Latest / Life After Birth by Her Health Room / Trying to Conceive Over 35: Low AMH, Short Cycles & What I Did

Transcript

Trying to Conceive Over 35: Low AMH, Short Cycles & What I Did · Life After Birth by Her Health Room

• 0:00
  I am pregnant.
• 0:00
  I'm in my third pregnancy.
• 0:02
  I'm also an obs and gynae doctor, and this pregnancy took me a little bit longer to conceive than the last time, and not by much, not by the amount that anyone would think that you need to seek help, but enough to make me concerned, enough to make me question my fertility.
• 0:17
  And in the background, I had done fertility tests, which had shown that I had a low egg reserve.
• 0:22
  My periods had changed, had in fact become shorter, and I wasn't ovulating halfway through my cycle.
• 0:28
  I'm gonna talk to you about all the things that I did in the build-up to getting pregnant, how it felt, what I would do differently the next time, and if you are considering having another baby, having your first baby, there will be some tips here for you that you can go away with and prepare before the positive pregnancy test And now this isn't gonna be some fertility hacking video or panic-inducing video, but just my honest take off of my experience and things that I've seen and heard so that it can encourage you on your own journey to conception I do have a video on this channel that talks about thirty-five not being a cliff edge drop off, the way that it's painted out to be.
• 1:06
  But there are still stories in and around the press of people who are in their late thirties who do struggle to conceive.
• 1:11
  And one of the stories that I remember quite vividly was Emma Grede.
• 1:15
  So she was on a podcast, and she had mentioned that she'd had her first two babies, no problem.
• 1:20
  The first month she wanted to conceive, she got pregnant, which is obviously a privilege, right?
• 1:23
  So what Emma Grede was saying was that when she was trying to conceive and it wasn't happening, she was devastated, and she was in her late thirties.
• 1:30
  And they went through rounds of IVF and in the end had to do surrogacy, and that's how she had her last two kids who were twins.
• 1:36
  And she said that for her, even though she'd had two kids, there was just like this pressure that she just wanted another one and it's weird because it's like obviously you have kids, but you still want kids and it's a really tricky place to navigate and not spoken about enough in the subfertility world.
• 1:53
  Which is why my one of my podcasts will be with a fertility specialist to dive into this deeper.
• 1:58
  What could be happening when you are trying to conceive for a really long time after you've had a baby?
• 2:04
  Because when you've had a baby, you're like almost convinced that the things work and then the second time you're like,"Why is this taking so long?" And so I was asking myself the question, should I be worried?
• 2:15
  And I'm type A, I'm a gynecologist.
• 2:17
  I knew my egg reserve was low, so I definitely was worried.
• 2:22
  But it's like, what do you do with that?
• 2:23
  What actions can you take?
• 2:26
  So I'll be telling you my story, interjecting some tips for you throughout the video, and use the comments down below to ask me some questions This is the first episode in a series around my own preconception, pregnancy, and my own postpartum journey.
• 2:41
  It's not lost on me that I'm building a pregnancy and postpartum company whilst also doing the exact same thing.
• 2:47
  so I wanna be able to come to you with like live tips of things that I've gone through, with the medical backing behind it, so that it can help you on your journey.
• 2:55
  So subscribe to this channel for more information.
• 2:58
  I am an obstetrics and gynecology doctor.
• 3:00
  I've been doing it for more than ten years, so I am very keen on there being evidence basis to it.
• 3:06
  But I'm also not just thinking about you as a physical person only, but also the mental aspects, the social aspects, the identity shifts that come with navigating through this season of life.
• 3:17
  So back to the video, the trying to conceive stage, the bit before the positive pregnancy test, the unseen parts before the pregnancy, the bump, the morning sickness, if you can even still call it that.
• 3:30
  Talking about all the bits before that and not seeing it as a passive time, but a time for activity, a time for change in order to support and promote a healthy pregnancy I've had two children before.
• 3:43
  Both of them, I was less than thirty-five, and they happened really quickly.
• 3:48
  And between pregnancies, I used contraception, and the one that I favor the most is the combined.
• 3:53
  Estrogen just makes me happy.
• 3:55
  In the past, I've used the pills, I've used the patches, and most recently, I was using the vaginal ring.
• 4:01
  So that is where it would go inside into the vagina for three weeks, and then you would swap it for another one if you didn't want a break, or you would take a break and have a period.
• 4:09
  So that's what I was using.
