Monthly Archives: January 2014

Miscarriage Research – Causes and Prevention- THE 411

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What Causes Miscarriage

 

What causes miscarriage:

  • chromosomal abnormalities of the fetus (causes 50% to 80% of first trimester miscarriages)
  • feeling stressed (associated with a 200% higher risk of miscarriage) 
  • low folate levels (47% higher risk of miscarriage) 
  • having both low folate and low vitamin B6 levels (causes a 310% increased risk of miscarriage) 
  • low magnesium levels 
  • low phosphorus levels 
  • low selenium levels 
  • low beta carotene levels 
  • low vitamin B12 levels 
  • low vitamin B6 levels 
  • low vitamin C levels 
  • low vitamin E levels 
  • low vitamin K levels 
  • high calcium levels 
  • high butter intake (100% increased risk of miscarriage) 
  • high oil intake (causes a 160% higher risk) 
  • eating too many or too few calories 
  • exercising one hour a day or more during the first 18 weeks of pregnancy (270% higher risk of miscarriage; however, there are opposing studies regarding exercise) 
  • exercising more than usual during implantation (causes a 150% higher risk of miscarriage) 
  • having a menstrual cycle longer or shorter than 30-31 days (causes a 200% higher risk) 
  • ovulating before day 11 (causes 122% higher risk of miscarriage) 
  • ovulating after day 16 or before day 12 (100% increased risk) 
  • high blood glucose 
  • high insulin levels (27% of women with recurrent miscarriage are insulin resistant) 
  • being overweight (causes a 67% higher risk of miscarriage) 
  • being underweight (causes a 70% increased risk) 
  • being 30-35 years old (12% increased risk)
  • being 35-39 years old (causes a 39% to 75% higher risk) 
  • being over 40 years old (162% to 400% increased risk)
  • having a partner over 35 years old (causes a 60% increased risk) 
  • needing more than one year to conceive (100% increased risk) 
  • having had an induced abortion in the past two years 
  • having had previous miscarriages (24% chance after 2 miscarriages; 87% after 7 miscarriages) 
  • high homocysteine levels 
  • having PCOS (contributing factors may actually be responsible for miscarriage) 
  • high testosterone levels 
  • high free testosterone levels (all subjects with free testosterone 1.30% and higher miscarried, none lower than .70% miscarried)
  • low progesterone levels (found in 17% to 35% of women with recurrent miscarriage) 
  • high estrogen levels (even in normal range) 
  • high FSH levels (even in normal range) 
  • high LH levels (even in normal range)
  • high prolactin levels (even in normal range) 
  • low SHBG levels 
  • having Factor V-Leiden gene mutation (causes a 1% higher risk of miscarriage) 
  • having the MTHFR gene mutation (450% to 530% increased risk) 
  • having a partner with the MTHFR gene mutation (130% higher risk)
  • having thyroid antibodies (causes a 173% increased risk of miscarriage) 
  • having a proinflammatory immune milieu 
  • having a high Th1/Th2 ratio 
  • chromosomal abnormalities (causes up to 80% of miscarriages)

Many of these traits can be altered. Each topic on this website includes research regarding how to improve one’s status without medical intervention.

How to prevent miscarriage:

  • consume chocolate (causes a 17% lower risk of miscarriage) 
  • consume dairy products daily (leads to a 33% lower risk of miscarriage) 
  • consume cheese (causes a 50% reduced risk) 
  • consume milk (40% lower risk) 
  • consume eggs (causes a 30% reduced risk) 
  • eat a high fiber diet 
  • eat fruit (causes a 46% to 70% lower risk of miscarriage, depending on the study) 
  • eat fish (leads to a 30% lower risk of miscarriage) 
  • eat poultry or fish twice a week (leads to a 15% lower risk) 
  • eat vegetables (causes a 40% reduced risk of miscarriage) 
  • conceive either one day before ovulation or on the day of ovulation (57% lower risk) 
  • extend your period to longer than 5 days (causes a 60% reduced risk of miscarriage) 
  • make it to 7 weeks pregnant with a visible fetal heartbeat (causes overall risk to drop to 5%) 
  • have morning sickness (70% lower risk of miscarriage; risk goes down as severity of nausea goes up) 
  • feel happy (causes a 60% lower risk) 
  • consume flaxseed (causes a 64% lower risk in cows) 
  • consume fish oil 
  • exercise (lowers risk of miscarriage of a healthy fetus by 40%; however, there are opposing studies) 

