Debra was 41 when she came to us, after 6 failed IVF cycles. After 3 months of treatment, she went for IVF again, where 12 eggs were collected and the consultant commented that they had never seen such good quality eggs in a woman of her age. Debra got successfully pregnant. Unfortunately, it was discovered this pregnancy was ectopic. She returned to TCM Healthcare for more improvements before another round of IVF.
“I was very pleased there was a significant improvement in egg quality. In fact, the best it’s ever been.”
Rochelle, 38, came to us after 4 failed cycles of IVF. After the last round, the consultant told her that her eggs were no good and she should consider donor eggs. When she started with us, she had an FSH of 13.2 (outside normal range), prolactin of 691 (outside normal range), oestradiol of 102 and AMH of 3.1 After 3 months of treatment, her FSH had dropped to 12.3 (now normal), prolactin 461 (normal), oestradiol 243 and AMH 3.
2 months later, in her fifth consultation, she found out she was pregnant.
“I am in shock. My IVF consultant said my eggs are no good; I should consider donor eggs. Here I am. I am pregnant. I can’t believe it.”
Susan came to us, then went through 2 failed cycles of IVF the next year. She restarted treatment with uslater on. We discharged her after we felt she was ready for natural pregnancy. She sent us this email some months after.
“My FSH result was 25 before. When I received the test result after a few months of treatment, I was so nervous thatI was too frightened to look at first. When I did, I was so pleased. It is now 13.9!”
Subsequently, she went for an IVF cycle with the clinic we work with. It was not successful, but she told us this.
“When the eggs were collected, the IVF clinic was surprised to find that all of my eggs are of excellent quality. They say this is very rare in a woman of my age.”
Six months on, she got pregnant naturally.
Lucy, 38, had low AMH (3.2), high FSH(14.9), high prolactin (609) and low oestrogen (90) — all outside of their respective normal ranges. She wanted to freeze her eggs but knew her hormones weren’t good enough to preserve good quality eggs.
After 3 months of treatment, her AMH rose to 6.3, FSH dropped to 7.5, prolactin dropped to 438 and oestrogen increased to 210. In short, all hormones were in the normal range.
“I am very pleased with the improvements to my hormones. Can you help me arrange to see the egg freezing specialist please?”
Egg quality is vitally important for a successful pregnancy — whether that’s natural or through IVF. Research has shown poor egg quality is strongly associated with chromosome abnormalities, which in turn impacts embryo quality. It is also the main cause for embryo arrest, IVF implant failure, and increased miscarriage risk for older women.
More and more women are considering freezing their eggs too. An egg freezing clinic will determine the likely quantity of one’s eggs, and the guidance on how to proceed, by looking at age, AMH and results from antral follicle scan (we can help with arranging an AMH test and antral follicle scan). Needless to say, regardless of procedural protocol, one would wish to freeze the highest quality eggs possible.
Gynaecologists and IVF clinics tend to think of egg quality decline as part of an irreversible ageing process that can’t be improved.
If you are a woman in your late thirties, or in your forties, you may be turned away for egg freezing or by an IVF clinic, saying your age and poor state of your ovaries are unlikely to respond well to stimulating hormones. You may be strongly advised to use donor eggs.
Women over 40 are statistically less likely to give birth, as they may produce fewer eggs, have fertilised eggs with more inclusions, with lower chance of implantation and full embryonic development. Even with donor eggs, older women still have less of a chance of conceiving. The problem is not just the quality of the eggs: The real problem is the IVF process only focusses on the last few weeks of the egg’s journey from initial follicle to the egg’s release.
The most important story about an egg’s journey from birth to maturity is often not fully told. It takes up to a full year for an egg to grow from a follicle in its resting state to being able to be released.
Follicles are selected from the pool of resting follicles almost a year before ovulation. About 5 months before ovulation, a follicle is chosen to become a primary follicle. A month later, it reaches its secondary stage, and approximately 65 days before ovulation, the follicle cycles through the pre-antral and antral phase. Over the course of these 5 months, the follicle quadruples in size and goes through many stages of proliferation.
During this period, before the follicle is signalled by follicle stimulating hormone (FSH) from the pituitary gland, key hormones prepare it to be healthy and responsive. The follicle only becomes dominant during the last 2–3 weeks through the ovary. During the selection phase, lasting ten days, the follicle activates mechanisms to make itself responsive to FSH. The follicle grows to twice its size, rises to the surface to the ovary and becomes oestrogen-producing.
