Also see fact
sheet - General
Infertility
How old is too old? When is the FSH level too high?
When to Stop?
Age 38, severe endometriosis, inconsistent FSH elevation
Elevated FSH?
CCCT
Passed CCCT, poor development of uterine lining
Questions: Could I be
a candidate for IVF, GIFT or ZIFT with my own eggs? I am now
41.5 and three months before my 40th birthday I was diagnosed
with borderline premature ovarian failure. My FSH has varied
from the low teens to 30s, and has been successfully suppressed
with Estrace, as well as Estinyl. I have had 2 cancelled cycles
using gonadotropins. I also had one cycle of Clomid with no
response and one natural IUI when I ovulated, but no pregnancy.
My RE in has been pushing me to do donor egg. I would do it,
but the cost here is rather prohibitive. Is there any hope
for me to get pregnant with my own eggs?
Comment: I think you
are not a candidate for IVF with your own eggs given the above
history and a certain degree of pragmatism. Your success would
be less than 5%. In all centers, pregnancy in individuals
age 42 or above with FSH levels over 20 is highly unlikely.
I agree with the use of donor eggs. sst
Question:
I was wondering about an age limit for IVF. I've done many
cycles already—two GIFTs, three IVFs, and one FET--but
have had no success. On my third IVF retrieval, I got a dreadful
infection that turned into an ovarian abscess and I ended
up losing an ovary. Even so, I did two subsequent IVFs after
that and stimulated very well. With two ovaries I produced
21, 25, and 32 eggs. With only one, I produced 11 and then
15. I am now 44, and started all this when I was 42. I've
had microsurgery to clean up the mess from the infection,
but am considering more aggressive treatment in the future.
Comment:
Bad news. I don't believe you will be pregnant using your
own eggs. You have been treated in at one of the best programs
in the country (name withheld), at least in terms of reported
success rate. You have had several cycles of therapy. There
is one ovary and you are 44. I know that I am repeating what
you just told me, but each of these factors, itself is a relatively
good predictor of poor chance of future success. It is important
to know your day 3 FSH level. If it is above 10, the chances
are very slim and if above 20, pregnancy is highly unlikely.
Having said this, success in women over age 40 is clearly
related to the number of eggs obtained at aspiration. By egg
number alone I would have thought that your chances were much
better than most. Given this response, I wonder if you have
PCOS. A suggestion of donor eggs comes from the number of
attempts and your age, not form other aspects of your history.
sst
Question:
Here is my situation. I only have one ovary. I have lots of
adhesions from numerous surgeries due to Stage IV endometriosis
(3 laparotomies and 3 laparoscopies). After a laparotomy that
included a bowel resection) for endometriosis, my surgeon
said he didn't foresee problems with us conceiving. A year
and several months have passed since that time, and still
no sign of a baby. The last time I used birth control of any
kind was over twelve years ago. Six years ago I started with
BBT, ovulation prediction kits, and timed intercourse. I have
never been pregnant. I am 38. Here are results of several
Day 3 hormone levels:FSH:19.6/E2:19; FSH:4.2/E2:<50; FSH:8.8.(50mg
Clomid days 5-9) FSH: 7.2/E2, FSH:18.9 (100mg Clomid days
5-9). E2: 1562. I know that elevated FSH levels are an indicator
of poor prognosis for success with one's own eggs, but I would
like your opinion as to our chances. We are not considering
using donor eggs at this time. Although it is my understanding
that the E2 has to be <50 for the FSH to be a valid indicator,
is there a chance of IVF success using a cycle with a low
FSH? I recently read of a 40-year-old woman whose eggs were
injected with cytoplasm (correct me if I'm wrong) from a younger
woman's eggs, She had success with IVF. Are you familiar with
this and if so, would it offer us any hope of having our own
child? At this point, I don't have much hope for a baby of
our own, but it sure would be nice. I'm very discouraged.
