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We’ve seen common themes emerge from what our patients have told us in the last 20 years. We think these deserve to be scrutinised more closely.Â
When women can’t conceive, most of them either already believe they have to go do IVF or they are told, by their doctors, that it is the best option.
What is curious is that, in many cases, patchy investigations are done to see why natural conception has been a problem before contemplating IVF. In our opinion, a proper investigation should include as a minimum: reproductive hormone tests, scanning of ovaries and uterus to check for fibroids, endometriosis, adenomyosis, cysts and check tubal patency.
Many of our patients have not had the above checks before they were offered IVF. When they did do checks, they tended to only cover some, not all, of the tests listed above. In many cases, the cause for natural conception failure had never been found but IVFÂ was routinely suggested anyhow.
It is not surprising therefore that recent research shows that natural conception occurred in 20% of women who went through IVFs before.
It is difficult to think of a medical discipline where a procedure is offered when the cause of the problem has not been identified. For example, it is hard to imagine an orthopaedic surgeon suggesting an operation if the cause of severe back pain has not been found, or an operation on the stomach for abdominal pain where no abnormality in the stomach has been identified. That’s why we at TCM Healthcare make sure any patient coming in with natural conception issues goes through some key tests first before we decide if there’s anything that can be done.
This is very common belief indeed and one that is promoted by IVF clinics all over the world. Virtually all the patients who went through IVF before they came to us told us that their doctors suggested that they should go for IVF as they are getting older. This belief turns out to have major problems for the following reasons:
1. This widespread belief seems to be based on IVF statistics which shows that age is the best predictor for IVF success i.e. the younger one is, the more likely one will be successful. While this is also broadly true for natural pregnancy, natural conception is much less sensitive to age. While there is no IVF success (0% success rate) for women over 46 using their own eggs, women over 46 can and do get pregnant naturally successfully.
2. In the pre contraceptives days, families were large where 10 children or more were not uncommon. Women regularly had children well into their 40's i.e. age wasn't a big problem before. We may wish to reflect on why we are led to believe age is THEÂ major factor now.
3. Age is not a recognised disease or medical condition listed in the International Classification of Disease ICD 11 - a medical classification maintained by the World Health Organisation and used globally in epidemiology, health management and for clinical purposes. It follows that medical procedures (usually IVF, IUIÂ or ICSI) recommended on the basis of age is unlikely to be sound medical reasoning.
4. Last but not least, scientific research on natural pregnancy does not support that age is as important a factor as it has been made out. A large scale study published in 2017 involving 2,962 couples in North America showed that women aged between 40 to 45 have a 55.5 % chance of getting pregnant through 12 cycles of menstruation, and 27.6 % chance of getting pregnant through 6 cycles of menstruation. The chances for women aged 37 to 39 are 67.4% and 46.3% respectively. The chances of women younger than 37 are even higher (You can find a full text of this research under our Resouces' page for Conceiving naturally).
If you have recurring miscarriages, IVF may not be the right choice and here’s why.
The single most important advantage IVF offers is that it guarantees that a sperm meets an egg. When a woman has a miscarriage, it is not because the sperm has not been able to meet an egg; it is highly likely a result of one of the following:
With recurring miscarriages, the evidence for poor-quality sperm and/or eggs becomes even more overwhelming. At the same time, the advantage that IVF offers seems to be less in this case.
The message is clear: IVF offers little advantage for women who suffer recurring miscarriages. One should look, instead, for solutions that improve egg or sperm quality.
More and more women are persuaded to do genetic testing on embryos as a way to understand why miscarriages occur or IVF fails. It is interesting that genetic testing is often offered after failed IVF cycles — it is seldom offered after miscarriages as a result of natural conception.
While genetic testing may explain why a particular embryo has issues, it is doubtful that what is learned from one embryo will tell us what the next embryo will be like — unless the parents have an inherent genetic issue. If there is an inherent genetic issue, it is unlikely there will be treatment anyway. This is why it is unclear how genetic testing on a failed embryo can help decision making for future rounds or whether one should abandon IVFs or not. It is important to note that research found that 20% of women achieved natural pregnancy after failed IVFs.
What’s more, the bigger picture is missed by looking down the development path. If egg quality is an issue, then the embryo may well have genetic issues — which means egg quality is what matters here. If the egg quality issue is fixed, so would the genetic issues.
