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    New comer trying to conceive after 18 years of last pregnancy.
    yramos1127 posted:
    Hello everyone my name is Yvette and i am 39 years old. Just had a tubal reversal a couple of weeks ago after 18 years of being sterile. I remarried 1 year ago and my husband and I want to try and have a baby of our own. We have 7 kids together from our previous marriage ranging from 24 years old to the youngest 18 years old. So if this dream of ours comes true it would be a new start literally for us. We are hopeful that this will work as I will be 40 years old next month November and my husband just turned 45. Will keep posting. Many blessings to all trying to conceive as I am. Yvette Ramos Ft. Hood, TX
    David K Walmer, MD, PhD responded:
    Yvette, I hope that this happens quickly for you. I would recommend you start taking a folic acid supplement and keep a calendar of your menstrual cycles, days you have intercourse and maybe even use an ovulation predictor kit to help you assess your fertile window and to confirm that your cycles have returned to normal. If you don't conceive in the first 4-6 months, that data might be very helpful to a health care provider that you see. You may want to see someone for preconception counseling either now or if not pregnant in the 1st 4-6 months of trying. If may take a little longer at the age of 39 and your window of opportunity won't be as wide as it was when you two had your first seven children. There have also been a lot of advances in assisted reproduction in the last 18 years and just knowing about them may help you make decisions. We want you to have success. Good luck.
    yramos1127 replied to David K Walmer, MD, PhD's response:
    Thank you Dr. Walmer for your advise. I have been taking prenatal vitamins and folic acid for 6months now also my husband and I have seen a specialist and had my egg reserve checked as well as my husbands sperm checked. We were told that everything looked good and that even though we are in that older bracket we may have a good chance of conceiving and that is why we decided to go forward with the reversal. Another option was IVF after 1 year of trying because we are older that. time frame is pushing it a bit but it's still an option. I am a little concerned about ectopic and miscarriages at my age. Would you be so kind and tell me about this and some statistics for women with my age and after reversal.

    Respectfully, Yvette Ramos
    David K Walmer, MD, PhD replied to yramos1127's response:
    I think that your plan is very sound. It is a little harder to counsel couples who elected to give up their childbearing. We believe that all women have an age-related decline in fertility but the rate of decline probably varies a lot. The patients that come to see us are more likely to be on a steeper slope and patients who show up in the obstetricians office are more likely to be on a more gradual slope. When you stop trying to conceive, we lose the ability to observe your fertility potential. If you really want to have a child together and have the resources, I would recommend trying for a few months (3-6) and then going straight to IVF. IVF gives you the ability to maximize your fertility and minimize the risk of a multiple pregnancy. It is true that your risk of an ectopic is a little higher after a tubal reversal but most pregnancies will end up in the uterus after a successful tubal reversal. If you invested in the surgery, it is worth giving it a shot for at least a few months. Good luck!
    David K Walmer, MD, PhD replied to yramos1127's response:
    It is hard to give you accurate statistics because the rate of decline in fertility varies a lot from woman to woman and we lost the ability to observe your fertility potential when you had your tubes tied. You are at a higher risk of miscarriage now than when you were younger and you are at a higher risk of an ectopic than before you had your tubes ligated. However, your ovarian reserve sounds like it is hanging in there. If you're OK with a little risk and are in the hands of a health care provider that you trust, I think that I would remain hopeful at this point. If you want to maximize your chances of success and have the resources, I would probably try on your own or with some gentle ovulation induction for 3-6 months and then jump to IVF if that doesn't work and you are getting frustrated. IVF can maximize your fertility without significantly increasing your risk of multiples. If you have the resources, IVF centers are increasingly acquiring the ability to examine the genetics of blastocysts (day 5-6 embryos), which allows couples to transfer embryos that are chromosomally normal (46xx or 46xy). This is expensive but it almost eliminates the effects of age on fertility following an embryo transfer based on data presented recently at the American Society for Reproductive Medicine meeting in San Diego. Good luck.
    yramos1127 replied to David K Walmer, MD, PhD's response:
    Thank you for the information Dr. Walmer. I will look into your suggestions.

    Dr. Walmer when do you suggest I start trying to conceive? My tubal reversal was done October 23, 2012. I was told I could start trying after my next cycle after my surgery. My cycle is just about done I got my menses in Oct. 28th and from my calculations i am fertile and start the ovulation process from Nov 7-14. It's only been 2 weeks and by the time i become fertile it would have only been 3 weeks since my surgery. Is it safe to start having intercourse so soon after my surgery, I mean am i healed completely inside. I am healing quite nicely outside my incision but still have swelling and discomfort around my abdomen so i am afraid .
    David K Walmer, MD, PhD replied to yramos1127's response:
    I typically tell patients to wait about 4 weeks after surgery because of the swelling (edema and inflammatory process) that is involved in healing and could theoretically increase your risk of an ectopic. However, I did do a tubal reversal once in early-November and the patient didn't take my advice and had a positive pregnancy test on Thanksgiving. Good luck!

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