factual when they told us the results and didn't give us much information afterwards.  The consultant has advised against taking DHEA as there is not enough evidence to prove its viability in improving AMH levels.  Then the IVF.... Which clinic do we choose? How do we compare the stats?  How do we know which have good success rates? 
I suppose I just feel as though I'm the only one going through this.  My friends and DH are very supportive but they don't really know what it feels like to be told that the one thing that you've waited a long time for, is not going to be possible the usual way and it's going to be harder to achieve, maybe unachievable.  I'm trying to keep positive everyday.  

Any help/advice anyone can give would be really great, just to talk with people who are going through/been through similar experience 

Elsi xxx


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## spudlin (Nov 12, 2012)

Hi, I did a lot of reading about dhea whilst still under the care of the nhs. My nhs doc did actually agree that I should take it prior to ivf.

My amh level did go up. I believe not everyones does but that there are still positives in relation to egg quality.

In relation to side effects, can't say I've experienced anything really. I had thought my hair had thinned,  but not sure whether I was just looking for side effects. I'm defo not bald lol  

My first private doc was all for it, but my new doc is indifferent. I still take it  

Good luck on your journey x


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## Elsi0553 (Sep 1, 2014)

Hi Spudlin,

Thanks for this, there's so much information out there that it's good to talk to someone who's actually using it.  My reflexologist has recommended taking it and I'd like to give anything a go, but as my NHS doc has said no, it's put me in two minds.  It seems it's big in the USA but only a few clinics here advocate it.  I'd read that's one of the side effects but doesn't everything have some effects these days?!   

Do you have any experience of IVF clinics, in that I mean, how to choose, what to look for?  I've tried looking at the stats but it's hard to compare when I don't really know what to look for.


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## beattie2 (Dec 30, 2005)

Hi Elsi
There is still hope for us older ladies with low AMH.  Your FSH does not look too bad. I have taken DHEA- I think it is definitely worth looking into. Really you want to be working with a clinic that has good experience with older ladies/ poor responders. There are a number of in London,not sure about other areas I also took good quality chinese herbs to improve my ovarian response, some clinics have also started using growth hormone in IVF cycles - again some studies have had some really positive results for us older ladies. Good luck x


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## littlewhisper (Feb 28, 2013)

Hi Elsi,
Just saw this post and wanted to say you are definitely not alone. Have a look at the over 40's current cyclers which is a really supportive thread. The only thing I'd say is maybe be a bit careful if you haven't had an initial assessment yet i.e ultrasound scan, HSG etc as there are certain circumstances where Dhea is not to be used for instance if you have PCOS. It would be better to get a fertility assessment then see what might support you in terms of supplements, just my opinion.
there are loads of success stories for over 40's so don't be discouraged. xx


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## spudlin (Nov 12, 2012)

I read loads on dhea and yes most of it relates to the states, I believe it is given as a matter of courses over there to ladies of a certain age  

If there aren't any contraindications to you taking it as littlewhisper has said, then go for it. It isn't expensive, I get mine from Biovea as they sell the micronised version which is what they recommend.


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## Elsi0553 (Sep 1, 2014)

Thank you all so much for your advice!  It's definitely helped. Beattie2, I'm going to do more research into clinics, my docs said that my age wasn't a factor, this would have happened at any time but obviously they said my FSH will rise as I get older.  I didn't even know there were such clinics, defo gonna have a look now, thanks.  Where do I find out Chinese herbs?  So many sites saying take this, don't take that, it's overwhelming at times.

Littlewhisper can I ask what is a fertility assessment?  So far I've been to a consultant, had FSH, LH and progesterone tests, had numerous scans, tried clomid as they thought I wasn't ovulating and then my AMH test came back so they've now said IVF, most probably with donor eggs but I'm not sure how I feel about that.  And what's' HSG?  Still trying to learn all the abbreviations on here  
Is there anything else I should be asking for? I'll have a look at the boards you've suggested, thank you.

Hi Spudlin, I think I will go for it, once I've checked it's ok for me, feeling much more positive and focused. 

Elsi xx


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## littlewhisper (Feb 28, 2013)

Hi Elsi,

It sounds like you've had a fertility assessment. It checks AMH, sometimes FSH, LH, ovarian scan and a few other hormone levels I think. I couldn't get that at a GP not sure about how others did it but I had to go private. I think if you are under a certain age ( 41?) you can go to the fertility clinic of your NHS hospital. The HSG is a test  to check your fallopian tubes are clear, its normally the next step if they find no issues from your scan( which only gives an image of the ovarians tubes etc it doesn't show if a tube is blocked). The HSG ( Hysterosalpingogram) is an x-ray process. An iodine dye is squirted up through your tubes and the xray shows whetehr it passes clearly or is obstructed. Its one of the first things I got done around the same time as my blood tests. If all is clear then you can rule out blocked tubes. It may not show fibroids though which if you had pain symptoms of these then they might suggest a laparoscopy. 
This is a slightly more intrusive process as a surgeon needs to make an incision in your abdomen and a fibre optic narrow cable is passed in to checke the whole pelvic area. I didn't go for that but others have. Its worth researching clinics near you as well as your NHS one if your are elligible to go there. then you can take all your test results and they can suggest an treatment for you whether it be IVF, Mild IVF, ICSI etc.

