menopause

Your diet and menopause

Diet, vitamins and menopause: Princeton IVF blog
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Can what you eat affect when you go into menopause?

New research from the UK suggests that it might.

They followed 914 women through menopause and sent them questionnaires about their diets, and what they found was interesting:

  • Fatty and oily fish delayed the age of menopause by 3.3 years for each daily portion

  • Fresh legumes delayed onset of menopause by 0.9 years for each daily portion

  • Refined pastas and rice was accelerated the age of menopause 1.5 years for each daily portion

They also asked these women about daily vitamin intake:

  • Vitamin B6 delayed menopause by 0.6 years

  • Zinc delayed menopause by 0.3 years per daily portion

Does this mean that making the right dietary choices can affect when one will go through menopause?

Perhaps, but not necessarily. Women who eat healthier may also live healthier lifestyles which could contribute to this as well.

Does this mean that these dietary choices can effect how long a woman will remain fertile?

While it certainly makes sense that dietary changes which delay when a woman runs out eggs should affect the quality of the ones that are left, this research does not address that issue.

AMH blood test- everything you wanted to know about this common blood test but were afraid to ask

AMH testing, a Q&A: Princeton IVF blog
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Common questions and answers about AMH testing

What is AMH?

Antimullerian hormone, commonly known at AMH, is hormone that is secreted by follicles in the ovary. It was initially studied for its role in reproductive development but is now widely used as a test of ovarian reserve.

What is ovarian reserve?

Ovarian reserve is a measure of the aging of the ovaries, and how many eggs the ovaries are likely to produce when given fertility medications. AMH, day 3 FSH and estradiol levels and antral follicle counts on ultrasound are commonly used measures of ovarian reserve.

What does a low AMH level mean?

A low AMH level, which most doctors consider a level of less than one, indicates that the ovary has fewer eggs available to stimulate. Women with low AMH levels, will usually make fewer eggs when given fertility drugs for IVF or insemination cycles.

Does a low AMH level mean that I am less likely to get pregnant?

AMH is a great test to determine how a woman will respond to medications, but it not as good at predicting pregnancy rates. It is true that women who produce more eggs are more likely to get pregnant, but particularly in young women, who do not need a large number of eggs, there does not seem to be reason to be concerned.

What does a high AMH level mean?

A high AMH level suggests that you are likely to respond very well to fertility injections and may be more likely to become hyperstimulated when taking them. It is also is considered a sign of polycystic ovaries (PCO) although AMH levels are not currently used to make the diagnosis.

Can the AMH level be used to predict if I will have trouble getting pregnant in the future?

Not really. Despite the early hope that AMH could help women know in advance if they might have infertility in the future, it turns out there is no evidence that AMH can predict future fertility.

Eggs and fertility after menopause?

Making Eggs after Menopause: Princeton IVF blog

Researchers in Greece report being able to generate eggs from women who have already gone through menopause.

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Doctors in Greece may have found a way to make postmenopausal women grow eggs.

As reported in the New Scientist, fertility researchers have been looking into a new way of potential of helping women in menopause continue to produce eggs. As a women ages, the number and quality of her eggs inevitably declines. By the average age of menopause at age 51-52, there are relatively few eggs left in the ovary, and those that do remain, generally are of such poor quality that ovulation just simply ceases. When this happens, fertility disappears, menstrual periods stop and the symptoms of the lack of estrogen such as hot flashes and vaginal dryness get worse. These symptoms of menopause actually start years before the periods stop but the potential for pregnancy, even if it small, remains.

What if there was a way to reverse this? With this in mind, a team in Greece tried using something called platelet-rich plasma to see if it was possible to regenerate eggs. Platelet rich plasma (PRP) has been used with some success to try and regenerate injured bone and muscle. Among other things, it contains a mixture of growth factors, chemicals found throughout the body that are involved in the natural processes of inflammation and tissue repair. The idea was to try to use the PRP to regenerate ovarian tissue and somehow activate the dormant eggs to grow.

Regenerative medicine for reproductive medicine

The researchers did find some success, and a number of these women did begin to ovulate again. In one patient, they were even able to harvest and fertilize some of these eggs through IVF. The embryos were frozen for later use, so it is unknown whether this procedure can actually result in a pregnancy.

There are still lots of unanswered questions before we can consider this an option for infertile couples in menopause, early or otherwise. We know that the eggs are generally of poor quality in women in their late 40's and when there is fertilization that embryos are generally unhealthy. These embryos rarely implant, and when they do the risk of miscarriage and genetic disorders such as Down Syndrome is quite high. It is not uncommon for women in above 45 to produce enough eggs to do IVF, but it is uncommon that any are good enough to result in a healthy pregnancy. Would the eggs from PRP be any different?

While it is possible that the PRP may improve the quality of these eggs to the point where they can result in a healthy baby, it is just as likely (if not more so) that they they will not. We don't know if the center that reported this data will be able continue to get patients to respond as time goes on or if other fertility clinics will be able to replicate these results. We also do not know if the benefits are short acting or long term, and if they are long acting what the implications are for these patients. Does it mean that a 60 year old can now conceive on her own or how will the continuation of menstrual cycles beyond the natural time affect a woman's risk of diseases such cancer or heart issues? The implications, both medical and ethical, could be enormous.

At this point, it is still just an interesting idea. Still, the prospect of being able to restart a menopausal ovary is intriguing to fertility specialists and their patients.