older, attempting pregnancy after miscarriage

[AZ Angie]

My DH and I are 44 years old with 3 sons age 9,12, and 15 (all helped along by clomid).   We recently became pregnant (surprisingly) and sadly miscarried at 6 weeks.  After 2 weeks to consider the prospects of another child, we fell in love with the hope --and--Awake -- Oh sleeping Giant! Now we really want another child.  We tried again and the very next month, we conceived and miscarried again at 5 weeks.  On 9-18 my HCG was 27 and on 9-20 it fell to 10, with a progesterone of 2.9.  On 9-22 I started with bleeding, and had only 2 days of menstrual-like bleeding and 2 days of very light spoting. Now my body feels as if back into a normal rhythm

My questions:  Is the progesterone level indicitive of a problem of too low progesterone -- or is is just low because the pregnancy failed from the very start?   Does it drop of that quickly?   I know that most miscarriages at my age are due to chromosomal mistakes, but are there any other "fixable"  issues that I can screen for?  I recently saw a OB, and requested some screening tests; Day 3 FSH, Day 22 Progesterone, thyroid screen, blood count.  Do you have any other sugggestions?  Besides my age, I am very healthy.  My sister had a healthy baby at age 42 on the first attempt.  My mother went thru menopause at 55.  I figure genetics might be on my side..
Thank  you, Angie

[llenda]

I am sorry to hear about your son.  I too had a daughter (when I was 17 years old).  She was interracial and I am from the deep south of US.  A lot of prejudice.  The system pretty much told me I was too young for housing to be given to me and since I did not have a place to live they would end up taking my baby from me.  I beleived them at the time and agreed to give my baby up for adoption.  Her father was killed before he ever knew I was preggo.  My choice of men went downhill after that and so did my life.  About 4 yrs ago, I met my husband now who is a well-rounded wonderful man.  He has helped encourage me to be who I am today.  He is a bit younger than me 6 1/2 yrs. and all he wants is one child.  I was ok knowing I could not have any children before I met him.  I kind of felt like it was my punishment for being so wild.  But, now I want to do something for this man who has done so much for me.  I have never laughed so much in my life till I met him.  Anyway, back to the IVF.  So my first IVF, they acted as if I was soooo special too.  It was like since I had no tubes to mess up the pregnancy, there was nothing to worry about.  Yes, grade 1 is the best.  After the IVF failed, my RE told me that a women my age has 3 out of 4 embies that are abnormal and won't implant.  Why didn't he tell me that before?  You are right, why didn't they transfer all 3?  I told my whole family and everybody at work that I was possibly having twins.  Me and DH, were not even thinking that it wouldn't work.  It was a very sad day for us both.  I think we now realize that it is like you said, a series of events.  I think that for people like you and me implantation and a successful birth are the biggest events.  I don't think the grade of embie is as important.  I read about a study in 2003, where they were thinking that the high estrogen levels that we actually need (200/mature follicle) may be causing the embies not to implant.  It makes since b/c we are only suppose to have one follicle a month (that means your estrogen would only go up to about 200) and then as the follicle is ovulated the progesterone counteracts the estrogen.  If your estrogen is so high and you are injecting progesterone, I wonder can it counteract that much estrogen in time.  I think age is a factor b/c as you know our body is not as fast, limber, and adaptive as when we were young.  I mean I used to could stay up all night drinking and then work all day.  Not anymore...LOL.  So, I think the younger girls have stronger grade 1 embies and their body adapts easier to all these meds given.  A grade 1 usually is looking at the number of cells developed and if they are round and if fragmentation is in there.  It doesn't really tell you the strenth or viability of the embie.  Not only that, but most of the younger girls have more eggs and are able to wait 5 or 6 days until transfer.  By that time, your body has more time to get rid of all that estrogen and also the embie is at the stage needed to implant.  Our embies are swimming around for a couple of days, we don't even know if they are still alive.  I think they tell everybody to act positive at the clinic b/c it is so unpredictable at our age and then we don't get stressed out and depressed.  I have read people getting preggo on there first try so don't think you can't.  Also, maybe you can freeze some.  That way your ovaries won't have to abnormally overstimulated the next time.  Hopefully you won't need a next time.  Well, good luck to you.  Also there is a forum on this same site called IVF/infertility I think that has a lot of people like us.  