Studies show the overall risk of miscarriage to be around 20%. Once a gestational sac has been observed, the chance of miscarriage decreases to around 13.5%. After a heartbeat is seen, the odds improve even further, and the chance of miscarriage decreases to 9.4% at 6 weeks and a mere 0.5% at 9 weeks.

However, miscarriage continues to affect many women, and so there has been considerable research regarding the particular causes. What causes miscarriage remains unclear and certainly much is left to be elucidated. That being said, here are some findings regarding the most common causes of miscarriage:

Chromosomal abnormalities: The most common cause of miscarriage seems to be a failure in cellular division which results in an abnormal number of chromosomes. This has been estimated to cause up to 80% of miscarriages. Although it has been assumed by some that there is little that can be done to prevent these miscarriages, certain factors increase one’s odds of having a chromosomal defect. Smoking and low levels of folate in both mother and father have been associated with a higher risk of chromosomal defects. Thus, elimination of smoking and supplementation of folic acid may reduce one’s risk of miscarriage from these causes. Also, an acidic PH level causes chromosomal defects in mice, so it could be postulated that adopting an alkaline diet might reduce the chances of miscarriage. Another factor may be the time to fertilization after ovulation. In hamsters, mating too late after ovulation results in higher rates of aneuploidy and triploidy, which causes miscarriage. Finally, although maternal age has been associated with chromosomal abnormalities, recent research has suggested that it is actually high levels of FSH resulting from a reduced egg supply that is the culprit and may cause miscarriage. Thus natural methods of reducing FSH, such as increasing dietary fiber intake, or consuming soy or vitex may be helpful in preventing miscarriage.

Thrombophilia: Of the known medical causes of miscarriage, thrombophilia is among the most common. In women with no physical, hormonal or chromosomal abnormalities, 92% have been found to have thrombophilia. Once thrombophilia has been identified by a doctor, the prescription medication heparin has been shown to reduce the chances of miscarriage in women with thrombophilia to that of healthy controls. To prevent hypercoagulation, reducing dietary fat, stress, and high BMI may be of some help.

Progesterone: Luteal phase defect is found in up to 35% of women with repeat miscarriage. Inadequate progesterone production is thought to be a contributing factor to luteal phase defect. Likewise, low progesterone may cause miscarriage. 91% of pregnancies with progesterone lower than 15 ng/ml end in miscarriage. Increasing progesterone may reduce one’s chances of miscarriage. In women with recurrent miscarriage, women who were given supplemental progesterone reduced their odds of miscarriage by 62% versus women who received placebo or no treatment. One may be able to increase their levels of progesterone naturally by supplementing with either vitamin C, vitamin E, L-arginine, beta carotene, vitamin B6, vitex, black cohosh (on cycle days 1 to 12) or selenium, as these have all shown positive results in various studies. Also, consuming dairy products, reducing obesity, avoiding overeating and saturated fat and improving insulin sensitivity have been shown beneficial to progesterone levels. Likewise, many of these solutions have been associated with a lower risk of miscarriage.

