QuestionHigh prolactin and no periods at age 26 following cessation of pill, no return of periods despite shrinking of prolactinoma found.
Many consultants heads being scratched over the years. Using HRT to guard against osteoporosis. Told would just need a little help conceiving, clomide maybe.Off HRT for 6 months whilst exploring potential IVF clinics using donor sperm. Aged 42, looked at adoption did not proceed as few babies for single white people in the UK. Had ORT at clinic. fsh at 0.8. e2 under 44.AMH low at 0.83. tsh normal/borderline at 4.36.Suggested that am tested for response with gonatrophins then if follicles appear can try with donor eggs. Donor eggs and sperm maybe a bit too far for me. Any thoughts, feels like end of road for me. but as clininc has to seek advice from endocrinologists thought would start to ask wider.
AnswerHello Jane from the U.K.,
There are several problem that you report. Let me take them one at a time.
You mentioned that you are not have periods since the age of 26 and now your are 42 years old. There must be some explanation for that and the only explanation I can see is that your FSH level is very very low (0.8). I presume the LH level is similarly low. We call that "hypogonadotrophic hypogonadism". It means that your hypothalamus is dysfunctioning and not producing adequate FSH to stimulate the ovaries to work. The treatment for a woman that wants pregnancy is to give FSH and LH (Menopur or Repronex) to stimulate the ovaries to work. This can be done with a reproductive endocrinologist, no a medical endocrinologist, also known as an infertility subspecialist.
Secondly, I noticed that your TSH level, albeit is within the normal limits, is higher than we like to see it. In general, and U.S. endocrinologists have now adjusted their tolerances as well, we like to see the TSH at less than 2.2. So your thyroid is functioning but it is a little hypothyroid. A little thryoid replacement hormone (synthroid) would probably help to bring that down.
Thirdly, I presume that your prolactin levels are normal now? If not, then need to be treated to get them down to less than 20.
Now, let's talk about your options to get pregnant assuming all the above findings. The one very significant problem that you have, in addition to those above, is your age. At 42 years old, your natural chances for pregnancy have diminished significantly. For example, a 26 year old would have an 85% chance of pregnancy per year. A 42 year old has a 1% chance of pregnancy per year. Therefore, you need to think beyond the envelope of getting pregnant by natural means i.e. just having intercourse or injecting sperm (IUI). IVF will be the treatment of choice, and the medications used to stimulate your eggs will be FSH and LH so that covers the hypothalamic problem. You might want to consider a gonadotropin stimulation test (trial of using the meds to see if your ovaries respond), but that is not necessary. If you enter the IVF cycle path and your ovaries don't stimulate, then you just cancel the cycle, so the IVF cycle will be test enough. At 42 years old, in my clinic, your chances of pregnancy would be 44% per cycle. That's significantly better than your natural chances. You certainly have the option of using donor eggs. Because donor eggs are taken from a younger woman, and pregnancy rates are dependent on the age of the eggs, your chances of pregnancy will remain the same no matter what age you are as long as your uterus is normal. That means the chances of pregnancy would be the same at 42 as at 45 years old. So that is a backup option that you will always have. If you wanted the best chances for pregnancy, then donor eggs would give you a 60-79% chance of pregnancy per attempt. In the U.S., we do allow donor egg cycles in single women.
So I hope that gives you some food for thought. I have written more extensively on this subject in my blog so you might want to look it up.
Good Luck,
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
