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  • Kassandra Vaughn

TTC Over 40: 5 Things You'll Learn About Your Fertility Doing a Meditated Fertility Cycle

I turned 46 last month... and decided to do a round of fertility meds this cycle... And I've learned A TON about my fertility, what to do next and what NOT to do.

Some historical context: I've been working with a local fertility center who has reminded me constantly that, at 45/46, I'm too old and there's less than 1% chance that I'll get pregnant using my own eggs. They've gone even further to say that IVF would be a total waste of time given my age.

So... I decided to do a monitored fertility cycle with this office for the current cycle. The cycle involved 5 mg of Letrozole (for 5 days), a trigger shot and progesterone pills taken daily throughout the luteal phase. I'm currently on Cycle Day 25 so I don't have a clear answer on whether this cycle worked or not but, even if I'm not pregnant, I learned so much by doing this... which is why, no matter what the pregnancy outcome, I'm so glad I did a medicated cycle.

Before I go into the things you'll learn, let me provide a few recommendations on things you'll want to do BEFORE jumping into a medicated fertility cycle:
  1. Track your hormones (estrogen, progesterone, and LH) for AT LEAST 3 menstrual cycles. Before doing a medicated fertility cycle, you need to know what your fertility looks like for three consecutive months with no assistance from fertility medications or interventions. I use Mira to track my fertility hormones but you can also use Inito or Oova.

  2. Track your basal body temperature daily. You can buy a cheap, effective basal body temperature on Amazon. Every morning, before you step one foot out of bed, take your temperature and use an app like the Fertility Friend app to track the temperatures. Sometimes, the Mira will be off in terms of when you ovulate but the temperatures will pinpoint exactly when ovulation occurred (or vice versa). Also, the temperatures may give you your first hint of pregnancy if your temperatures (in the luteal phase) go triphasic. It's helpful to have both ways of collecting data about your cycle.

  3. Use a CGM (Continuous Glucose Monitor) to track your glucose impacts egg quality, implantation and so many things related to fertility. Knowing how your baseline glucose changes in each phase of your menstrual cycle is critical to helping you determine whether your blood sugar levels are playing a role in getting pregnant. Track your glucose and jot down your glucose first thing in the morning (fasting glucose level) every morning for a minimum of three months. I use FreeStyle Libre 3 and love it!

Here are 5 things I've learned (and you'll probably learn) by doing a medicated fertility cycle:
  1. My uterine health is solid: My uterine lining, throughout this cycle, is exactly where it needed to be... which means my menstrual flow was enough to shed the lining, my lining thickened at the rate that it needed to at each part of the cycle and, having already taken antibiotics to deal with endometritis a few months ago, my lining is in a solid, welcoming place for an embryo to implant. This is one variable that I can't monitor at home so having a few ultrasounds helped me confirm that, at least at this time, my uterus is in good shape.

  2. I have a cyst on my right ovary: The nurse found one cyst on my right ovary (the ovary that they suspect has endometriosis) and they tested estrogen to make sure that everything was still good for proceeding and it was. But, knowing that my right ovary (that's already challenged with possible endometriosis) now has a cyst on it tells me that I need to really focus in on improving my nutrition as well as work on dealing with my emotional inflammation (stress and anger specifically) since, metaphysically, cysts represent anger held in.

  3. My follicle grows well on my left side: Due to having ultrasounds through this cycle, the nurse was able to monitor each of the follicle's developments (the left follicle grew normally from 15 to 20 in two days while the right follicle stayed at 15 and did not grow as it needed to). This tells me that A- my follicles do grow to the maturation level needed to release and B- the right ovary is challenged which is why that right follicle stayed at 15). I do think the second follicle eventually released but it took much longer.

  4. Progesterone support is necessary: My fertility coach talks about progesterone being solid when it's at least 10 throughout the luteal cycle. With no assistance, my progesterone tends to go up and down like a rollercoaster (very often going far below 10) which isn't good for thickening the lining so an embryo can implant and stay. Taking the progesterone pills this cycle has ensured that my progesterone level has been at and remained 30 every single day. 30 is a bit high but better to be at 30 than far below 10 so this tells me a few things: 1) Cortisol tanks progesterone and the reason my progesterone is so naturally wonky (in addition to me being 46) is that my cortisol is probably too high (drinking coffee daily doesn't help), 2) I need to reduce my cortisol levels to help my natural progesterone levels, 3) Even with managing cortisol better, I will still probably need the help of a progesterone pill or suppository and 4) Using the progesterone cream didn't do much at all so I'm no longer going to waste time and money on a topical progesterone cream.

  5. Fertility medications do not help my fertility: This was the biggest lesson I learned. While I understand that both Clomid and Letrozole are designed to suppress estrogen to trick the body in thinking it needs to produce more estrogen so more than one follicle grows, my estrogen AND my LH levels tanked being on the fertility meds. Even the trigger shot did not help... which tells me that my body doesn't like the fertility medication and is negatively affected by it.

What does this mean for next steps on my fertility journey?

It means a few things:

  1. I'm going to take at least 2 cycles to work on the issues I know I need to work on (high cortisol, going auto-immune paleo with my nutrition, and building some muscle which will help with glucose).

  2. I'm going to continue to use the progesterone pills during the luteal phase to support a possible pregnancy.

  3. Re-evaluate the use of fertility meds and adding in an IUI cycle for an upcoming cycle to see if an IUI helps achieve pregnancy... if pregnancy hasn't happened by then.

  4. Incorporate daily meditation, deep breathing, spirit baby meditations, and yoga. I need to make these non-negotiable in my life. I think a lot of my infertility is connected to stress and emotional inflammation, not physical challenges... even at 46.

  5. Trust the process. Yes, I feel like time is running out but I cannot make decisions based on that scarcity feeling of rush. I have to trust that what is for me IS for me... and listen to my intuition.

At the end of the day, my fertility journey is unique to me... and your fertility journey is unique to you. Be sure you're listening to your own Inner Knowing about what to do next.

Your intuition will show you the way...

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