• 4:11
  And then, unfortunately, last year, I got a headache with an aura, and what that means is where you get, like, a migraine, but it's almost like you get warning of it.
• 4:19
  So, like, for the first time ever in my life, I had these, like, flashing lights through my eyes for about thirty minutes.
• 4:27
  But actually, for you to be able to use the combined oral contraceptive pill, there are criteria that you must meet to make sure that it's safe for you.
• 4:34
  So there's increased risk of blood clots with that.
• 4:36
  So if you've had a blood clot or anyone in your family has had, If you have migraines, there may well still be some benefit of use for it.
• 4:45
  But if you've had a migraine with an aura, which is what I'd had, therefore means that that type of contraception is a no-no.
• 4:51
  So I can't use it again.
• 4:52
  But after that, it prompted me to stop it.
• 4:54
  And it's not that we were super ready to start trying at that point, but I knew that I was gonna start trying, I guess, in the next sort of six months or so.
• 5:01
  So I was like,"You know what?
• 5:02
  Let me just let my body go back to its baseline, do what it wants to do." And my periods aren't particularly painful anymore, thankfully, and they're not particularly heavy, so I kinda just sucked it up But, you know, having a period can be annoying.
• 5:16
  I find it annoying.
• 5:17
  I find it to be a bit of a nuisance.
• 5:19
  Knowing when it's coming, making sure that you've got the right products and things like that.
• 5:24
  So what I had noticed is when I stopped the pill, is that my period started coming every three weeks.
• 5:29
  Whereas before, it was every sort of twenty-six to twenty-eight days.
• 5:33
  It was literally like every twenty-first day, my period would start.
• 5:37
  I'd bleed maybe for three days, four days, and it was light-ish, not painful, and then I I'd have ovulation symptoms.
• 5:46
  So for me, that's typically right-sided pelvic pain, a change in discharge, and I would have that about day fourteen, and then I'd bleed by day twenty-one.
• 5:58
  And now the problem with being a doctor is that you have knowledge, right?
• 6:01
  But you have knowledge that's based on population information, right?
• 6:05
  So even I went to Google and was like,"Why am I having a period a week after my ovulation?" If you've got a short period, the time between ovulation and when your period starts should still be about two weeks.
• 6:16
  That's kinda like the generic teaching.
• 6:18
  So I know that in the first half of my period, where the growth of the egg is happening, that's taking two weeks.
• 6:24
  But then the second half, which should take two weeks, is now shorter.
• 6:28
  I had an Oura Ring actually from about last year, and I would track my period and the ovulation that, symptoms that I felt was tracking with the changes in temperature that the Oura Ring would pick up on.
• 6:40
  So it means I'm having a short luteal phase.
• 6:43
  Which means that just a period between ovulation and when the period actually starts is shorter.
• 6:47
  I saw a video by the fertility specialist where she was talking about a short luteal phase they see in their fertility clinics and how it can sometimes affect how you conceive so then I had that in my head that, also understanding that when your cycles get shorter, it could be a sign of perimenopause and changes in your hormones so I did the test, and mine came back as low.
• 7:09
  It's called the anti-Mullerian hormone test, AMH.
• 7:11
  On its own is not enough to say if you're ever gonna have a baby or not.
• 7:17
  But they use it, for you to be referred for IVF under the NHS.
• 7:21
  Now, the NHS criteria will try and favor couples who are going to have a good outcome, but typically the cutoff for the AMH is about five point four.
• 7:31
  So if it's less than that, the N-NHS won't fund the IVF because there's a higher chance of it not being successful.
• 7:38
  Previously, that number was four.
• 7:40
  And as well as doing this blood test, you can also have a scan that looks for those tiny eggs to see what your follicle count is.
• 7:47
  So I had done the test, my test had come back as three.
• 7:50
  And it's low.
• 7:51
  It's low for my age.
• 7:52
  And sometimes it could be suppressed by taking, contraception, but I wasn't on any at that point.
• 7:57
  So it felt very much like a reflection of what my symptoms were as well, where my periods were changing, having that short luteal phase, and then on top of that, having this AMH of three.
• 8:06
  And AMH, it's not a perfect test because I've seen in practice where people might have an AMH of like nought point five and they will conceive naturally.
• 8:14
  So it's not a thing where actually if it's low, you'll never conceive.
• 8:18
  But it can be an indication of how well you would do with egg freezing, for instance, or IVF.
• 8:24
  So knowing that, having that information was useful, but it wasn't gonna stop me because the only thing I could do was try, right?
