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Thursday, May 23, 2013
Is my ovaraian reserve diminished?
I am 27. I have been trying to conceive for 2 years now. The first 1 year and 3 months without help. We conceived once at that time and miscarried within a week. And then we tried 3 IUIS which failed. And then 2 IVFs. Both failed. In both my IVF cycles, I responded poorly to meds. we got 3 mature eggs on the regular Lupron protocol. And 1 mature egg on the antagonist protocol. We had 3 day transfers both times with 6 and 7 cell embryos. The doctor said that the embryos divided reasonably well and were not fragmented. My fsh was 8.7 last year. And this year it was 3.3. I was on birth control pills(pre-IVF) when I took this test. So Iam not sure, if that would have masked the result. Do I have a low ovarian reserve ? Can I possibly conceive with my own eggs ?
Your poor response to standard IVF stimulation is unusual in someone your age. Your day 3 FSH levels are both well within the normal range. I assume that your cycles are regular, and that other endocrine tests (such as prolactin, thyroid and male hormones) are all normal. When we see this situation, we assume that you might have a problem that we cannot measure, such as antibodies against FSH or ovarian receptors. Another possibility is that your FSH receptors are not normal. Unfortunately, there are no diagnostic tests to determine if you have one of these uncommon problems. When standard approaches to get more eggs do not work, the most effective next step is to use donor eggs for IVF. Another relatively new approach is to retrieve immature eggs from small follicle in your ovaries and allow them to mature in the laboratory using an approach called "in vitro maturation." Only a few centers in the country are currently using this protocol.
William W Hurd, MD
Professor of Reproductive Biology
School of Medicine
Case Western Reserve University