Diet: Avoiding poor dietary choices may be beneficial in avoiding miscarriage. While there have only been a handful of studies regarding which food choices influence one’s risk of miscarriage, the findings have been significant. One study found that those who consumed the most butter doubled their chances of miscarriage over those who consumed the least, even after adjusting for BMI. Likewise, those with the highest levels of oil consumption had a 60% higher chance of miscarriage. High levels of dietary fat may cause miscarriage because they cause higher levels of inflammation and blood coagulation, or because they deleteriously affect hormone production. For those wanting to avoid miscarriage, consuming fruit may be one of the most powerful tools easily available. Women with the highest level of fruit consumption reduced their chance of miscarriage by 70%. Similarly, women with the highest level of vegetable consumption had a 40% lower chance of miscarriage. While meat consumption per se does not seem to cause miscarriage, those who consumed the most fish reduced their chance of miscarriage by 30% and those who consumed the most eggs also reduced their risk of miscarriage by 30%. Consuming dairy products every day has been shown to reduce the odds of miscarriage by 33%. This may be due to dairy’s ability to reduce inflammation or increase levels of estrogen. Surprisingly, eating chocolate seems to reduce the odds of miscarriage by 19%.

The Big Lie In Putting Off Pregnancy – by CNN

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(CNN) — Blame it on the baby bump and our pop cultural infatuation with celebrity, but today, regular women have yet another reason to feel inadequate: motherhood.

In the past decade, for the celebrity set, babies have become as fashionable as Birkin bags. The media has fueled the fertility frenzy by outing every pregnant, or potentially pregnant, Hollywood starlet. But then there’s more — with every aspect of a celeb mom’s glamorized pregnancy reported, from excessive weight gain to dramatic post-partum weight loss, regular women are fed a distorted depiction of pregnancy.

But perhaps nothing does a tragic disservice to women more than the media’s coverage of those over-35 celebrities who seem to easily get pregnant whenever they choose, writes Tanya Selvaratnam in her new book, “The Big Lie: Motherhood, Feminism and the Reality of the Biological Clock.”

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“For the celebrity set, babies have become as fashionable as Birkin bags,” Wendy Sachs writes.

We’ve all seen the US Weekly and People magazine images. There’s Halle Berry having a baby at 47 years old, and Kelly Preston doing the same. Uma Thurman had her third child at 42. Julianne Moore, Tina Fey and Salma Hayek each had daughters at 41 years old. Jane Seymour had twins at 45 and Mariah Carey birthed hers at 42. Not only do these women look ageless, they defy biology.

“One of the reasons I wrote the book was because I was frustrated by the conflicting messages and information out there,” Selvaratnam said. “We see celebrities having kids seemingly without any problems and we have no idea what they went through. We see the end result, but not the struggle.”

Ironically, motherhood has never been so chic at a time when so many women are struggling to get pregnant. The number of women between age 40 and 44 who remain childless has doubled in a generation; in 1976 it was one out of 10, by 2006 it was one in five, according to the U.S. Census.

In Selvaratnam’s deeply personal and provocative book, she shares her own journey of three miscarriages, multiple IVF treatments, cancer and the ultimate toll it took on her marriage. She explores the impact of delayed motherhood and the bad information that women receive, not only from aspirational celebrity images, but also from their own doctors.

Selvaratnam writes that after her first miscarriage at 37 years old, her OB-GYN told her that she still “had time” to get pregnant. So instead of rushing to a fertility center, she waited, and that was a serious mistake.

The “Big Lie,” she writes is that women can do what they want on their own timetables. They can delay motherhood until they are emotionally and financially ready, secure in their careers and have found that perfect partner and if they have trouble getting pregnant, modern medicine will miraculously give them a child.

Forty may be the new 30, but our ovaries have not gotten the same makeover. Even with all the advances in reproductive technology, our eggs have a finite shelf life and the odds of having a child over 40 years old are shockingly slim.

Tiny miracle after massive heartbreak

Having a family when there’s infertility

Family adopts embryos, gets a surprise

According to the Southern California Center for Reproductive Medicine, a woman in her 20s has a 20-25% chance of conceiving naturally per menstrual cycle. In her early 30s, the chance of pregnancy is 15% per cycle. After 35, the odds of pregnancy without medical intervention are at 10%. After 40, that number falls to 5%, and women over 45 have a 1% chance of conception.