Comment:
I am sorry, but I can't be very encouraging. These FSH levels
are a real problem, even though there have been a few in the
more normal range. There is one school of thought that suggests
we use the highest FSH level as a predictor. I believe that
the FSH levels are elevated to such an extent that ovarian
stimulation will be met with marginal response. This may be
in part due to age, but I also believe it is related to one
ovary, partial compromise of the second ovary by endometriosis,
scar tissue and surgery. It is probably not one of these factors,
but a combination that is a source of your infertility. Since
you have not tried gonadotropin therapy or IVF it may be reasonable
to attempt this therapy. That is, if you are prepared that
it may not work and it will not compromise your financial
resources for other options. Success with IVF is probably
less than 10%, but the only way you will ever know is to try.
Use of donor oocytes is probably your best option. “Donor
cytoplasm” is an intriguing experimental procedure,
which is presently banned in the US due to some of its aspects
resembling cloning. sst
Question:
I was diagnosed with possible ovarian depletion. (FSH of 12)
with other values normal at age 40. With the help of alternative
therapies, I got pregnant in a couple of months, just before
I was to start gonadotropin treatment. I've never been sure
if my original diagnosis was too doom-laden, if I turned it
around with my own research and treatment (my cycles certainly
became longer and my periods much fuller), or if I just got
really lucky. I have a beautiful son of 18 months, who is
still nursing heavily, including at night. I have only recently
returned to regular cycles, and my question is has the prolonged
amenorrhea (over two years including the pregnancy) done anything
to preserve whatever fertility I have left? In other words,
can I assume that I am more or less where I was two years
ago? I ask this because I am 42 and would love to have another
child, but my husband has no interest in trying for one till
his professional life (and our financial situation) turn around.
I can't seem to get a straight answer to this question.
Comment:
A modestly to moderately elevated FSH, which yours was, does
not exclude a pregnancy, just predicts the response to ovarian
stimulation medications. The body attempts to preserve ovulation
for as long as it can. With massive amounts of fertility drugs
still you may have only ovulated only a single egg. Your story
is not uncommon, but unfortunately, the miscarriage rate is
increased. Obviously, you were smiled upon. I would repeat
the FSH level. I do not know of significant risks, other than
financial, of fertility therapy, but it may be a rough trip
emotionally. sst
Question:
I did a Clomiphene Challenge Test. FSH on day 3 was 7 and
on day 10 was 29! Should we not even bother with any other
tests? Big waste of time and money? An RE told me that chances
of conceiving are very low and donor eggs are the only way
to go. He also said we should re-test.
Comment:
Some consider the clomiphene challenge test (CCCT) to be superior
to a single FSH measurement, but there is not universal agreement
on this. Traditionally the test is performed by obtaining
a blood sample on day 2 or 3 for measurement of FSH and estradiol
followed by a repeat blood test for FSH on cycle day 10 after
100 mg of clomiphene citrate is given on days 5-9. A level
over 25 IU/L is evidence of reducing follicle stores. Women
over age 35 have much higher rates of abnormal CCCT. If you
are under 40, I might not consider donor oocytes yet. These
results may be worrisome but hardly reason to give up hope
based on this test alone. sst
Question:
I got the news a couple of days ago that I passed the Clomid
challenge test. I was going to have an IUI done yesterday
but it was canceled due to the fact that my lining was only
2. I had a failed IVF this past spring. My reproductive endocrinologist
is saying I have poor egg reserve but tests continue to show
I have good egg reserve. How can you thicken the uterine lining?
Comment:
Clomiphene can have a very negative effect on the uterine
lining. It is thought that is why the ovulation rate with
clomiphene is much higher than the pregnancy rate. It sounds
as if you are receiving mixed messages. If you "passed"
the CCCT, that usually indicates that you are a candidate
for either IVF and/or gonadotropin injections. The uterus
is not usually one of the criteria of the CCCT. If there was
a marginal response to your last IVF stimulation this may
be a better predictor of ovarian reserve than the CCCT. Sometimes
it may be a subjective feeling by your RE that your ovarian
reserve is low. If your day 3 FSH is over 10 this single factor
alone is a poor prognostic factor. A poor uterine response
may be completely a result of clomiphene use. A poor endometrial
response also may be a reason t not to do an insemination.
sst
Also see fact sheet -
General
Infertility
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