Andrea Fertility Summary

⏱️ Reproductive History

Late 2020

First Pregnancy — Molar Pregnancy

Conceived naturally. Diagnosed as molar pregnancy. D&C performed January 2021. Required 6–8 months of serial hCG bloodwork to confirm complete clearance before cleared to TTC again.

Oct 2022

Grace Fertility — IVF Cycle 1 Workup

Comprehensive baseline: CBC, metabolic panel, lipids, thyroid, hormones (FSH, estradiol, prolactin, AMH 9.5), infectious disease serology, cervical screening (Pap normal), HSV/VZV PCR (negative). First assessment with Dr. Anthony Cheung.

Jul–Aug 2023

Second Pregnancy — Natural Conception

Conceived naturally. Full repeat workup in Aug 2023 (AMH 11.7, blood type confirmed O+, serology repeated). IVF Cycle 2 workup completed but pregnancy occurred naturally before treatment.

Apr 2024

Live Birth — Nathan

Natural vaginal delivery at 35 weeks and 5 days (slightly preterm). Healthy baby boy.

Sep–Oct 2025

Stopped Breastfeeding & TTC

Weaned from breastfeeding. Began actively trying to conceive Baby 2.

Nov–Dec 2025

Pre-IVF Workup (Round 3)

Full repeat at Grace Fertility: CBC, metabolic, lipids, thyroid, fertility hormones, infectious disease serology, blood type, HTLV, partner (Adam) serology & semen analysis. HSG showed bilateral tubal occlusion.

Dec 2025

HSG — Bilateral Tubal Occlusion

Hysterosalpingogram: both fallopian tubes showed no filling with contrast. Uterine cavity normal. Radiologist noted may be amenable to bilateral recanalization. This finding is the primary indication for IVF.

Mar 2026

IVF Cycle 1 — Grace Fertility

Minimal stim protocol (Clomid + Puregon). 7 eggs retrieved, 6 fertilized, 3 transferred Day 3 fresh. No embryos reached blastocyst. Outcome: negative.

Apr 2026

Current — Planning Next Steps

Evaluating European IVF options (Czech Republic/Slovakia), next cycle timing, protocol adjustments. BC public waitlist active (est. 2028).

🥚 Ovarian Reserve

Marker	Oct 2022	Aug 2023	Dec 2025	Ref Range
AMH	9.5 pmol/L	11.7 pmol/L	9.3 pmol/L	1.1–53.5
FSH	2.8 IU/L	7.6 IU/L	3.4 IU/L	<8.7 (follicular)
Estradiol	610 pmol/L	195 pmol/L	312 pmol/L	77–921 (follicular)
AFC	—	—	~4	Median ~11 for age

Diminished Ovarian Reserve (DOR)

AFC ~4 is low for age 39. AMH has been relatively stable across 3 years (9.3–11.7 pmol/L) — low-normal, below age median, but not in steep decline. The Aug 2023 bump to 11.7 likely reflects normal cycle-to-cycle variation. FSH values remain reassuringly normal. The combination of low AFC with borderline AMH supports a DOR diagnosis and favors IVF with careful protocol selection, especially given the concurrent tubal factor.

📈 Lab Trends (3 Workups)

Test	Oct 2022	Aug 2023	Nov/Dec 2025	Ref
TSH	2.01	2.09	1.99–2.20	0.32–5.04 mU/L
HbA1c	5.7%	5.9%	5.8%	4.5–5.9%
Fasting Glucose	4.8	4.6	4.9	3.3–5.5 mmol/L
Fasting Insulin	39	34	48	20–180 pmol/L
Total Cholesterol	5.73	6.17	5.37	<5.19 mmol/L
LDL	3.32	3.63	2.94	1.50–3.40
HDL	1.95	1.77	1.54	>1.19 mmol/L
Ferritin	128	—	105–115	15–247 ug/L
CRP	1.0	1.3	1.4	<5.0 mg/L
Prolactin	16.3	9.4	9.2	4.2–28.2 ug/L
Progesterone	—	<0.6 (follicular)	33.0 (luteal)	>18 = ovulation
LH	—	3.1	2.3	2.4–6.6 (follicular)
TPO Ab	<9	<9	—	<35 IU/mL

Patterns: Total cholesterol has been consistently above reference across all three workups (5.37–6.17). HDL remains strong and risk ratio stays within range. HbA1c sits at the upper boundary of normal (5.7–5.9%). Thyroid, kidney, liver, and inflammatory markers have been consistently normal. Dec 2025 progesterone of 33.0 confirmed active ovulation.