[IVFcostsRsinful]

Wow, I really didn't expect someone to respond to my post so quickly.  Get this Llenda!  When I first went to the IVF clinic, and looking at stats on IVF sites, it appears that the way we respond is "suppose" to be unheard of.  Why are they so surprise that I had 19 to 21 antral follicles upon inception of the cycle?  Not sure?  

The reason I bring this up is b/c I see sooooo many women around our age posting on the internet that have extraordinary numbers.  It doesn't really seem to be that uncommon after all.  Again, the RE's made me feel like I was special or something.  However, there was another women that was my age that only had 2 on one side and 4 on the other (antral follicles).

Okay, let me tell you that I did come back from my appointment today and my estradial level (without anymore injections b/c RE withdrew me from taking anymore due to my good responses) went from 4000 to 6000.  Nurse sounded real excited for me on the phone.  Well, anyway, I AM going to retrieval on TUESDAY.  I told the RE about what the nurse said to me about the 3 eggs and he kinda of seemed irritated that she would tell me that.  He told me, when I asked, that I would have "at least 10 eggs at retrieval."  He did not say whether or not that they would all be mature.

But Llenda, you are starting to scare me!  How is that you had the best quality eggs ( isn't that what grade 1 means?  or is it the worst quality?  Please let me know b/c it will change what I about to say to you.  And that is why didn't it take in the Uterus?  What makes it stick?  Llenda this whole thing seems like a series of crapshoots that we have to overcome.  It isn't just one, in my opinion there are several levels.  First being the initial workup levels, then stimulation response, then how many mature, then how many fertilize, then what grade are each, and then how many finally get to go to transfer and finally will any stick?

Okay, Llenda, why is it that your RE was concerned about triplets??? We are older women!!!!!  I can't believe they only transferred two for you.  I believe that was your problem right there.  I read the statistics.  For someone our age transferring two is an extremely low percentage.  Actually, the transfer of 6 gave a percentage over 50%!!!  That is right, over 50%!!  Your RE shouldn't have been concerned about triplets.  There is NO WAY that my RE will talk me into less.  Here is the thing:  Being that I am an Biochemistry BS degree graduate, I know how to read and interpret scientific journal studies.  And let me tell this:  Women our age who have  excellent functioning ovaries, lots of antral follicles, low FSH and basal estrodial levels, still have lower pregnancy rates then that of women who are much younger then us that have the profiles of women that definitely would NOT get pregnant in their 40's.  For example, take my profile against a women that is 26 that may have an FSH of 11, and a total of 6 antral follicles.  Well supposedly and statistically speaking she has a better chance at pregnancy then we do.  So, again, I am thinking that chronological age, and not ovarian age has something to do with this.  

I will be so grateful to God if I get pregnant with the IVF cycle.  If I do, I will be due right on my birthday: July 15!!  I can't believe that with that coincidence that the good lord would let me fail.  What better story then to have gotten pg. on first cycle and be due on your own birthday.  This would be truly a miracle for me since my first child was stolen from me by my first husband who used me as a surrogate 14 years ago.  That is a long story.  Short story is this: He is a closet gay, and a lawyer, and 20 years older then me.  Read between the lines LOL. Not to difficult to see his motive (gay), means (lawyer), and desperation (older) to have a child.  He got me pg, then married me, and then on the day I had my son told me he was going to take it from me.  4 months later he divorced me, and I lost my son forever :-(.  Truly an evil person!!!  And he got away with it!!!. And our system supported him.  

Well, where are you in this cycle?  You did say you were presently in one correct?