When women are told their egg reserve is too low, they often believe that using donor eggs is the only option. However, for natural pregnancy, egg quantity isn’t the issue as a woman would never runs out of eggs.
Another reason why women think about using donor eggs is after a few failed cycles of IVF, so she now thinks or being told that her own eggs are no longer viable.
After a bit of questioning by us, we usually find there has been little or no investigation into what was causing the issues with natural conception before they began IVF. In most cases, we find that egg quality is the culprit for both natural conception and IVF failures. Once we address this issue of poor egg quality with our natural herb treatments, we frequently see successful natural conception or IVF using one’s own eggs.
Another reason women think they need an egg donor is because of their age.
While age is associated with many medical conditions, such as high blood pressure, higher chance of heart attack, stroke and dementia to name but a few, age itself is not a recognised disease. That is to say, age is never a direct cause of medical condition.
Just as age is not the direct cause of heart attacks, strokes, diabetes, dementia and so on, age is not the direct cause of poor egg quality. Rather, as a woman gets older, her hormones gradually get more and more imbalanced, which leads to poorer egg quality. In the case of pre-existing hormonal imbalance conditions like PCOS, ageing tends to amplify their effect. Regardless, it is hormonal imbalance that directly impacts poor egg quality.Â
From this, it follows that if hormonal imbalance can be corrected, egg quality can be improved.
Age cannot be changed, but hormones can. Better hormones mean better egg quality.
Low AMH does not mean one has no eggs at all. The common consensus among the scientific community is that even when a woman is in her 50's and at menopause — so she has lost her period completely and she is not ovulating at all — she should still have a few hundred to a thousand eggs left.
In most cases that we see, however, women who are worried about their egg quantity still have their periods and are ovulating. This means that by definition, she has eggs regardless of AMH level.
High AMH is not always good. For example, women with polycystic ovary syndrome (PCOS) have high AMH — it is one of two hormone markers for the condition — and it is well known that PCOS impacts fertility negatively. This is because PCOS means hormonal imbalance, and hormonal imbalance means poor egg quality — needless to say, poor egg quality means lower fertility.
If you are 51 or over and you have had no periods for more than 12 consecutive months, you are right.
However, many women who contact us do not fall into these categories. They are 45 or younger and they still have periods— although their periods are not regular, or they have missed some periods. Women with this circumstance are almost certainly not in menopause. Nonetheless, many of these women are led to believe they are in menopause, and, not surprisingly, the advice they get is they should use donor eggs.
In short, there is no need to panic. By simply doing a standard hormone test to check AMH, FSH, LH, prolactin, oestradiol and testosterone, we can see why your periods are irregular or missing.
The good news is hormones can be improved, check this out here.
If a woman does not have periods for 12 consecutive months and has an FSH level higher than 30, she will be diagnosed with POF (primary ovarian failure), or early menopause. This is technically correct, but the question must be asked, why is she going through menopause 15 years early?
This question is important because severe hormonal imbalance and early menopause share similar, or even identical, symptoms — including hormone test results. It is just as likely that she has severe hormone balance as she is actually in early menopause.
Hormone imbalance can be reversed, but menopause cannot. The situation can be made worse if the patient accepts HRT, which seems to be keenly offered by doctors who cite bone density, uterus lining thinning, or even heart problems if it is not taken. The situation gets worse if the early menopause diagnosis is wrong, as taking HRT will not address the problem. Rather it is a self fulfilling prophesy i.e. in time, one will certainly have menopause, alas, the initial diagnosis has to be correct.
An “ovarian regeneration” procedure has become popular in the last 10 years or so. It is claimed that platelet-rich plasma (PRP) injections will “regenerate” a woman’s ovaries and bring back natural periods.
PRP is a procedure that helps support wound healing and joint injury, and is commonly used in trauma units.
It is unclear how PRP will work when it comes to ovaries, as a woman without periods does not have ovarian injuries: Her ovaries and her glands in her brain are just not communicating as well as they should. That’s why her FSH goes up and the periods stop.
Patients told us that after PRP, they are told to check their AMH. This is a bit strange as low AMH is not responsible for missing periods — rather, high FSH is. The FSH levels remain high after PRP in nearly all the cases we see. It is unclear what exactly has been “regenerated”.
Accurate information, vigorous reasoning and sound judgment are behind all good decisions. We hope the above will go some way in helping patients to navigate the rocky terrain of fertility.
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