QuestionHi,I have been trying to concieve since 1 year.I am 29 yrs old,and a professional with busy working schedules.I recently got myself investigated and found that my FSH levels r 7.09 and LH levels 3.0, AMH levels 3.29.I have undergone 2 ovulation induction cycles which showed normal ovulation but i have a tendency towards cyst formation.HSG is normal.My antral follicle count is 6 and 4 in both ovaries.Kindly opine if i should undergo IUI cycles with clomiphene or with gonadotropins or should i directly go ahead with IVF cycle?Iam worried as my FSH levels are on the higher side and also my FSH:LH ratio is >2:1....Kindly reply asap.Thank you.
AnswerHello Shellee from India,
First, let me reassure you that your lab tests, including FSH level, are all normal. I would presume that you have regular menstrual cycles which is an indication that you are ovulating so Clomid is probably not the appropriate treatment either. Many doctors jump onto Clomid treatments thinking that it is a fertility enhancing drug, when in fact, it is only used to induce ovulation in patients that don't ovulate. Also, from the information that you provided, I don't see a diagnosis for your infertility. Before proceeding to any treatment, I would recommend that you undergo a complete infertility evaluation, which is more than just hormones, HSG and ultrasound. Additional testing includes hysteroscopy or hysterosonogram to make sure the uterine cavity is normal, testing for TSH (thyroid) and Prolactin (pituitary), laparoscopy (to check the pelvis for adhesions or endometriosis) and semen analysis. If you decide, and can afford, to go directly to IVF, then you don't need the laparoscopy because IVF bypasses the pelvis.
I would also recommend (highly) that you see an infertility sub-specialist (one that does all levels of care including IVF). That way you can get to the right treatment faster.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