Leeda

[llenda]

Hey leeda, I feel your frustration.  I just turned 40 and will be trying my third IVF in November.  My blood work came back great.  I was in great shape to be my age.  My tubes were all messed up so they removed them.  They said my uterus looked great and also my ovaries looked great.  I just knew the first IVF was going to work.  My RE clinic did the same thing to me.  They acted as if I was doing so good, then right around retrieval time my RE called and said he wanted to cancel the whole thing b/c I only had one mature follicle.  I was thinking the same way you are, why were they making it sound as if I was doing so good.  I was very disappointed and decided to go ahead with the IVF.  They retrieved 9 eggs and 3 fertilized.  Two where the best grade (1) and transfered, they told me that the chance of having triplets was too great to put all three back.  The third did not make it to freeze, and of course I did not get preg.  Known the less, the second IVF, they changed some meds but the same thing happened.  My RE said that my system works so well that they can not override it.  Your body normally only excretes one dominate follicle, but with IVF, they are trying to make it excrete a lot of dominate follicles, and my body won't let that happen.  Even though, my blood work shows I have good reserve and all, the best dominate follicles are ovulated earlier in your life.  Not saying you can't get preggo but I think the dominate follicle at 20 years old is a lot stronger than the dominate follicle at 40 years old.  I also think that getting the eggs and fertilizing them is the easiest part.  I mean you really don't need but one really good embie.  The problem seems to be more after transfer, trying to get them to implant.  I don't think they know enough about why these perfect embies don't implant.  I am sure once they find out I will be past menopause..LOL.   Anyway, I wouldn't worry so much about the quantity as the quality and the ability for your body to let the embie implant.  I used to drink and smoke a lot too.  I don't do either anymore.  I am a critical care nurse though and I know that smoking increases your chance to have blood clots which may be counteracting the affects of better blood flow that they usually want you to have with IVF.  They usually put you on a baby aspirin to cause your blood flow to be a little better.  I know how hard it is to stop smoking believe me.  Good luck and I hope this helps.  

[IVFcostsRsinful]

I am 38 years old.  I had one son at age 25.  My present husband is 58.  He had vasectomy reversal two years ago to no avail due to antibodies on his sperms.  

I recently read a post where a young lady had 37 follicles and 28 eggs retrieved.  This is unbelievable.  I would sure like to know how old she is??!!!!

Anyway, when I started out this "thing."  I was turned down for the "shared risk program" one day before I started the stim meds, which I thought was real wrong of the staff.  I told them that I would get pg. the first time in spite of it, and that their investors were going to be sorry for making their decision.  Anyway, the turned me down b/c I am a smoker.  Yes, I do smoke and have done so for 25 years, all except when I was pg. with my son.  I did NOT smoke a single cigarette b/c as soon as I found out that I was pg, the smoke made me very sick.  It was easy.

Anyway, my FSH reading when I first went to the clinic in Feb 2006 was 4.0.  Now, in July of 2007, and my 38th birthday, my  FSH level was 5.19.  That is a 20% jump.  That is pretty big.  Anyway, my estradiol levels were 40.1, and my initial antral follicle count before lupron was 21.  Right before I started my stim meds my IVF cycle antral follicle count was 19.  How does this fair to other 38 year olds?  I thought I was outstanding or something until I read the tread about the gal that had 37.  Like the 44 year old women above, my mother just went through menopause last year at age 59.  My maternal grandmother had her last child at age 48.  Does this mean anything for me?

Well, anyway, it is Saturday, and I am due for retrieval on Tuesday.  The doctors and nurses have said that I have "amazing" ovaries, and that I have done so much better then they would have imagined.  Why is that?  I wasn't surprised by my results.  Furthermore, when nurse called me today to tell to STOP taking stim meds altogether, I was thinking, "damn," I must really be in the upper 99% to be asked to do that.  My estradiol level today is at 4000.  