The number of childless women in the United States today is growing. According to a Pew study conducted in 2008, about 18% of women in the United States don’t have children by the end of their childbearing years. In 2008, there were 1.9 million childless women between 40 and 44, compared with 580,000 in 1976.

From the Pew report: “Among older women, ages 40-44, there are equal numbers of women who are childless by choice and those who would like children but cannot have them, according to an analysis of data from the National Survey of Family Growth.”

Perhaps one of the greatest myths today is the ability of science to step in and make babies for women at virtually any age. Selvaratnam says that we see the success stories, but rarely hear about the huge numbers of failed attempts. A 2009 report on Assisted Reproductive Technologies, or ARTs, by the Centers for Disease Control and Prevention found that the single most important factor affecting the chances of a successful pregnancy through ARTs is a woman’s age. Selvaratnam reports that at age 40, the chance is 18.7%; at 42, it’s 10%; at 44, it’s only 2.9%.

“We are the guinea pig generation for testing the limits of our fertility, or our chances of having a child. The shock and the lack of preparation when you’re not prepared and the pressure women feel in general about our reproductive selves adds to the shame women feel when they can’t get pregnant,” Selvaratnam said.

She also argues that feminism may have misled Gen X women by avoiding the topic of motherhood and biology. The trend of delaying motherhood was meant to empower women, but ironically it may have boomeranged, leaving scores of women infertile and desperate to have a baby. Selvaratnam believes that we need to reset the conversation and reconcile motherhood with also being an educated, independent, successful woman.

Like birth control, Selvaratnam suggests that information be promoted about fertility and the realities of delaying motherhood. She suggests that every young woman be shown a chart of her overall fertility so she understands when her eggs are best and when the number will start declining. She thinks that with the information, women can be more strategic about trying to get pregnant or at least not be blindsided if they have difficulties because they waited.

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The attrition rate of our eggs is startling. Selvaratnam reports that the number of eggs at a girl’s first menstrual cycle is 300,000 to 400,000. By age 30, we’re down to between 39,000 to 52,000, which is about 13% of the eggs we had at puberty. By age 40, we have only 3% of our initial cache of eggs — about 9,000 to 12,000 eggs — and many of these eggs will not be viable.

Ironically, in our uber-sharing age, infertility still remains shrouded in silence. Selvaratnam wants to de-stigmatize miscarriage and infertility and get people connected and talking.

“When women have miscarriages or infertility we feel like failures. I want people to realize how common these issues are. When you see the statistics, it becomes clear you are not alone,” Selvaratnam said. “You look at celebs and think ‘What’s wrong with me?’ when it seems to work out for all of these other people. But the truth is, for most people, it doesn’t work out.”

Selvaratnam is also hoping that her book will be a policy changer. She’s advocating for better health insurance to cover infertility treatments as well as better public education for women. Changing the paradigm for women in the workplace, increasing work-life flexibility and creating more affordable child care, she believes, is also intricately linked with supporting women so they can become mothers. Taking some time off from your career, or easily coming back to your job is a fundamental issue for easing the path for women to have a baby in their late 20s or early 30s — the optimal time for fertility, but often a terrible time to interrupt careers.

“We place so much pressure on women in regard to … their reproductive selves and on their careers. So many women are suffering,” Selvaratnam said. “We need to find ways to advocate, small and big. Instead of judging each other,we should be supporting each other. I want people to look at my story and see and see how they can prevent it from happening to them.”

What the Statistics Won’t Tell You About Single Mothers – by Leah Campbell

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Yet again, single mothers are in the news. The most recent Shriver Report has a list of statistics that make the plight of single motherhood seem quite daunting—numbers that say they are more likely to live with regret and at the height of poverty, struggling so much more than those with partners by their sides.

