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Forge Ahead with the Right Fertility Treatment for You

a blog by Traci Shahan, RN, WHNP-BC, Doctor of Nursing, Albrecht Women’s Care Denver IVF, January 23, 2012

Snow fell in Denver last Saturday evening, not enough to make headlines to be sure, but enough to make me reconsider my Sunday morning trail run. I quickly exhausted my excuse list — too tired, too out of shape, too much snow, schoolwork to do, dogs to wash, children in need of time, a house populated with dust bunnies — then set out.

The early morning was sunny but cold. My breath hovered in fleeting tiny crystals, my feet padded and crunched the ground cover. After a half mile, I turned toward the hardest part of the run: a serpentine, ascendant trail blanketed in last night’s snow.

I have learned a lot over the years from running; out of the gates sprint is not necessarily the winning pace, running all out down a ski mountain can result in long term ankle problems, Porta Potties are life savers at seven miles, any hill is surmountable with the right playlist and liberal decelerations, and though the trail can seem desolate, I am not the only one to ever traverse it.

Such was the case last Sunday.

With the Red Rocker screaming through my ear buds about unrequited heavy metal love, I turned west and uttered a word that is unprintable in this medium. I run best when I direct my thinking away from physical discomfort and challenge toward other people or recent events.

My mind settled in on an unlikely pregnancy that occurred recently in one of our patients who had been told by two other practices that she was too old and that her antimullerian hormone (AMH) level was too low to try in vitro fertilization (IVF) with her own eggs. In sum, she felt slighted by such a pronouncement and believed enough in her body’s inner wisdom to continue searching for a medical team who shared her belief.

She landed in our waiting room.

Our fertility clinic has had a meeting with embryology and reproductive endocrinologists present who quietly heckled us for our arguably progressive approach with such patients. Admittedly we are willing to try unusual protocols if the patient agrees, which is exactly what we did with this woman’s IVF cycle. Dr. Albrecht vehemently believes that each patient deserves the right to use her biological eggs, and he refuses to define our practice by IVF statistics. Similarly, I have seen many different patients over the years who declined third party eggs for various reasons, which obviously leaves these patients with fewer options.

Bottom line: Medicine should not be practiced by numbers alone. I think this bears repeating, because I think it is critical in this day and age of cookie cutter, reductionist medicine: We don’t practice medicine by numbers.

Case in point is the woman referenced above. Her AMH was low,

And so we implemented an unusual protocol, waited after the embryo transfer when her pregnancy hormones returned unfailingly consistent with a healthy pregnancy. I had the honor of performing her first OB ultrasound and there, despite hecklers, naysayers and conventional contemporary RE thought, lay firmly ensconced her womb a single 10 mm embryo with a strong heartbeat. Call it what you will — miracle, luck, chance or well-thought-out protocol — the baby is due in the fall. Though this certainly won’t work for every patient with low AMH, readers please note: Medicine should not be practiced by numbers alone. If your doctor is not willing to walk with you on your terms — ahem! — find a new doctor!

In addition to unusual protocols, there are practices who believe that single egg retrieval in such a patient is as, or more, helpful than peppering ovaries with huge amounts of costly drugs.

Maybe a third of the way across the trail, I looked down at the earth below me and was startled to see a single set of fresh footprints in the otherwise pristine snow — a woman’s I thought, judging from the small size. I changed my gait so that my feet fell neatly in step with her footprints. I finished the climb with my upper lip stuck to my frozen braces in an unfettered, albeit probably goofy looking, smile, thinking that I only thought I was the first one to navigate the trail. Instead I found that someone whom I would never meet had gone before me.

And so it is for all of you with low AMH and high expectations: It only seems as if you are alone, but the truth is women like the one above have blazed the trail before you. Listen to your inner wisdom, seek competent care that is provided with a spirit of loving kindness, patience and respect. And if you don’t have that kind of care now, be intentional about finding and fostering it. As the Celts might say: you are your own Anam Cara, friend of your soul.


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