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'm 31 years old and have been diagnosed with a high FSH level
of 13. I went through 1 cycle of IVF while on the maximum
dose of Gonal F. I only produced 4 follicles and 3 fertilized
and were put back but, it didn't work. I am now taking 450
ml (max my doctor will give) and continue to try with artificial
insemination. Do you think this will work or do I need to
consider egg donation?
Comment:
Gonal F is FSH. More FSH will not treat levels that are already
high. We also usually limit therapy at 450 IU, or 6 amps of
injectable drugs. With the above previous response you would
be classified as a low, perhaps even a poor responder. We
are quite usually pleased to have 3 embryos to transfer. Not
only the number of embryos, but their quality is important.
If these were good quality embryos, then I might try IVF again.
No center has good success with poor responders. There are
a number of different protocols for poor/ low responders and
patients tend to respond differently to different protocols.
Sometimes changing form FSH to HMG injection can be useful.
Sometimes using a "Lupron" flare regimen or one
the GnRH antagonists, rather than standard Lupron offers better
chances. Clearly your chances are reduced, but certainly not
zero.
The decision to use donor oocytes (eggs)
is a very big step. This decision should be made in concert
with your partner and your physician. When to consider egg
donation a question of economics and efficiency. It should
feel "like the best thing to do".
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