These statistics aren’t unique—they come to light every time somebody decides to do another study on the struggles single mothers face. The research would tell you that the challenges endured by single mothers are extreme and that their ability to succeed in that role is limited.

But the research doesn’t always tell you the full story.

I am a Single Mother by Choice, part of a growing demographic of women who choose single motherhood as their path to parenting. Most of us are in our 30s, well educated, successful—far outside the statistics. And for many of us, there is no regret in how we have become mothers. Our children are our lives, the best things that have ever happened to us.

There is something to be said for that choice—for the mothers who strive towards single motherhood, rather than recoiling from it

There is something to be said for that choice—for the mothers who strive towards single motherhood, rather than recoiling from it. Too often, the statistics seem to more accurately represent Single Mothers by Chance—those who became unexpectedly pregnant or those who entered parenthood with partners by their side, only to be left alone without much of a say at some point down the line. The numbers speak more to poverty and a lack of options than they do to single motherhood as a whole.

It’s a flaw in the research that fails to differentiate between the two groups and possibilities. But there are plenty of voices telling a different story than the ones the numbers are portraying.

Take Tarsha Downing (blog: http://www.tarshastreasurechest.blogspot.com), for instance, a 32-year-old law office manager living in Maine. She chose to adopt her daughter, Imani, from Uganda as a single woman, purely because she knew she was ready to be a parent. She says she doesn’t even think about the fact that she is a single mom anymore. “It’s our only way,” she explained. “I would do it all over again for my girl.” She says the stats on single motherhood aren’t representative of her, and that “we are not doomed to become something because the ones before us did.”

Then there is Rebecca (last name withheld for privacy). She is a 42-year old senior vice president in banking who is a Single Mother by Choice to daughter Ella, 21 months old. While she had believed she found the love of her life years before, it never quite worked out, and in her late 30s she decided that she would rather pursue motherhood on her own than never at all. Ella was born 15 weeks premature, from complications due to preeclampsia. Because of that, she has developmental delays and requires more care than Rebecca had initially planned for, including a private nanny who is capable of dealing with Ella’s medical issues. For Rebecca, addressing those concerns is the biggest challenge of motherhood, but she is quick to point out that the same would be true even if she had a partner. She told me she sometimes catches herself saying, “When I was single…” in reference to her previous life, because, in her mind, she isn’t single anymore. She’s part of a family of two.

Lindsay Curtis, a 33-year-old communications specialist and mommy to daughter Evelyn, 11 months old, said that for as long as she could remember she wanted to be a mother. The long-term relationships just weren’t working out, and she decided to take the plunge on her own. She worries about being the only financial provider, but lives comfortably enough and is quick to recognize the benefits of single motherhood. “I discovered strength, patience and love I didn’t know I was capable of or had,” she told me. And, she enjoys the fact that she gets to call all the shots. No fighting or compromising on parenting styles, names or anything else. She gets to parent exactly as she wants to. In her mind, that’s a benefit to the choice she has made.

For these women, and many more like them, it came down to a matter of choice. They knew what they were getting into before they ever pursued becoming parents—and perhaps it is that level of thought that sets them apart from the single mothers so often represented by these studies. It was not too long ago that a report came out declaring homosexual parents were faring better than their heterosexual counterparts. According to the researchers, the difference was how the two groups had come to be parents in the first place—the homosexual group was full of parents who had to put a great deal of thought and effort into achieving their dreams of child rearing, while the heterosexual parent group was a mix of those who had truly dreamed of being parents and those who had found themselves raising children quite by accident. These differences created a dynamic where homosexual parents seemed more motivated and committed to their roles as parents according to the numbers, purely because each of them had needed to fight to get there in the first place.

