Causes & Treatment

My real-time IVF prep plan – Part 3: testing

Eloise Edington  |  3 Aug 2023


Around about the time I started preparing (mentally and physically) for our fifth round of IVF, I picked up with my fertility support network (yes, I’ve got one and you should, too!) on the tests it would be smart to run, to see where my body is at. I turned 38 at the beginning of the year, and following a chemical pregnancy, wanted to check in. 

But when it comes to tests, where do you start – and stop? As a CEO and founder, I do like looking at numbers, and results. But as an IVF mum, I know there’s so much more to it – not least, luck on the day – plus an element of surrender. You can only do so many tests, after all, and each one can open a can of worms. 

My friend and IVF prep expert, fertility nutritionist Melanie Brown helped me pin down a couple of starting points, for pre-IVF at-home testing. And from there, I threw in a bit of my own experience, awareness and research. I ended up limiting testing (aside from the usual gamut of clinical assessment) to: 

  • DHEA testing 
  • AMH testing 
  • vaginal microbiome testing

At age 38, and with a recent early loss as part of my journey, I’m keen to understand my microbiome – and the environment I’m nourishing for implantation (see my IVF supplements and superfoods check-lists for context). Plus, understand how my DHEA and AMH levels sit, for a rough picture of my egg status, pre-collection.

Here are the three at-home tests I’ve used to measure and dive into DHEA, AMH and vaginal microbiome status. All super straightforward, and with very different results.

Have you read Part 2: superfoods? Do head over there if not, for how my IVF prep kitchen is looking, plus Part 1, and the supplements I’m taking ahead of egg retrieval and IVF

This is IVF at age 38, and the insight I prioritise. Here are the tests I went for, and my results. 

DHEA TESTING: MEDICHECKS

Why?

Dehydroepiandrosterone (DHEA) is a hormone produced in our adrenal glands. It’s a sex hormone – an androgen – and converted by the body into other hormones, including oestrogen and testosterone. No surprises then, that it’s an important aspect of our fertility profile. 

Running things over ahead of my fifth round of IVF with fertility nutritionist Melanie Brown, I knew that DHEA might be a helpful hormone to check out. At age 38 my DHEA levels will almost definitely be quite a bit lower than when I first started IVF in my early 30s. They do naturally decline as we age.

DHEA is often recommended by doctors as a supplement during IVF prep, particularly if any of these are part of your profile: 

  • diminished ovarian reserve (DOR)
  • age-related infertility
  • poor response to IVF
  • Premature ovarian failure (POF) or aging 

You do need to manage this carefully and with professional guidance, however, because supplementation can easily lead to hormonal imbalance.

Which test?

I went for the DHEA Sulphate (DHEAS) Blood Test, from Medichecks. This is a blood sample test you can do easily at home, with results estimated in two working days.

DHEAS is the sulphated form of DHEA, and how most of the DHEA in our body shows up.

Super easy and straightforward, this was such a simple test to sort out and use to support my IVF prep. It would be fantastic if fertility clinics could offer this kind of at-home blood testing too, to give a more joined-up and accessible experience for those with busy lifestyles like mine.

Medichecks does include a doctor’s comments in this test (you can opt out of this, if you like), as well as other offering other types of testing, too – they recently launched a partnership with the UK’s largest IVF insurance provider to offer at-home AMH testing to their clients, for example.

dhea-test-medichecks

Results

I tested my DHEA levels with Medichecks in April 2023, around three months before starting IVF treatment. Getting them back, my levels read as follows: 

  • 4.15 µmol/L (normal) 

This was an encouraging result for me, showing that (at the time of testing) my DHEA was within the reference range for my age group. According to the NHS, normal DHEA levels for women aged 20 to 55 are: 

  • age 20-25 years – 4.02 – 11.0 µmol/L
  • age 25-35 years – 2.68 – 9.23 µmol/L
  • age 35-45 years – 1.65 – 9.15 µmol/L
  • age 45-55 years – 0.96 – 6.95 µmol/L

My next steps

With levels confirmed, I decided to supplement my DHEA in preparation for this fifth IVF cycle in order to maintain that normal result. For this, I went for Fertinatal® from Ovaterra, by Fertility Nutraceuticals. Available in the US, UK and Europe, we’ve covered Fertinatal® in a bit more detail in today’s wrap-up below.

