QuestionHi. I am 35 years old (yesterday). Have been trying for baby #2 (#1 spontaneous conception) for 14 months. Sperm analysis perfect. FSH 12.2, E2 less than 32, Prolactin 4.5, TSH 4.56 CD3 labs. CD21 P4: 7.6 OB says start clomid. Not comfortable, go to RE. RE draws repeat TSH and AMH labs. TSH 2.4 ?? (Lab draw on CD 18). First questions: Could it drop so drastically without medication? In only 2 weeks?
I am scheduled to have repeat CD3's after next menses and a HSG. Also to start Meds with that cycle. My second question is this: With my age (started trying to conceive again @ 33), my 12.2 fsh, along w/ bbt charts showing clear thermal shift every month (varying luteal phase of 11-14 days depending on wich side i ovulated), and a period every 29 days, how could I have diminished ovarian reserve? Shouldn't I have gotten pregnant if I have charts showing clear ovuation every month? I shoudn't have "bad eggs" at my age.
Question 3: Could fluctuating TSH cause my infertility problems?
Question 4: since giving birth bleeding days decrease to 4-5 days to one very heavy day followed by 2 minimal days, is that suggestive of anything??
AnswerHello Katie from the U.S.,
Happy Birthday!
I think you are misinterpreting the meaning of the FSH level. It does not indicate that your ovaries have shut down, are dysfunctioning or have bad eggs. The FSH is only an indication of how the ovaries would stimulate with fertility medications. We worry when the FSH level is 10 or above because that mean the ovaries won't stimulate well, and IVF success is often dependent on the number of eggs retrieved as a result of stimulation. That is what we call low ovarian reserve. We also take this to mean that time is more critical than usual, mainly because we can't predict when the ovaries will get worst, so we are more aggressive. A better measure of your egg quality is the age of your eggs and at 35 years old, your eqq quality is reduced. For example, a 25 year old has an 85% chance of pregnancy per year, whereas a 35 year old has a 30% chance of natural pregnancy per year. This is solely due to the quality of eggs. With the combination of the "age related egg factor" and elevated FSH, I would recommend that you move to a more aggressive treatment plan i.e. IVF. I'd hate to see you go through several IUI cycles, not be successful and then find that your FSH level is 15 and you have to use donor eggs. Certainly considering that you have gotten pregnant in the past, IUI is an option, but I would limit the number to no more than four attempts.
In terms of your TSH level, it can certainly change. It is still not in the ideal level, because we prefer that it is less than 2.2, but it is probably not affecting your fertility.
Your bleeding pattern is not suggestive of anything. It is a normal variant.
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