For my part, pursuing single motherhood came after losing my fertility at a young age. It was a blow which made me realize how ready I was to be a mother, despite how elusive finding a long-term love had been. In the first few months of caring for my newborn, I remember thinking to myself “How do couples do this? I barely have enough time for just myself and her.” I couldn’t even imagine making the space for another person. I know that people do it, but I have to say, there were benefits to the fact that I didn’t have to. I was able to build a cocoon around myself and my daughter, making her the priority in my every waking moment. Would I love to find a partner in my life now, someone she can look up to and I can rely upon and trust? Absolutely. I would love for my daughter to grow up in a warm and stable two-parent home. But if that isn’t in the cards, and it is only just the two of us? I can still guarantee that we will be happy, safe and cared for. There will forever be enough love in our home. We will be just fine, my girl and I.And we will never be what those statistics might try to tell others we are.

Because I make a choice, every day, to commit to motherhood and my little girl.

And because I was lucky enough to have entered single motherhood at a time when I had opportunities and options.

Because that really is what those statistics come down to—poverty and a lack of options.

Not parenting on one’s own.

Reproductive Endocrinologist – the 411

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Reproductive Endocrinologist - the 411

Today, after an infuriating exchange with my OB’s office, I decided to make an appointment with and start seeing an RE.

I have to undergo a battery of blood tests and baseline ultrasounds over the course of the next few months and I need a doctor I feel is capable of managing my care.

The difference between and RE and a OB/GYN:

RE stands for Reproductive Endocrinologist. REs complete the same educational and medical requirements as an OB/GYN (Obstetrician and Gynecologist) which is a four year residency in Obstretrics and Gynecology. In addition to the four year residency program, REs complete an additional three years of a fellowship in reproductive endocrinology. REs have special training that enable them to provide the treatment needed for couples facing fertility issues.

OB/GYNs have been trained in two specialities; an obstetrician manages pregnancies and a gynecologist is trained in reproductive health. An OB/GYN may offer services to treat fertility problems. However, when these preliminary tests and treatments do not resolve a fertility problem, an OB/GYN may refer the couple to a specialist, known as a Reproductive Endocrinologist.

IVF Medications and Possible Side Effects- The 411

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IVF Medications and Possible Side Effects- The 411

I am on cycle day one and will be starting Estrace in twenty more days ! YAY ! I got my detailed medication protocol this morning and got some awesome documents from my doctor which explains the various medications, their purpose and possible side effects.

► Clomiphene Citrate: (Clomid) This medication increases the amount of FSH the pituitary gland will secrete. This is often used to stimulate ovulation in women who have absent
periods, infrequent periods or long cycles, or unexplained infertility.
The dosage is usually started at 100mg a day and taken for 5 days. Dosage may be increased if ovulation still does not occur. Potential side effects from Clomid include:
Increased incidence of multiple birth, Hot flashes, nausea, and breast tenderness, Headaches or blurred vision
Depression and mood swings, Ovarian cysts and pelvic discomfort from over stimulation of the ovaries

► Follicle Stimulation Hormone (FSH): (Gonal-f, Follistim, Bravelle) This is an injection given just below the skin (subcutaneous injection) that bypasses the hypothalamus and pituitary glands to directly stimulate follicle growth in the ovaries.

Potential side effects include:
Increased incidence of multiple birth, Breast tenderness, swelling, rash at injection site, Mood swings, fatigue and depression, Ovarian hyper-stimulation syndrome which includes enlarged ovaries, abdominal pain and bloating

► Human Menopausal Gonadatropins (hMG): (Menopur, Repronex) An injection that contains equal parts of FSH and LH (Luteinizing hormone), given to stimulate the ovaries to produce multiple eggs during one cycle. Menopur is the most common hMG used. Potential side
effects are the same as noted for the FSH.

► GnRH Antagonists: (Cetrotide, Ganirelix) This is an injection given just below the skin (subcutaneous injection) that helps prevent premature ovulation by decreasing the amount of LH released from the pituitary. It is started when the follicles are of a certain size.

