44 Yr. Old Has Clomid Challenge Test

Question:

Hi Dr. Ramirez,

I'm 44 yrs. old and recently had a clomiphene citrate challenge test with two ultrasounds. I took 100 mg. of Clomiphene Citrate from days 5-9.

The results are as follows: Before Clomiphene Citrate: FSH 5.5, Estradiol 131, with a baseline vaginal ultrasound showing one follicular at 4.2mm in right ovary(I believe) and endometrial lining 4.39, could not locate left ovary. Then, after taking last cc pill another blood test on 11/14 showing FSH of 27.6 and Estradiol of 90. Then, another ultrasound on 11/16 showing two follicles, 10.0 mm, 10.2 mm, in right ovary and 6mm in left ovary, with endometrial lining of 8.2 mm.

What are my options? Should I pursue taking HCG shots or other fertility drugs using my own eggs? Should I pursue donor eggs? My sister is willing to donate her eggs, she recently had a normal, healthy baby boy 10 months ago and she is 41 years old. Thank you in advance for your answers.

Answer:

Thank you for your question.

The purpose of the Clomid challenge test is to evaluate if the ovaries will respond well to stimulation. The Clomid is used for stimulation. A "positive" test is when there is an elevation of the FSH level on cycle day# 11. This shows that there is significant resistance to stimulation and the ovary will probably not stimulate well. The only way to overcome the "age" factor is to get lots of eggs from the ovary. If only a few eggs are retrieved, then the chances for success decrease significantly. Your ovaries are still working, which means that you can be stimulated to get a few (1-3) eggs, but the chances for pregnancy are not good. I do have patients try this but it is with this clear understanding. Most patients do want to try at least once on their own. As I tell them, there are always exceptions to the rule and you only need one good egg, so from an emotional and psychological point of view, it might be worth the try. Expect the worst, however.

Donor eggs is probably your best chance for pregnancy from a statistical point of view. Although your sister was recently successful, she is not the best donor candidate. IVF pregnancy rates are very dependent on the eggs retrieved. If you are going to use a donor, you want the best eggs that you can get. For that reason, we recommend donors that are under the age of 35 years old. The other problem with older eggs is the risk of genetic abnormalities, such as Down's syndrome. You would have a risk of 1:50 for this syndrome with your sister's eggs. I am sure that both you and she would be crushed if that happened. Therefore, I would recommend that you consider an anonymous donor under the age of 35.

I hope this helps,

Sincerely,

Edward J. Ramirez, M.D., FACOG

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Program

www.montereybayivf.com