TRB bonus: Any clinic that signs up via Plasma by Medichecks to offer at-home blood tests to their clients can get 10% off their first month of tests right now using code TRB10.

AMH TESTING: LetsGetChecked

Why?

The team recently put together a really helpful guide to AMH levels for IVF – have a read up for the why and how on understanding your AMH levels ahead of treatment. And, why it’s important not to obsess about this marker! 

In a nutshell though, anti-müllerian hormone (AMH) can be a helpful indicator of ovarian reserve, as we head into an IVF cycle. Levels decline naturally with age, and for women around age 40, the normal range sits at between 1-1.5 ng/mL. However, there’s often a large overlap. 

IVF teams often see better outcomes with AMH at 1.5 ng/mL or higher. So while there’s nothing much I can do about my age – or the number of eggs I have left in my ovaries – knowing where I’m at helps me to focus on the proactive work I can do to support my fertility, including boosting my egg quality with targeted supplements and eating habits.

Which test?

Before we jump in, read up on where my AMH levels sat at age 35, when I first tested with LetsGetChecked. It was very easy to do back then, and even easier now, a few years on. 

Again, I went for the at-home Anti-Mullerian Hormone AMH Test by LetsGetChecked. This is part of their home Ovarian Reserve Test, and is a blood sample test with results estimated in five days. You can get it as a one-time test or subscription, and there’s a library of helpful detail available on the LetsGetChecked site, to help you order, collect and return your test. 

One of the things I love about LetsGetChecked is this level of patient care and clear, supportive information. Results are super easy to read, and you can book in call to follow up and get a better understanding of your results, often the same or next day.

AMH testing-LetsGetChecked

Results

I tested my AMH levels with LetsGetChecked in July 2023, just before starting my treatment. Getting them back, my levels read as follows: 

  • 1.1 ng/mL (normal) 

Knowing the importance of not obsessing over AMH, I tried to treat these with a pinch of salt. My results had come back as normal for my age – which is good – but I also know that for IVF, slightly higher levels are ideal (around 1.5 ng/mL or higher). 

Fertility Help

My next steps

Again, I’ve learned not to obsess too much over AMH. Plus, having levels in the normal range for my age was an encouraging confirmation that my body is doing its thing at the expected rate! With this in mind, I turned my focus, with Melanie Brown’s support, to egg health and quality

Team TRB bonus: Get 25% off the entire LetsGetChecked range with my exclusive code ELOISE25

VAGINAL MICROBIOME TESTING: INVIVO®

Why?

Before diving in to my test and results, check out our mini library of content covering all things vaginal microbiome, fertility and IVF: 

Dysbiosis – the imbalance of our microbiome – has been linked to multiple health conditions and suboptimal functioning. Plus, it’s no longer just about the gut (although this is still very important to our whole body health). The research around vaginal microbiome and fertility is very exciting, with tests and studies showing links to: 

  • increased risk of sexually transmitted infections (STIs)
  • bacterial vaginosis (BV) 
  • infertility
  • miscarriage
  • premature delivery in pregnancy

All of these are baseline aspects of our overall fertility profile and pregnancy history, whether going for IVF (or assisted conception), or trying to conceive naturally. Optimising our vaginal microbiome is great to include in a proactive IVF prep plan, but it helps to know where you’re starting from, and what your unique ecosystem might need.

Which test?

I went for the Vaginal EcologiX Vaginal Health & Microbiome Profile by Invivo, for my IVF prep. This groundbreaking test is available through Invivo-verified healthcare providers (you can easily find one on their site), and I did mine with the amazing Melanie Brown, who’s supported so many aspects of my fertility nutrition journey. 

Vaginal EcologiX is a vaginal swab test, and simple to use. Its analysis is anything but simple, however, and uses quantitative real-time PCR (qPCR) and enzyme-linked immunosorbent assay (ELISA) – in plain English, a super-advanced vaginal microbiome profile – to give an accurate picture of your microbiota abundance (the strains you have most of), host inflammatory markers and your pH. 

microbiome testing companies-invivo

Here’s a list of the biomarkers Vaginal EcologiX checks for: 

  • Lactobacillus crispatus
  • Lactobacillus iners
  • Lactobacillus jensenii
  • Lactobacillus gasseri
  • Atopobium vaginae
  • BVAB2
  • Gardnerella vaginalis
  • Megasphaera 1
  • Mobiluncus mulieris
  • Mobiluncus curtisii
  • Prevotella bivia
  • Streptococcus agalactiae
  • Staphylococcus aureus
  • Escherichia coli
  • Enterococcus faecalis
  • Candida albicans
  • Candida parapsilosis
  • Candida krusei
  • Candida glabrata
  • Ureaplasma urealyticum
  • Mycoplasma genitalium
  • Mycoplasma hominis
  • Trichomonas vaginalis

Hit the Resources button on the Invivo site for all the detail on how to collect and send off your sample. 