• 8:32
  Like, there was no harm in having unprotected sex.
• 8:36
  And so then I go back to thinking about what I would say to a person in clinic.
• 8:40
  So if someone in clinic had come with those results, I'd be honest and say,"Okay, it is on the lower side.
• 8:46
  Having said that, you're probably not gonna get NHS funded IVF.
• 8:50
  You could pursue fertility treatment on your own outside of that.
• 8:55
  And if you're over the age of thirty-five, you probably want to do that after sort of six months of trying." But I would also encourage them to continue to try if there were no other things wrong.
• 9:05
  So we started trying.
• 9:06
  And again, the advice around trying is when you're trying to conceive, is that you and your partner have sex two to three times a week, and by that you're likely to catch your ovulation window.
• 9:16
  First month came and went, nothing happened.
• 9:19
  The second month came and went, nothing happened.
• 9:22
  And by month three, which we know from stats around the UK is that about 68% of people will conceive within trying for three months, it hadn't happened.
• 9:32
  And I sat down with my husband and said,"Look, I don't know that I actually want to keep trying because, I'm a bit type A, and I had a specific window for which I wanted the birthdays to land." And if it wasn't gonna be then, I was like,"Look, we can just delay it." And he very sensibly said to me, like,"If you're worried that your age isn't on your side, your fertility or, like, your hormone profile wasn't that great, why should we stop?
• 9:54
  We should just keep going until something happens." And then month five was actually when I was then able to get pregnant.
• 10:00
  Other than the, hormone tests what else was I doing in that time to make sure that I was healthy enough to be carrying a pregnancy to optimize the chances of being healthily pregnant and not just getting a positive test for the pregnancy?
• 10:14
  I'll be the first to acknowledge how ridiculous it is to suggest that it took too long because, based on definitions, we would encourage testing after six months, treatment after one year if you're above the age of 35 so I completely understand that it wasn't very long at all in the grand scheme of it medically.
• 10:34
  But with all the things that I said I was navigating beneath that, there was also obviously an emotional side of it.
• 10:40
  Because there is a emotional and mental health side of waiting to get pregnant, when I work in fertility clinics and a couple comes in and the next time we can see them is in four months or six months, that's like six months of still waiting for what it is that you want, and it's a really big deal.
• 10:59
  And it is something that I'll go on to touch on later in the video.
• 11:02
  So while I was still waiting to conceive and actively trying and obviously worrying about, whether or not I was actually going to be able to achieve a pregnancy, I was thinking about my health.
• 11:13
  so I w-was working full-time in hospital.
• 11:16
  I was pretty much stressed a lot.
• 11:19
  parenting two kids, had this idea to build a health room, had started filming videos, and my levels of stress were really high.
• 11:25
  Like, I felt stressed.
• 11:27
  I felt burnt out.
• 11:28
  I felt tired a lot of the time, and that in itself took me to the GP.
• 11:32
  I went and got some bloods done, and it was very clear that I had iron deficiency anemia.
• 11:36
  And this will come up again in my pregnancy videos in the episodes to come, so do subscribe to find out what sort of happened with that.
• 11:43
  But so there was the iron deficiency anemia.
• 11:46
  I was having some aches and pains in my tummy that I wanted looked at.
• 11:49
  So I was like,"How can I optimize my health?" And so if you're trying to conceive, the things that are absolutely recommended are folic acid even before you're pregnant, cause by the time you get a p-positive pregnancy test, You're already, like, four to six weeks pregnant for most people.
• 12:05
  So then you might have missed that window to have had the folic acid.
• 12:08
  So the advice is really strong around folic acid whilst you're trying to conceive, so that by the time you are pregnant you're not deficient, you have enough levels.
• 12:18
  It prevents neural tube defect.
• 12:19
  Another thing is vitamin D.
• 12:21
  So a lot of us, especially if you're dark skinned, not going out much through winter, you're more likely to be vitamin D deficient.
• 12:29
  And therefore supplementing that for everybody really, but specifically if you're trying to get pregnant, is really important and very much recommended in my case, I needed to be taking iron tablets, which I know I needed to take, but I find them really difficult to tolerate.
• 12:43
  I was taking liquid iron, because I can tolerate that a little bit better.
• 12:47
  And because I was having some symptoms as well, checking in with my GP, checking that I was overall healthy.
• 12:53
  I started exercising as well, which I think is also really important to mention.
• 12:57
  I had, put on overall five or six kilos between pregnancies.