I took chinese herbs for six months. I went to  proper chinese medical practictioner ( look at your local area and check their credentials!) and he gave me traditional acupuncture and herbs. They don't taste good ( had to boil them into a tea, but hold you breth and just glug them down and you'll be grand. they made me feel great after my IVF treatment as my body was full of toxins I felt. Didn't get me pregnant though but tohers have had success and the comination of acu and herbs improves AF flow.

hope this helps

LW xx

hope this helps


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## CrazyHorse (May 8, 2014)

Hi, Elsie, given your AMH level, there's not really any point (if you're going private) in paying for an HSG to assess your Fallopian tubes prior to starting fertility treatment, as statistically speaking the cost per pregnancy will almost certainly be lower if you proceed straight to IVF than if you start with IUI. In IVF, of course, whether your tubes are open doesn't matter, although your IVF consultant will look on ultrasound to see if you have a hydrosalpinx (if you do, that will need to be removed if possible prior to IVF). Fibroids will also be visible on ultrasound, although these usually don't need to be removed unless they're inside the uterus or seriously deform the uterine cavity.

It is definitely still possible for women to get pregnant with their own eggs with an AMH level as low as yours, particularly given your FSH isn't bad. You won't really have a good idea of whether that is likely to happen for you until you've had a couple of OE IVF cycles. Once you've had a couple of cycles you can see where the problems are -- whether you have enough follicles develop (you may need to try both short and long protocol cycles to see which gives you more follies), whether they manage to retrieve mature eggs from those follicles, whether the eggs fertilise, whether the fertilised eggs divide successfully, whether the embryos are good quality, whether your uterine lining is too thin or too thick.

If doing more than 2 IVF cycles is prohibitively expensive for you, THEN going straight to donor eggs might be the thing to do, as your odds of success in the first round or two will be higher with eggs from a younger donor.

There's a bit of evidence that CoQ10 improves egg quality in older ladies, and it doesn't have any significant side effects, so I'd suggest ordering a bottle of CoQ10 and starting off with 200 mg a day. I know some clinics actually instruct their patients to take 600 mg or 800 mg a day, but I'm not sure there's a lot of evidence that the higher doses give a lot of extra benefit. Getting extra selenium may also help egg quality, and eating some Brazil nuts each day is a natural way to do that.

For DHEA, I really recommend getting your free testosterone and serum DHEA-S levels checked before you start taking it. You can arrange these blood tests yourself through a service like Blue Horizon Medicals (http://www.bluehorizonmedicals.co.uk/). If your free testosterone or DHEA levels are already high or at the upper end of normal, then I definitely would not recommend taking DHEA without regular monitoring of your hormone levels. I was very interested in trying DHEA, in spite of the fact that at age 40 I still suffer with acne, until I got my blood work back and saw that my DHEA is near the top of the normal range for a female (probably the reason for my acne!). It's one of those things where balance is key.

Wishing you best of luck!

This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites


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## Tracyev (Jun 4, 2014)

Sorry to barge in but just want to support Crazy Horse's advice to have DHEA levels checked before supplementing. If your levels are already in the normal range, taking DHEA can lead to androgen excess which can effect how your eggs mature (or don't in this case). Had this happen to me. While you may see an improvement in AMH this is a "false positive" as the AMH is being produced by PCOS like follicles. Good luck.


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## goldbunny (Mar 26, 2012)

Then the IVF.... Which clinic do we choose? How do we compare the stats?  How do we know which have good success rates? 

definitely imo go straight for IVF given your age. It's not guaranteed to work first time and the sooner you start, the more you know. even a failed cycle can tell you loads about your egg/sperm quality etc which will help you decide about further treatment.

choosing a clinic is a very personal decision but the main factors are

can you travel? logistically and psychologically, think about how you are with travelling - for me, i don't travel well so i needed to keep all my appointments as close to home as possible. Some people however jet around the world at a moment's notice. Travelling if you aren't used to it can just add a whole heap of stress. Then again some people relax more when they are able to step out of their normal routine. 

do you have specialist issues that are best handled by specific specialists? This is a general question which obviously affects any clinic choice decision... 