Results

As it turned out, my vaginal microbiome really did look pretty good. Melanie Brown helped me go over everything, and the results were absolutely fascinating – maybe especially because I had such an incentive (a fresh IVF cycle!) to understand my vaginal health. 

Invivo results come with a clearly set out chart-style report, which you can run through with your Invivo verified healthcare provider for support and next steps.

vaginal microbiome testing-invivo

My standout results were as follows: 

  • more variety needed across ‘good’ bacteria (Lactobacilli species), but no big concern
  • Lactobacillus Crispatus levels at 17.6 (excellent) 
  • Enterococcus Faecalis levels at 2.5 (this is a pathobiont – an organism which can cause harm under certain circumstances – so one to treat ahead of IVF) 

It’s common to find a dominance of one type of lactobacillus (good bacteria) in each person’s microbiome, and mine showed up as Lactobacillus Crispatus, which is known for being vital for healthy embryo implantation. So this was great to see, and Melanie just suggested I try to up a few of the other species too, for optimal diversity. 

We also saw a tiny amount of Enterococcus Faecalis in my results, which is a pathobiont. These bad bacteria can cause harm in certain circumstances, for example if the host (me!) has a weakened immune system. It was a very low amount, but definitely worth treating. 

My next steps

To sort that small amount of bad bacteria, I used a topical gel – Canesbalance® by Canesten® – which is a short-course treatment, widely available and one to use just before bed. 

Once I’d finished the treatment, I used a vaginal probiotic – Canesflor®, also by Canesten® – to help prevent the bad bacteria we’d seen in my results repopulating. 

I ensured all this was done and dusted well five days ahead of egg collection, so that none of the more targeted pathobiont treatment was in my system at that crucial time. I did, however, start and continue the Vaginal Care raw probiotic by Garden of Life, which contains 38 different vaginal health-supporting probiotic strains for diversity boost and ongoing protection. 

Team TRB bonus: Get 15% off the entire Invivo supplement range with code RIBBON15*.

*15% off RRP on any supplements purchased through the Invivo website. The offer expires August 31st 2023 and is limited to 1 use per person and cannot be used in conjunction with other any other offers. Invivo promotional T’s and C’s apply. To be advertised on The Ribbon Box Website only.

My DHEA SUPPLEMENT: OVATERRA 

This separate section (see above under DHEA testing for why this hormone can be an important one to get tested ahead of IVF) is for those interested in my DHEA supplementation. Every single patient will require a unique treatment plan and protocol however, so do consult a healthcare professional before supplementing with DHEA. 

Following my results and with professional support, I decided to supplement my DHEA with the groundbreaking patented  Fertinatal® from Ovaterra, by Fertility Nutraceuticals. Made with just five clean ingredients, Fertinatal® has been developed in partnership with the Center for Human Reproduction (CHR), a globally recognized IVF centre in NYC that led the early research into DHEA and female reproductive health. 

dhea for egg quality ivf-ovaterra-supplements

With this supplement, I know exactly what I’m getting, and that the formulation has been specifically for women aged over 35, to support ovarian health. Which, when you’re prepping all sorts of things for IVF success, is a real reassurance and support. 

Team TRB bonus: Get 10% off the entire Ovaterra range with code TRB10.

That’s it! My personal IVF preparation testing to-do list, to give everyone a few things to think about and look into. Remember, however, that every journey is completely unique – these are the tests I researched and went for, but you may require something very different. 

Check with your team and healthcare provider – I can’t recommend an expert fertility nutritionist enough at this time! – and build your own bespoke plan to support your TTC and treatment journey. 

I’ll see you on the other side of my egg collection in a few weeks time, with how it all went. Plus, all the things I do to support my body just after egg collection, ahead of transfer.

All products in this article have been selected by us. While we only ever recommend products we actually use and love, we may make commission on some of them.

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