Question:
Dear Dr. Ramirez,
First, thank you very much for taking the time to answer so many questions. Your column has been an important part of my education on IVF.
I am writing from Cincinnati, OH. I am 43 years old and am considering IVF. I just learnt that my FSH is 30, substantially above the cutoff rate for my fertility clinic (their cutoff is 10). Are there any options other than donor eggs? Is there a way to lower FSH? Would love to get your perspective. Thank you. S.
Answer:
Hello S. from the U.S.,
I'm assuming, of course, that your FSH levels were accurately tested. The FSH level is only valid for interpretation if it is done on cycle day #2 or 3. The FSH is a measure of ovarian function (or ovarian resistance). This is mainly important to determine how well the ovaries will respond to stimulation. It is NOT a measure of fertility. However, if the CD#3 FSH level of 30 is correct, that would indicate that you are perimenopausal and your ovaries would be shutting down. You would no longer be having periods and you would have menopausal symptoms such as hot flashes. Is this the case?
If so, unfortunately, with an elevated FSH of 30 you are not eligible for any other treatments other than donor eggs. I'm sorry but there is no way to revive the ovaries at this time. I see on the web that there are many lay people claiming that there are "natural" alternatives like acupressure that can help lower your FSH levels. This is simply not true!
Please see my previous post:"41 Yr Old With High FSH, High Estradiol..." where I go into greater detail regarding this distressing issue. Remember, there are many paths you can take to motherhood and from my experience as an infertility specialist, all those paths can bring happiness.
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.
Thank you for this post, Dr. Ramirez.
ReplyDeleteI am curious about your statement that someone with a CD3 FSH of 30 would no longer be having periods and their ovaries would be shut down. I haven't heard it said quite this way before - my FSH on CD3 has been in the high range over the past year and a half (although it's hard to tell what my true FSH really is when I've been taking so many hormones). And I have not responded well to stimulation, that is certain. However, I continue to have regular periods so my ovaries are still kicking. And I've read many stories of women with very high CD3 FSH (as high as 100) becoming pregnant, either naturally or through IVF - yes, these may be rare, but their existence demonstrates that it is not impossible.
As you know, donor eggs are not an option for everyone - if S. from the U.S. really wants to been given the chance to conceive with her own eggs, there are doctors out there who will work with her - she should check out the High FSH Support Board (http://www.network54.com/Forum/209394/) and the International Premature Ovarian Failure Association (http://www.pofsupport.org/) for help in finding a High-FSH-Friendly RE near her to consult with.
Best of luck to you S.,
Maddy
Hi Maddy,
ReplyDeleteThank you for your comment. I am sure that like you, there are other anectodal experiences of women that get pregnant from spontaneous ovulations after the ovaries have shut down, such as premature ovarian failure. However, that is not the norm, and I try to stick to the facts.
One has to understand the physiological basis of the FSH test. FSH is the hormone secreted by the brain to stimulate the ovary to ovulate - follicle stimulating hormone. If the ovaries pick of the FSH from the blood stream, then the levels will be low. If it does not, then the levels will be higher. It has been determined by studies in the past, that once the FSH level reaches 20 in the blood stream, then the ovaries are unlikely to be functioning. However, this is an indirect measure because there is nothing, even AMH, that can determine for sure that the ovaries are shut down. 99% of women will be menopausal at this point, however. In your case you may be having periods, but that does not necessarily mean that ovulation is occurring either. Bleeding can come from many different sources. There only has to be a source for the bleeding such as an endometrium or endometrial polyp or fibroid. It can then occur without normal hormonal function.
As you have seen from my blog writings, I try to encourage patients not to give up. There are always alternatives. However, I am also realistic and always try to give the best advice. I don't want to give false hope.
I understand your point, Dr. Ramirez - you are, after all, the doctor and I respect that. I am a great fan of your blog, and I think you usually give wonderful advice and yes, you do encourage women not to give up. I'm sure it must be very difficult to have to tell people things they may not want to hear, and I fully admit I absolutely don't want to hear what you're saying here. I guess the statement I have the most trouble with is "...you are not eligible for any other treatments other than donor eggs." This is just not true. There are doctors out there who will work with someone who has had an FSH of over 20 (like me) - you may not agree with the practice, but if one has the money to spend, these doctors will try to help them conceive with their own eggs. Yes, it's a long shot, but for those of us for whom donor eggs are not an option, it's the only shot we have, and I think it's important to acknowledge it. No, I may not be pregnant yet, but I am very fortunate in that my last 14 cycles have been monitored and I have ovulated in all 14. I wouldn't want S. to have false hope, but I wouldn't want her to have no hope, either. There's no harm in S. having her cycles monitored to see if she is ovulating, in taking Femara to see if it helps, or even trying low dose stims to see what happens. Again, you're the doctor, and I'm just a patient, but some of us are more stubborn than others. ;-)
ReplyDeleteHi and thanks again for your comment. In this world of infertility, certainly anyone can do anything, but not all things done are prudent or wise. Individual choices have to be made based on your own set of circumstances, risks and benefits. You then make the BEST choice that you can and don't look back. If that is the only option that you have and the only choice you can make, and you can accept or tolerate the risks, then go for it. It's ultimately your decision.
ReplyDeleteDonor eggs are the best option by age 43. Most clinics won't accept patients over age 43 using their own eggs, because it is a waste of time and money.
ReplyDeleteHi and thanks for the opinion. I agree that statistically most women over 40 will do better with donor eggs since egg quality is the prime issue. However, I believe that patients have to make their own choice, I don't know what will happen in the future and don't know who will be the exception. The oldest patient I have helped to become pregnant with IVF using her own eggs is 44. I have had several 43 year olds. How can anyone predict who will fail and who will be the exception. Since I believe that patients are adults and should make the decisions, I counsel them strongly regarding the pros and cons, including the statistics and, certainly, I counsel that donor eggs gives them a better chance. However, most will want to at least try with their own eggs so that they can reassure themselves that they have done everything they could. Since it's their money, is that not a reasonable option?
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