thirdly, (having figured out the first two) how do you feel about the clinic facilities and staff? I really think (since you're putting your future in their hands) that a feeling that you trust them and get on with them is hugely important. Visit clinics you may be going to use, try and talk to the staff you would be dealing with (it's easier to get to talk to nurses than consultants who obviously tend to charge for their time, but, since you are going to spend more time dealing with the nurses than the consultant, it doesn't matter). If you have to pay to see a consultant/clinic or two (or more) before deciding, do it... you don't have to settle with the first one if you are not sure. 
Another criteria for judging them is to ask how much they personalise your treatment. You'll pay more for a clinic where they eg scan every day as compared to somewhere using a one-size-fits-all plan.


i'd put bonding with the clinic and feeling at ease far higher than some 'on paper' stats. For a start, a clinic may get lower statistical success but be more willing to try with harder cases.  Secondly stats are never quite up to date, they're usually a year or two old... thirdly, reality isn't black and white. On paper, my baby wouldn't be here, it's just way too unlikely. But he made it!
can't tell you how important it is to relax about this but that doesn't mean doing nothing, just being calm about making a plan. When i hit 40 i was frantic to the point of pretty much being unable to ask for help. good luck.     
there's loads of help in this site and lots you can do to improve your chances.


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## Hbkmorris (Apr 7, 2010)

Elsi. 

I echo EVERYTHING Goldbunny has said. All the factors she has discussed and raised are so valid and I wish to god I knew about them before I started any IVF. 

The clinic you chose is SO important, you have to click, trust, like and above all believe they are doing everything for the best for you to have the best outcome ever. My first clinic was an NHS hospital, stupidly I went there because they were cheap and I had heard of a few peeps getting pregnant with them. They weren't very close a good 45 mins drive from my house and the staff treated you as a number NOT a person. The cycles themselves were a 'Fit all' and no further testing or even suggestions on trying to find out what's wrong before going for another cycle. As they messed up my cycle no 4 I decided enough was enough and I was leaving armed with 8 frozen eggs. 

I'm now with a clinic who are just amazing, I clicked with them all straight away. They are so personal it's untrue.. My next cycle has been totally tailor made for me. They will scan me every day/two days and we are trying different meds. Best of all they have moved to only 15 mins away from my home with free parking.. Excellent. 

I actually had a scan with them yesterday and I'd not been to them for 20 months.. I walked in and the receptionist called me by my first name before I'd even said who I was, the medical director came, the nurse manager (who is my allocated manager) came over with opening arms along with two other nurses.. It really does make all the difference my consultant is just amazing and I'm so happy, relaxed and have every faith that if I can get pregnant they will make it happen for me.. If it doesn't it's not their fault it's my silly body. 

I wish you all the very best and please listen to what Goldbunny has said.. so very important. 

How are things Goldbunny? not seen or spoke to you for a while x

Love to everyone else.. Hello again Crazyhorse x


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## Elsi0553 (Sep 1, 2014)

LW,
Thank you again for all your help and advice, invaluable!!  I've been to my NHS clinic which is where I've had all my tests done and they've offered to check my tubes are clear so that's another thing we are considering. I'll have a look for Chinese herb practitioners too, I have a great reflexologist who has given me lots of tips and advice on vitamins to take, etc so I'm slowly but surely getting my head round it all.  
Crazy horse,
I've had a number of internal scans both before and during taking Clomid.  I seemed to have follicles there, all at the right size for the time in my cycle, etc however they are not sure if I ovulate and I definitely have a short luteal phase, about 6-7 days.  I agree that doing a cycle will definitely tell us more, it's just IVF is so expensive and we are not sure how many go's we will be able to afford?  Some great advice, thank you, and I'll definitely look into CoQ10.  I still suffer from acne too, thought I was past all that at my age!!
Tracyev, thank you for your thoughts  
Goldbunny,
I never even knew that you could visit before deciding.  My NHS clinic just said 'these are the clinics closest to you, ring me back tomorrow and let me know which one you choose'. Asking us to make one of the biggest decisions I've ever had to make in 12 hours with no other information??  
We are happy to travel some distance but not too far, but your point about trusting the clinic and it being personal to me has really hit home.  We don't want to feel like a number as we have done up til now.  It's easy to say about relaxing isn't it, but do to it is so much harder.  Every time I think about the situation I worry and want to get things underway as soon as, then I bury my head in the sand and think it'll still happen for us without IVF.  Such a roller coaster of emotion.  I'm scared to make the wrong decision as that'll be another thing that will be down to me.  Keep calm and make a plan, is what I'll do.  . It's so nice to hear good stories and glad you have your little boy.
Hbkmorris, 
Thank you for your comments, you sound really happy with your clinic and I will definitely think about everything that has been said on here.

You ladies are amazing, I thank you all for your sharing your thoughts, advice and good luck wishes with me, I don't know what I'd have done without it.

Xxxxxxxx


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