This question and answer was originally published on the blog clomidandcabranet.com by Katie: "Infertility Warrior, Mommy to two, wife of rock and roller, Child and Adolescent Pshcyotherapist , and Parenting Expert in Los Angeles, CA"
Dear Dr. Marc,
I know it is hard answering questions without seeing all of a person's info. Anyway I am 31 will be 32 next month. I have gone through 2 prior IVFs, both of which failed. The reason being my FSH is a 15. The first IVF I had 4 eggs 2 fertilized and 1 made it to day 3 but was very poor. I went to a different clinic for my 2nd. I had 10 eggs 8 were mature 6 fertilized 4 made it to day 3 and 2 made it to day 5. I had one embryo that was a few hours behind and the other was almost a day behind. The doc said they would catch up. Everything was fine up until the embryos didn’t take then I was told my eggs were no good. With this bit of info is there a chance or should I give up IVF altogether? I am looking for a new clinic now, one that is FSH friendly. I have also read DHEA can aid in helping. Is this something you encourage your patients to take? Thanks for any insight.
Hi friendly FSH,
Let me give you a little background on FSH and then talk about what you can do to improve your chances going forward.
FSH (follicle stimulating hormone) is the primary hormone responsible for human egg stimulation. FSH originates in the brain and travels to the ovary where it stimulates the egg through follicle growth. A follicle is a small sac of fluid within the ovary; each follicle houses an egg (oocyte). The normal relationship between the brain and ovary, in terms of FSH, is that the FSH is released in a specific pattern and quantity. In the first few days of the menstrual cycle, the ovary responds to the FSH through follicle/egg growth and estrogen production. If the estrogen is produced in the appropriate amount, the brain will recognize the estrogen and will be “satisfied” with the ovarian response; subsequently decreasing the amount of FSH it releases. If the ovary does not respond appropriately, the brain will not be satisfied. The brain then will release more FSH in an attempt to further stimulate the ovary. Thus, if the FSH on day 3 of the cycle is low, then the brain is satisfied with the ovarian response; a high level of FSH means that the brain is not satisfied because ovary is less responsive. Another term used to describe less responsive ovaries is diminished ovarian reserve (DOR).
It is natural for the ovarian reserve to diminish over time. In fact, menopause is defined by the absence of ovarian reserve and a very high FSH level. Until menopause however, we spend a great deal of time and effort trying to assess the ovarian reserve because there is a correlation between ovarian reserve and pregnancy rate.
With that being said, FSH is only one way of assessing ovarian reserve. In my opinion, too much emphasis is placed upon its value. FSH should be interpreted in the context of the patient’s age, fertility history, antral follicle count and past treatments. Further, it should never be used as the sole benchmark to determine ones fertility.
In answer to your question, there are a couple things that I think are quite encouraging for you. First at 32, your oocyte quality should still be pretty good. In many ways, your age trumps your FSH level! This is because we know that in two different patients with the same diminished ovarian reserve, the younger patient will always have a greater chance of conceiving.
Next, it appears that your second IVF cycle was significantly better than your first. This is not totally unexpected because I’m sure that a more appropriate stimulation protocol was used in the second cycle. My guess is that a third cycle could be even better.
In terms of improving ovarian reserve, I often work in conjunction with an acupuncture practitioner and sometimes utilize DHEA. The scientific literature for both of these methods is not perfect so you should definitely discuss it with your doctor.
In conclusion, my instinct is to encourage you to try again. I believe that with the right stimulation protocol, a bit of pre-cycle preparation and a smidgen of good luck, you can be successful. If you have any questions, feel free to contact me, I'm happy to discuss it further.