Wednesday, May 27, 2009

AMH and Adrenals

Ed note 5/30/09: I discovered that I mysteriously lost part of my post, so I added it back in. If you read this post before this date, you might want to read the beginning again.

Tomorrow will be day 3 of my cycle. I know it seems like yesterday when I posted on my day 3 results, but since I have the world's shortest luteal phase (a whopping 7 days this time), day 3 has come around again. I will be waiting one more cycle to do my official day 3 testing at BigShotFertilityClinic. You see, I've been holding out on you. I did have my AMH tested after all, and let me tell you, it was grim. BigShotFertilityClinic likes to see a level above 0.6, and I think that is even kinda borderline. Mine was 0.1. At least I didn't get back a result of less than 0.1, so I guess it could have been worse. AMH is used to predict resting follicle levels and sometimes IVF success. The predictive use of AMH for IVF is fairly new. Basically, what this means is that my ovaries need some serious resuscitation! Skip the CPR, and fire up the electro-shock pads!

I immediately consulted Dr. Google when I got the bad news. I wanted to know if the AMH number could change with Chinese medicine and acupuncture. I did find some information that it can change, and that women with low AMH do get pregnant! My acupuncturist EM wants to increase my kidney yin, and thereby AMH, by taking more evening primrose oil. In Chinese medicine, when they talk about an organ, like kidney or spleen or liver, they don't necessarily mean the actual organ. For example, a kidney deficiency, either kidney yin or kidney yang deficiency, usually refers to one's fertility. It can also refer to adrenal function, and the adrenal glands sit on top of the kidneys. I was comforted when EM said, "we treat the patient, not the number."

Part of my strategy of improving my fertility was to have my adrenal glands checked. I have a friend who finally had success getting pregnant at age 42 with her own eggs after battling infertility for seven years. She had one failed IVF with her own eggs and one failed IVF with donor eggs. She never gave up and kept looking for answers. Her success came when she was treated for her adrenals and sub-clinical hypothyroidism. Her thyroid numbers were normal, but she had all the symptoms of hypothyroidism. She gave birth to her daughter at age 43.

I did a test with Dr. F, my other acupuncturist, to test my "Adrenal Stress Index" through Diagnos_Techs lab. I was diagnosed with adrenal fatigue. The good news is that I have a mild case of it, so it will be fairly easy to treat. I dusted off my copy of "Adrenal_Fatigue, The_21st Century Stress Syndrome" by James_Wilson. It had some interesting things to say about taking DHEA and pregnenolone for adrenal fatigue:

"It is my clinical experience that women often do not do well on DHEA unless their adrenals are very fatigued. Levels as low as 10-25 mg have produced symptoms of excess DHEA, such as facial hair and acne. A safer and more successful way of raising DHEA levels in women is to have them take either progesterone or pregnenolone, although some studies of women with chronic fatigue syndrome or lupus have found benefit from using 200 mg of DHEA/day."

I have problems with taking DHEA. It raises my testosterone levels and gives me heart palpatations. I already have high testosterone, as expressed by my "sexy"_Lauren_Bacall voice, and I certainly don't need anymore! I take pregnenolone instead, about 60 mg a day, though I'm experimenting with taking up to 120 mg per day. When I have taken DHEA, I can only tolerate 5 mg a day, and only for about 5 or 6 weeks, before I have to switch back to pregnenolone. BigShotFertilityClinic recommends 75 mg of DHEA twice a day to improve egg quality. I would drop dead if I took this dose, or start growing a beard, neither of which appeals to me. I respond much better to the pregnenolone.

"Progesterone and pregnenolone are hormones that are manufacutred in the adrenal cascade as well as in the ovaries and testicles before they are metabolized into DHEA. Both can be converted into several other adrenal hormones besides DHEA, including the sex hormones, aldosterone and cortisol. Thus, taking replacement hormones like pregnenolone and progesterone that occur early in the adrenal cascade lets your body's wisdom choose which other hormones it will make from them, according to your body's needs. With adrenal fatigue, the sex hormone levels often fall because your adrenal glands are not able to manufacture adequate levels of hormones."

Pregnenolone is a precursor to DHEA, as you can see in the flow chart below. Pregnenolone is also a precursor to other hormones, and that's why it's safer than DHEA. Your body can determine where you need it the most. Maybe your adrenal glands have to heal before you can produce more of the sex hormones. We all know how stressful infertility can be!

I am also taking a cortisol supplement called Iso_Cort, though I have already had to cut back on that after taking it for a couple of weeks as I'm starting to get symptoms that I am getting too much cortisol, such as rapid heartbeat and anxiety.

Another strategy for me to improve my adrenal health is to go to bed by 10:00pm. This is very hard for me, and I have had to set limits on my internet use at night. In fact, I am already past my "internet bedtime"! Couple this with my busy schedule at work, and I've been a pretty lame commenter this week for ICLW. I will post more about the other supplements I have been taking to improve egg quality and to improve my mental health.


Retro Girl said...

My AMH was .5. BigShotFertilityClinic wasn't pleased at all, and Dr. S. basically said we could "give it a go, but if it didn't work, we'll know why".

I think they are still really trying to figure out the AMH thing. I asked them for some more literature about it or if they could point me to some medical journals that address it and they couldn't (or maybe wouldn't).

DAVs said...

All very interesting stuff. And I work in the world of hormones all day long :)

Blossom and Her Fruit said...

What a PITA! I can't believe all the minute tweaking required. Who is monitoring you through this? Since BigShotClinic isn't very open minded on many things preferring to stick fingers in their ears, rock back and forth, and say, "I know what I know. I know what I know."

Sue said...

Great post! I learned a ton! and I am super- surprised that you have also gotten that side effect from the DHEA (heart palpitations). I tried the clinics recommended 75 mg 2x a day for a few weeks and made it exactly 2 before the headaches, lack of sleep, acne, heart palpitations and hairloss really got bad. Had to go off it immediately, which I was not happy about. I hope all goes well with what you are taking! though I am sorry about the amh - nothing fun to say about that but I've seen women get pregnant with really bad numbers, so it is still possible!

Anonymous said...

what an informative post! that's really good to know about DHEA. me and my little chin hairs definitely won't be trying that one! and i hear you on getting to bed. everything i read says that i really need to be asleep by 11:00, but my little bouts of insomnia kind of wreck that, and i'm trying to work it out.

i'm looking forward to seeing what other supplements you're taking and how they work for you.

happy end of iclw week. i'm so glad i found you blog and i'll be stopping by and checking on you!

In Due Time said...

Very interesting post. Thanks for sharing with us.

Duck said...

This sucks - sorry to hear about the hormonal crap - have no idea if my clinic tracks this stuff ( i did ask about dhea but was ruled a no go). As you know I am taking l-arginine (a study showed that women who took 16 mg of this before egg retrieval had much better eggies). I am taking 6mg a day to build up for a few months and then eventually when we find a new home for our babies - we will cycle.
So hope that things look up on this round of tests.

The Muser (aka Beautiful Mama) said...

Sending wishes for happy, happy eggs. You are brave to go through all this and to keep working...

Dora said...

My clinic tests AMH. My RE said the research is still fairly new, but they (and I) believe it is more accurate than FSH. Mine was .04! My response to stims bears that out.

kayjay said...

You know, I thought I was the only one who didn't seem to do so well on DHEA - broke out in acne like I was a teenager again and I had *horrible* headaches all the time. It makes sense how you explained it, that those who don't need it do terrible on it. My AMH came back okay but I still don't respond very well to all the stim drugs. Very informative post!