• 13:01
  So I had a personal trainer.
• 13:03
  I was eating a more balanced diet.
• 13:05
  And I think it did stand me in good stead.
• 13:07
  Because what happens is when you go for your booking appointment and they weigh you, the weight that you are at the start of the pregnancy can be a risk factor for things that happen in pregnancy for how they, like, triage you, whether you need midwifery care or, or obstetric care and what extra checks you have.
• 13:22
  I must say, throughout the pregnancy, I've struggled to keep up with that, and I will cover that off in one of the next episodes cause my daughter came into the room one day.
• 13:30
  She's like,"Uh, Mummy, you were exercising, like, three times a week before, and now you're not doing anything.
• 13:36
  Why, why not?" And I was like,"Oh,'cause I'm pregnant," which is not necessarily a good excuse.
• 13:41
  And she was like,"I still think you can exercise even when you're pregnant." And she was not, is not wrong.
• 13:47
  But I will tell you why I felt unable to carry on with exercise in my next episode And so I think ultimately when you are taking the supplements and prepping for pregnancy and things like that, don't get swept away by the BS that's out there.
• 14:04
  There are so many things that they'll try and sell you or egg boosters or hormone balancers and things like that.
• 14:12
  I also try to be a really balanced doctor.
• 14:14
  I don't think that just because there is no evidence doesn't mean it doesn't work.
• 14:19
  And I do think as long as it's not harmful then there's probably no risk to it.
• 14:24
  But making sure that the company itself has done its due diligence, is evidence focused, is evidence forward and not just slapping ridiculous price tags on vitamin D and folic acid, things that you can pick up for really cheap.
• 14:39
  There's a lot of scope in the supplement world to feed you fads.
• 14:43
  And being pregnant is a really vulnerable time as well.
• 14:47
  So what you don't wanna do is take ingredients that are then harmful to a growing infant because someone hasn't done their due diligence.
• 14:55
  What you should be doing is looking for verified companies and don't fall into the pressure of am I doing enough?
• 15:02
  Like I know I've listed supplements, exercise, eating well, sleeping well, reducing stress, checking that you're healthy.
• 15:10
  Like I know I've mentioned all that, and those things are vital, but they're vital for your health overall.
• 15:15
  Don't necessarily fall into the pressure that you need to do that.
• 15:17
  And the other side of it is doing nothing.
• 15:20
  A report a few years ago, I've quoted this before, where they were looking at the people who are more likely or less likely to seek fertility care.
• 15:28
  And they found that, Black couples, take longer to seek help than their counterparts.
• 15:33
  And this isn't surprising.
• 15:35
  It's something I've seen in clinical practice.
• 15:37
  It's something I've seen in church.
• 15:39
  It's something I've seen in social settings where you're trying to conceive, and maybe because you've had a baby before, you're feeling reassured that all the parts work.
• 15:49
  The sperm is fine.
• 15:50
  The eggs are fine.
• 15:51
  The tubes are fine.
• 15:52
  And then you're just taking long to get to seek help and get to the bottom of it.
• 15:58
  And I don't think that that is useful either.
• 16:00
  I think at the very least, doing some basic tests to find out if there's anything wrong and fixable are important.
• 16:08
  And if there's absolutely nothing wrong, like it's an unexplained reason why you've not yet conceived, then you can then at that point decide if you want to keep trying or if you wanna go down the route of IVF or fertility treatment.
• 16:21
  And I think that's all really valid.
• 16:23
  The bit that I want to talk to you about from my own personal experience is the emotional toll.
• 16:27
  But what was going on through my mind most of that time was had I missed the window?
• 16:32
  Had I missed the window to have another baby?
• 16:35
  Had I lost my chance, I guess, to do so?
• 16:39
  And could I say that it was on my mind twenty-four/seven?
• 16:42
  It was on my mind a lot in the sense that any time my period came, I would be looking at it under a microscope.
• 16:49
  Like, how much bleeding am I having?
• 16:52
  Any pain?
• 16:53
  Any time I got any twinges in the pelvis between periods, I was like,"Is this ovulation?
• 16:57
  Is it not?" Do I want to consider IVF?
• 16:59
  Do I want to think about fertility treatment?
• 17:01
  There was that sort of mental and emotional toll of like, okay, what are my next steps?
• 17:07
  Like, I'm a planner.
• 17:08
  I, I'm a problem solver.
• 17:09
  Like, okay, this is where I'm at now.
• 17:11
  If it doesn't work by this date, what am I gonna do next?