Potential side effects are:
Tenderness, rash or swelling at injection site, Headaches and nausea

► GnRH Agonist: Lupron (or the generic form leuprolide acetate) is an injection given below the skin (subcutaneous injection) designed to prevent mid-cycle LH surge which can result in premature ovulation.

Potential side effects include:
Hot flashes
Headache
Mood swings
Vaginal dryness
Decreased breast size
Painful intercourse

►Human Chorionic Gonadatropin (HCG): (Ovidrel, Novaryl, Pregnyl, generic HCG) HCG is intended to induce ovulation. In the case of IVF, HCG is administered 36 hours prior to egg retrieval to provide final maturity to the developing egg.

Potential side effects include:
Nausea, Tenderness, rash or swelling at injection site

► Estrace: (Estradiol) This is a medication that comes in pill form that will be taken at a designated time in your cycle. You may be instructed to take this medication vaginally, orally, or both. If you are instructed to take this medication vaginally you will insert the pill as high into
the vagina as possible.

Potential side effects include:
Breast tenderness
Mild nausea
Bloating
Vaginal itching or discharge

► Progesterone Support: (Crinone, Endometrin, progesterone in oil) is a medication that will be taken at a designated time in your cycle to support the endometrial lining.

Potential side effects include:
Breast tenderness
Menstrual like cramping
Nausea
Mood swings and depression

Risks and Side Effects

Ovarian Hyperstimulation:

Hyperstimulation of the ovaries is potential risk when taking ovulation induction medications. Ovarian Hyperstimulation occurs when the ovaries become enlarged. In mild to moderate cases of ovarian hyperstimulation, a person may experience abdominal bloating and/or abdominal pain. Approximately 20% of people will experience mild hyperstimulation. Symptoms usually resolve with the onset of menses, however with a pregnancy may continue for several weeks.

In severe hyperstimulation, you may also experience a significant accumulation of fluid in the abdomen, nausea, vomiting, weight gain, dehydration and a decrease in urine output. Clients who experience severe hyperstimulation may require hospitalization.

Mild to moderate uncomplicated ovarian hyperstimulation, which may be accompanied by abdominal distention and /or abdominal pain, occurs in approximately 20% of clients treated with Gonadatropins an hCG. It generally resolves without treatment within a few weeks, or with menses. However, if pregnancy occurs, it may persist several weeks into the pregnancy. Clients experiencing mild to moderate ovarian enlargement usually report pelvic fullness and some abdominal pain and discomfort, usually about 2 to 6 days after administration of hCG. The degree of ovarian hyperstimulation is related to both the estradiol level and the number of follicles.
Multiple Pregnancy:

The administration of fertility medications increase the probability that more oocytes are developed in the ovaries. With the production of more oocytes the risk of multiple pregnancy increases. Multiple pregnancies are associated with an increase risk of complications and premature delivery. Multiple pregnancies can result in the need to reduce the number of fetuses. This procedure is called selective reduction.

Moving Along In The Process – the 411

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I am moving along in my process and will be starting my estrogen priming protocol in a few weeks.  I have to take Estrace for 7 days with the start of my period and go in for baseline and ultrasound.  After this, the next month, I start my injection meds, which are going to be a lot less costly than I thought now that I have been introduced to Freedom Fertility Pharmacy. 

I have selected one donor that I think is somewhat the male version of me LOL.  I am still combing through profiles on two cryobank sites looking for 3-4 more donors and then my siblings, mom, and friends will have a donor selection party to select “HIM”.

I can not wait until March when I go in for my retrieval and transfer.  I am praying that all goes well with my medication protocol and that I produce healthy eggs and enough that I can have twins.  I was speaking to another lady today and she transferred three embryos and is having TRIPLETS !  That I do not think I could handle, but I know I will never do selective reduction either.  I guess I will cross that bridge when I get to it.  I will see where I am after the retrieval and decide then how many embryos to transfer.  The doctor suggested transferring as many as 5.  SAY WHAT?  I can not see that happening, being that they may ALL take !