🩺 Active Diagnoses

1. Bilateral Tubal Occlusion

HSG (Dec 18, 2025): Both fallopian tubes showed no filling with contrast dye. Uterine cavity is normal. Radiologist noted potential for bilateral recanalization. This is the primary structural barrier to natural conception and the main indication for IVF.

2. Diminished Ovarian Reserve (DOR)

AFC ~4 (low for age). AMH 9.3–11.7 pmol/L across 3 years (low-normal, below age median, stable decline). Expected to yield fewer eggs per IVF cycle — Cycle 1 retrieved 7, which is a reasonable response for DOR with minimal stim.

3. Borderline Hypercholesterolemia

Total cholesterol elevated across 3 years of testing (5.37–6.17 mmol/L; ref <5.19). LDL borderline high in 2023 (3.63). Favorable HDL (1.77–1.95) keeps risk ratio within range. Not directly fertility-impacting but relevant for pregnancy cardiovascular risk.

4. History of Molar Pregnancy

First pregnancy (late 2020) was molar. D&C Jan 2021. Required 6–8 months of serial hCG monitoring to confirm complete clearance. No recurrence. Successfully conceived naturally in 2023 and carried to term. Risk of recurrence in subsequent pregnancies is low (~1–2%).

🔬 Infectious Disease & Immunity

Tested across 4 rounds: Oct 2022, Nov 2025, Dec 2025 (Andrea), Dec 2025 (Adam). All consistently clear.

Test	Status
HIV	Nonreactive
Hepatitis B	Non-reactive
Hepatitis C	Nonreactive
Syphilis	Nonreactive
HTLV I+II	Nonreactive
Chlamydia	Negative (urine & vaginal)
Gonorrhea	Negative (urine & vaginal)
HSV/VZV DNA	Negative (cervical PCR, Oct 2022)
HPV	Negative (all high-risk types, May 2025)

Immunity status

Rubella (IgG 30+)

Varicella (IgG+)

Measles (IgG+)

Mumps (IgG+)

CMV (past infection)

Cervical screening

Date	Test	Result
Oct 2022	Pap smear	Negative
Apr 2025	Pap smear	Unsatisfactory (insufficient sample)
May 2025	HPV DNA (repeat)	Negative — next screen 2030

Partner (Adam): Dec 2025 serology all clear (Syphilis, Hep C, HIV, HTLV nonreactive). CMV IgG nonreactive (no past infection — discordant with Andrea's CMV+ status; low clinical significance for IVF). Semen analysis (Feb 2026): volume 6.4 ml, concentration 120 M/ml, morphology 7% normal. Total motility 47% and progressive motility 42% are below reference but total progressive motile count (322.6 M) is excellent. Suitable for IUI and standard IVF.

🧬 IVF Treatment

Cycle 1 — Grace Fertility (Mar 2026)

ProtocolMinimal stim (Clomid + Puregon + Orgalutran)

Eggs retrieved7

Fertilized6 of 7 (86%)

Transferred3 (Day 3 fresh)

Blastocysts / Frozen0 / 0

OutcomeNegative (Apr 4)

ClinicDr. Anthony Cheung, Grace Fertility Centre

Full cycle detail →

BC Public IVF Waitlist

StatusActive — applied

Estimated start~2028

Next Steps

European optionsCzech Republic / Slovakia clinics under evaluation

Consults booked7 clinics, Apr 14–29

Target windowSummer 2026

European clinic research →