• 17:14
  And I think that's probably where I was emotionally.
• 17:18
  And obviously, if it had gone on for much longer, I probably would have felt more down and more like my body wasn't doing the things that I wanted it to do.
• 17:27
  And my overwhelming thought was like,"Actually, you know what?
• 17:29
  If this is not gonna work, I'd rather just not try.
• 17:31
  I'd rather not every month check to see if it's worked or not, spend money on pregnancy tests, and things like that." When the pregnancy test was in fact positive, I had taken the test on the day my period was due.
• 17:44
  And it was faintly positive, like really, really faint, and I was happy because I was like,"Okay, it, it's worked." And what I'll talk about in the next episode is how all these things I've mentioned impacted my first trimester, what it meant for sort of timing the pregnancy and things like that.
• 18:03
  But what I want you to go away with in this video is that if you're over 35, even with a low egg reserve result, it's not impossible to get pregnant.
• 18:12
  It might take some time, and while it's taking time, other things that you can do to improve your chances or to make sure that when you are pregnant, it's as healthy as possible.
• 18:21
  If you're above the age of thirty-five and you are trying to conceive for more than six months, then you should seek help.
• 18:26
  Full stop.
• 18:27
  Dot.
• 18:28
  Nothing else to discuss.
• 18:29
  Like, you should seek help.
• 18:30
  If you've got fibroids, PCOS, endometriosis, any gyne condition, and you've been trying for six months, even if you're under the age of thirty-five, you should seek help.
• 18:43
  And what that help looks like depends on where you are in the world so if you're in the NHS, you go with your partner, you have some entry-level tests, and you get referred on to a fertility clinic.
• 18:55
  And then from that fertility clinic, you then get assessed again, and then they can refer you on appropriately to IVF.
• 19:01
  If you're in other parts of the world, you can probably go straight to a fertility clinic yourself, an IVF specialist, and then decide what treatment you want to do.
• 19:09
  And so when you should seek help is six months if you're over thirty-five, six months if you've got a gyne condition.
• 19:14
  If you don't have any of those, then it is one year.
• 19:17
  And then in the NHS, you're eligible for IVF after one to two years of trying, depending on which category you fall under.
• 19:25
  If you are doing paid and private IVF, like, the rules are different, and that will depend on where you are in the world, what country you're in, what they're willing to do, to help you achieve the pregnancy.
• 19:36
  So seeking help is first and foremost paramount.
• 19:39
  But before you get to that six-month stage, making sure you're taking folic acid.
• 19:44
  And then the vitamin D, making sure that you're taking enough supplements.
• 19:47
  Eating well, dieting.
• 19:49
  And I say this with a really loose caveat because there are people who don't eat well, who don't exercise, who have high BMIs, who get pregnant, and they don't need to do any of these things.
• 20:01
  They don't need to stand on their heads.
• 20:02
  So this is more for, your generic health and making sure in the pregnancy you're healthy, more so than actually if you do these Things like exercise and eat well that you will conceive.
• 20:14
  I think that's, can be misleading, and can make women who are healthy or healthy appearing feel hard done by when they aren't getting pregnant.
• 20:25
  And so I'm gonna leave you with this.
• 20:26
  The, the bit before you get pregnant is not a passive stage, it's an active stage.
• 20:31
  As you can hear, I was very active in the months leading up to a positive pregnancy test.
• 20:36
  And the things that you need to be thinking about if you're thinking about having a baby is, am I able to have a baby?
• 20:44
  So am I getting clues in my body, clues with testing and things like that, that I might not be able to have a baby.
• 20:50
  That's part of the work.
• 20:51
  But the other part of the work is when I am pregnant, am I giving myself the chance to be as healthy as possible throughout the pregnancy and for the baby to be as healthy as possible?
• 21:01
  And so those are the things that you need to consider and make sure that even in the phase before the test, that you're still actively doing stuff, that you're still making decisions that prioritize your health and your future health in the pregnancy and beyond.
• 21:15
  I do have a video on this channel about how being over thirty-five isn't a cliff, and what you can be doing if you are over the age of thirty-five and trying to conceive.
• 21:25
  And I very much recommend that you go and watch that.
• 21:27
  And subscribe to my channel.
• 21:28
  And if you are in this phase of what trying to conceive, I've also got a gyne health checklist that you can go through, and it's almost like a self-audit of where your periods are, what your periods are doing but subscribe to this channel for more, and I will catch you in my next one