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Conception Jun 17, 2021
6 Minutes

Ask the expert: low AMH, IVF, infertility + miscarriage…

Despite a healthy lifestyle Monika Friedman was told aged just 29, that she had the egg reserve of a 44 year old. This kicked off a multi-year journey through several rounds of IVF, miscarriage, soul searching and culminated in two babies and a career change. Monika became so passionate about helping others navigate their own fertility challenges that she became a fertility coach: helping women emotionally and physically through a sometimes arduous journey. She shares her story, what she learnt along the way, and some of the key tips and tricks she shares with her clients. 

For our conversation in full check out our podcast here. Or read on for some of the highlights. 

Most things had worked out for me in life: fertility did not. Emotionally it hit me very hard:   

When I was told I had the egg reserve of a 44 year old (despite being 29 and living a healthy lifestyle) I became an emotional mess. Four rounds of IVF, a miscarriage, seemingly thousands of tests really took their tool. I tried everything from traditional to alternative methods (ovary rejuvenation in Greece and Buddhist retreats) and even ended up developing Orthorexia (addiction to healthy eating) as I was so desperate to be able to solve my issues. 

When I finally had my baby – I realised how much I needed someone to have help me through this… 

I saw a therapist for my mental health but I realised I needed so much more. Someone to hold my hand in an educated and rational way to support me on this journey. So, I quit my job and have decided to help women just like me. 

What worked for me? A holistic combination of Eastern and Western medicine

Through my years of personal experience I have managed to distill my broad approach down to a combination of three pillars:

One: managing mental health, stress and cortisol levels on a daily basis. This also includes genuinely believing you can get pregnant and have a healthy baby in the end. 

Two: lifestyle: your diet, exercise, exposure to environmental toxins and your supplements. Essentially taking good care of your body.

Three: is your fertility tactics: how to track your cycle, understanding your ovulation or how to find a clinic for IVF, how to ask tricky questions/what cutting edge treatments may be worth thinking about. 

Looking outside of the box: I discovered I had a high presence of natural killer cells… 

I discovered part of my problem was something not necessarily picked up in mainstream testing. I experienced miscarriage and one theory that is linked to this (particularly when it is recurrent) is the presence of abnormal Natural Killer Cells. Click here for our conversation with Dr Hasan Shehata who is a pioneer in this field. It is still a bit controversial and most doctors will usually only proactively recommend doing something when it has been around 10-15 years. Nevertheless we tried it and it turned out I did have elevated natural killer cells. Treating this started before transfer and continued on until week 24 of my pregnancy. Most conventional testing would not have picked this up. 

The second time I got pregnant naturally! 

My body re-set after my first pregnancy. I started ovulating after I stopped breastfeeding. However, I still have low AMH so I knew that IVF would be the most likely outcome which we planned to do post COVID. However, it ended up working naturally which I still can’t quite believe! 

This is a message of hope….

Sometimes we need help, but trust that your body can recover if you treat it well and you give it time. 

On having low AMH/egg reserve/high FSH…

To this day I still have no idea why. My mother was fine, I even have a twin who has normal AMH (click here to learn more about AMH). I did a lot of research and the causes can be many: age, anything that disrupts the feedback cycle of follicular development (like autoimmune disorders, endocrine disruptors, genetics). I think for me I wasn’t treating my body well enough from a hormonal perspective. There was too much stress. I over exercised (that was my coping mechanism), I had a highly stressful job and was climbing the corporate ladder. My hypothalamus was overloaded with stress and because of that the pituitary gland wasn’t able to communicate with my ovaries. I didn’t even have a period: something known as Hypothalamic Amenorrhea. 

Managing stress: the ultimate battle! 

Huge disclaimer – I am a fertility coach and yoga instructor – but even I don’t follow my own advice every day! When you’re a type ‘A’ personality you can have a tendency to go to extremes on everything which also isn’t healthy. Establishing a mindfulness or meditation routine is key but this doesn’t need to be sitting in a dark room with music. It can be as simple as taking three deep breaths in the morning mindfully. Or a body scan and just being mindful in that moment creates a moment of pause. 

All about progress and not perfection: 

I genuinely make it a priority. It is effort at the start but you quickly get into the routine and then you crave it. It can just be about taking a few mins out consistently. Would I love to get in a yoga session every night before bed? Sure, but it doesn’t always work out like that. Life is busy. However, once you start out on the path of mindfulness you will want more purely because it feels better. Click here for more. 

AMH/egg reserve improvement? 

Most research agrees it is hard to really boost it higher, however there are ways to help reduce the pace of further decline. Thinking about diet: how can you eat for cellular health? Specifically focusing on how we can eat to support the mitochondria (cell powerhouse). Plus, how can we eat and nurture ourselves to prevent oxidative stress which can damage our cells in excess (click here for more). We can slow down our biological ageing. Research has shown a Mediterranean diet full of pesticide free foods, whole foods, high protein for eggs (20g/meal is ideal) plus healthy fats and low mercury fish can be effective. Click here for more. 

Supplements for egg health: 

Supplements where there is good research behind include Ubiquonol/Co-Q10, Methylfolate, Vitamin D, good probiotic, DHA/fish oil and then depending on your own situations ie. if you have PCOS/low estrogen. There is more you can do. As always it is best to have a personalised approach. Everyone is different. 

One supplement I do want to focus on with a word of caution: DHEA…

For women with low ovarian reserve DHEA is often seen as a panacea given its benefits around IVF outcomes. However, it is extremely important not to self medicate when it comes to this drug however and I speak about this from experience! It is essential to have your androgen levels checked first. The side effects can be very unpleasant if you don’t get it right: acne, hair loss, weight gain. Always check in with a doctor first. 

Exercise: fighting mitochondrial damage: 

When it comes to fertility, research suggests it is all about low impact moderate exercise. Strength training has shown to improve mitochondrial function of cells. Restorative like yoga and walking. This is not the time to be marathon training etc. 

Endocrine disrupting chemicals 

There are hormone disruptors everywhere. It can seem like a lot but the reality is we can influence a lot about what we take in from our environment. We can decide on our personal care items and cleaning products. We can do a lot to avoid these chemicals interrupting our reproductive hormones. They also have a big negative impact on sperm health. We have also seen an increase in testicular cancer which can potentially be traced back to these chemicals – as they speed up the oxidation in cells. The key is knowing where to look and small changes and awareness can be really powerful. Click here for more. 

More from Monika: 

To get more from Monika check out her website here where you can also download her mind-body-fertlity guide. 



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