Friday, May 7, 2010

39 Yr. Old U.K. Patient With FSH Of 10 Has Failed IVF With Own & Donor Eggs: Can She Still Succeed? Possibly!


I am 39 years old, and have a son of 5 years old whom I conceived naturally. I was born with one ovary and one fallopian tube (left ovary and fallopian tube missing).

I had a failed long protocol IVF and aborted the trial as we only had one follicle of a good size. We opted for IUI, and was unfortunate to get an infection of the womb, which turned into salpingitus. As a result my fallopian tube is now blocked.

With a decreasing AMH of about 3.5 and FSH of 10, I was advised that my chances of having a successful IVF with ICSI was very small. The clinics opinion was that we looked at egg donation. I have had two attempts this year of egg donation which have failed.

A friend of mine with an AMH of 1% and 15 FSH levels has just fallen pregnant after IVF. Although so early days yet, this has made me want to reconsider undergoing IVF/ICSI with a short protocol.

Can you give me your opinion? Many thanks in advance. S. from the U.K.


Hello S. from the U.K.

The biggest factor you have working against you in terms of IVF is your age. The biggest plus is that you have had a child in the past, which means you have secondary infertility. With secondary infertility age may play a factor. Part of what makes IVF more successful in older patients is that with IVF we are able to recruit a lot more eggs at one time. It is an increased statistical chance of finding a good egg in the group. If your ovaries don't stimulate well and the number of eggs are decreased, then the chances decrease as well. However, they don't go to zero as evidenced by your friend. I usually will not give up on an IVF cycle, even if there is only one follicle because it could contain the perfect egg and IVF is still better than IUI because more of the steps required to become pregnant are accomplished.

That being said, however, using donor eggs certainly gives you a statistically better chance of success. Remember, we are dealing with statistics here, which is just a reflection of things and not an absolute prediction. That doesn't mean that you can't get pregnant with your own eggs, it just may take many more attempts with IVF than if you used younger eggs. Last year, there was an article in a New York newspaper about a woman who delivered at child at 49 that was conceived by IVF using her own eggs. She is, of course, the oldest to be successfully pregnant with IVF using her own eggs. However, it took her two years of trying to achieve this. It would be the same for you, as long as you ovaries are still responding to stimulation. There is a chance that there is still a good egg present in your ovaries. Finding it is the difficult part.

So, certainly there is the option for you to try with your own eggs, and potentially become pregnant. The donor cycle should have worked and statistically is the better way to go, but since it didn't, I can't necessarily tout it as the best option for you. You have to be willing to attempt several tries with your own eggs, however, so as long as that is what you want and are dedicated to it, then that is the way you should go. Ultimately, it is your decision to make.

Follow-Up Question:

Hi there. Thank you so much for your quick response and informative opinion. It is very much appreciated.I have one final question regarding the egg donor transfers that I had. Both of them seemed to work and then overnight disappeared. Do you think that I need to check as to whether I have Hydrosalpinx, as I believe this could have an impact by fluid spilling out into the uterus cavity and could potentially kill off or dislodge the planted embryo?? The notes I have from my last ultrasound (which I had to check the thickness of the lining of the womb prior to embryo transfer) states there is no evidence of dilation of the fallopian tube?Can I also say how unique this site is to get an experts opinion on fertility, and appreciate you taking time to respond. Best S.

Follow-Up Answer:

Hello Again,

Evaluating the tubes for hydrosalpinx should have been part of the basic pre-IVF evaluation, because it can reduce the pregnancy rate by 50% if left intact. This is done by a comprehensive ultrasound examination, not the ones looking for follicles, or by HSG (hysterosalpingogram). It usually affects implantation, because it causes a low level endometritis (inflammation of the uterine lining.) If this has not yet been done, then I would recommend that you request it. I would also recommend that you seek a different clinic because it is something that they missed and should not have.

Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

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