Okay, I know what you all are thinking   What is there for this gal to complain about.  Well, here it is:  When the nurse called me today to deliver that news she was "excited" to tell me that I had 3 mature follicles over 18 cm. on the left ovary, and 5 immature on the right btwn 11 adn 14 cm.  Well, how can this be good???  Okay, 3 is the min. for required transfer.  Why is she saying that I am doing great?  Is it b/c I have 3 more days left?  Will I  have more eggs?  3 mature eggs are NOT enough for me.  That doesn't mean they will all fertilize via ICSI, and if they do what about quality.  Again, this doesn't make sense to me!  Can someone explain to me why this nurse, the doctors, etc. have been so optomistic with my progress?  Am I missing something?  I do know that I sneaked a peak at my file and saw that I had a total of 24 follicles the day before.  And of course under that number was but only a handful measured out and recorded.  What is going on?  

Also, how does any of this predict my egg quality?  Could it be that I would respond so well, and have highly functioning ovaries for my age, and have zilch in the quality department?  That wouldn't make sense, but from what I have been reading, it seems that AGE alone is a primarily absolute factor in determining quality.  Futhermore, is this AGE factor based on CHRONOLOGICAL age or is it based on OVARIAN AGE?  My husband seems to think that my ovarian age is that of a 26 year old.  Well if that is the case, then why is it that I am warned that I still have to overcome the egg quality obstacle.  Isn't my functioning any prediction of quality?  How is that a person could have excellent functioning ovaries and have bad quality eggs?  Or is that untrue?  Maybe ovarian functioning is directly coorelated to the quality is some fashion.  I do know that failing ovarian functioning in older women cooresponds very highly to their present quality.  Well, how could it be that I could be compared to my cohort's quality if it is based on my age.  It just doesn't make sense!

Does anybody have a prognosis for my outcome.  Trust me, I won' t hold you to it if it doesn't come out the way that it is "statistically" supppose to according to all my stats.  I just can't find a journal that shows me where I stand with the above stats.  What is my ovarian age??  Is it my chronological age?  Or could it be younger?

Got to know? And why is it that the doctors are so impressed with my ovarian functioning when I have smoked since I was 15 and done some ungodly drinking for years after my first divorce.  I don't drink anymore, but I did so during that time period.  Could it be that one's profile, and or outcome is SOLEY based on genetics??? I would think!  There is a gal in my clinic that is 36.  She never smoked, drank or anything and she only has a total of 6 antral follicles!  What is up with that?  I feel so guilty that I didn't have the heart to tel her the truth about myself.  Do most woment that smoke not have a good of stats as I do?  Again, my doctors really look amazed everytime they see me, but really won't tell me anything.  

I am real confused!

IVF'nNsmok'n (Leeda)

[Forum-M.D.-SP]

You have really studied up well and know your stuff! The low progesterone level is most likely because the pregnancy was abnormal in the first place, and yes the reason is most likely due to chromosomal abnormalities based on age. The odds are, unfortunately, stacked against you - what you have recently experienced is unfortunately all to common. If you refer to the CDC/SART website www.cdc.gov/art/art2004, section 2, figure 13 you will note that the chances of getting pregnant (with IVF) when you are 44 is only 7.4%. Then, if you are one of the fortunate who do get pregnant, the chance of delivering a baby falls to 3.3%. This is because those few pregnancies that occur in women who are getting older usually end in miscarriage (according to figure 14 close to 60% of all pregnancies in 44 year-olds) because of chromosome abnormalities. There is probably nothing you can do to fix these chances, short of using a younger egg donor. One thing you might try, although as I said above the low progesterone is most likely because of an abnormal pregnancy rather than a cause, is to take supplemental progesterone in the second half of your cycle after you ovulate. The way we time this is to do urine ovulation prediction testing starting on day 10 or 11 of your cycle, have intercourse the day your urine turns positive and the day after, and start progesterone 3 days after your urine turns positive. Since taking progesterone can delay a period even when you are not pregnant, get a pregnancy test on day 32 if you have not had a period. If it is negative, stop the progesterone and wait for a period. If positive, stay on the progesterone until 8-10 weeks. The easiest way to take progesterone is intravaginally, either crinone 8% once a day or prometrium 200 mg three times a day. Good luck!