It fulfils its major purpose and releases its egg, which leaves the ovary and travels down the fallopian tube, seeking its chance to become fertilised. The follicle ends its life cycle by turning into an endocrine gland, called the corpus luteum, which secretes the progesterone needed to maintain the pregnancy if the egg gets fertilised.
The intricate hormonal map that an egg has to navigate strongly suggests that when there is a hormonal imbalance, the chances of a good quality egg maturing would likely be compromised.
It is important to note that while age is a major factor for egg quantity and quality, there are many others to consider, especially hormones. The immediate manifestation of how well your hormones are working is your periods; each menstrual cycle is governed by the growth of a single egg. When your menstrual cycle is not going well, the chances are you are unlikely to make strong, healthy eggs.
An egg grows in an antral follicle into a mature egg in its dominant follicle. Both the egg and follicle have to function properly for the cycle to go well.
Ideally ovulation occurs on day 11 or 12. Delayed ovulation may be fine, but earlier ovulation implies lower quality eggs.
Premenstrual spotting is not good, as it means you are not producing enough progesterone, which stabilises the lining of the uterus. Low progesterone is caused by low-quality follicles.
Long cycles are OK, but short cycles are not as they are because of early ovulation and shortened luteal phases.
Poor follicle development is likely caused by poor general health, lower blood flow to the ovaries, and hormone imbalance. We at TCM Healthcare aim to improve all three, thereby helping follicle development and egg quality.
Our approach focusses on using natural herbal remedies and acupuncture to strengthen the reproductive system and general health, bringing the hormones into balance and ensure a regular period. We do not prescribe any synthetic hormones. Once hormonal balance is achieved and the period regulated, ovulation is likely to occur and egg quality will improve, where natural pregnancy results. We primarily use bespoke herbal remedies, but will use acupuncture if the situation warrants it.
Patients bring us their test results and medical record. We do a 40 minutes long first consultation, in which we do non-invasive and pain-free Chinese medical diagnostic procedures, in order to understand your particular condition and circumstances thoroughly.
Our specialist prescribes a unique herbal formula, usually consisting of around 20 kinds of herbs, from which you will make drinks and consume twice a day for 18 days in a month.
A month after the first consultation, you will be done with the first round of herbal remedy. We do a second consultation, lasting 30 minutes, doing another diagnostic procedure to see how well you’ve responded to the treatment. Another prescription will be written.
This monthly cycle will repeat 3 or 4 times before you are asked to have another AMH test carried out. Most patients see significant improvements. They also report their periods are now much more regular, which increases the chance of a successful IVF cycle (for instance, a higher dosage of stimulating hormone can be used). They then pursue a number of options, including working with us for longer to achieve natural pregnancy, or combining our treatment with IVF — we work some of the best IVF clinicians, who can offer the best of both worlds to our patients.
The fees come to about £350–400 a month, all inclusive.
Once a month. Most patients come from 3 to 9 months. Some combine our treatment with further IVF cycles.
A traditional Chinese medical consultation involves the following steps.
The practitioner may scrutinise your complexion, eyes, tongue, and movements to gain insight into how your organs are functioning. The tongue is a particularly important source of information, and its colour, body, coating, and moisture will all be taken into account.
The practitioner assesses the patient’s energy and general condition by taking into account your body heat, odour, skin sensitivity, and uses other senses to gain an insight into the your condition.
To gain a full picture, the practitioner will ask detailed questions about your complaint and your medical history. They will want to find out whether your problems vary at all according to the time of year and your diet, feelings or emotions.
This can provide a highly sensitive and detailed picture of your general health. The practitioner will take a number of different ‘pulses’ using three fingers put on the wrist of each hand of the patient. This enables him to gain further information about the quality and functioning of the five major organs. The practitioner will take account of your general health and strength, as well as all of your symptoms, whether they seem to you to be connected or not. This will be the basis for deciding on the best treatment.
Monthly consultations are required to gauge your progress. The prescriptions will be devised accordingly — for treating a changing condition, a fixed single herb or formula is unlikely to be effective over time.
Patients want to know how long they need to see us for. We say after 3 months of treatment, we will review progress, retesting hormones and check subjective experience, such as period cycle regularity and sexual interest. If they are at normal levels, we discharge the patients.
If they are better but still need further improvement, patients may need second course of treatment at the same or less intensity.
Typically, women see us for 3 courses of treatment, ie 9 months total.
The point is that the way we treat patients means they should not rely on our treatment for too long. Their improved health and function should stay with them if they look after their health.