QuestionQUESTION: Hello,
I recently came off the pill, loestrin 24fe in June to undergo fertility
testing. I had a period July 11th & an egg reserve test in which the level
was 13.8. My next period was not until September 15th, after which I
had an HSG which showed my left tube is blocked. I haven't had a
period since & had a sonogram 11/8 which showed a relatively thin
uterine lining so no period any time soon. My ovaries showed either
follicles or cysts, the doctor wasn't sure. I want to have a baby and I'm
now afraid that I've waited too late. Is there any hope of 'restarting' my
ovaries?
ANSWER: Hello Nicole from the U.S.,
The elevated FSH level, the measure for ovarian reserve, shows that time is getting critical for you. Certainly, since your ovaries are not currently functioning correctly, you could undergo treatment called ovulation induction, in order to get your ovaries to ovulate spontaneously. This could be combined with either timed intercourse or insemination (IUI), but because of your age and elevated FSH, I would not recommend that course. Your chances of a spontaneous pregnancy or natural pregnancy in your age group is already low. You would have to use a lot of time to achieve pregnancy if those work, and if they don't, you may lose your chance to become pregnant with your own eggs. For that reason, I think you need to move to the most aggressive treatment plan, which is to use IVF (In Vitro Fertilization). This treatment gives you the highest chances of pregnancy in the fastest period of time. In our practice, it is as high as 63% per cycle, but this pregnancy rate depends on many factors. This is considerably better than the 1-2% pregnancy rate you would have with IUI.
The elevated FSH doesn't mean that your ovaries have shut down, only that it is on the way to doing so, but that could still take several years. Don't waste time.
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
---------- FOLLOW-UP ----------
QUESTION: I appreciate your response. I am now experiencing lessening
of the hot flashes (sorry, didn't mention them in the
previous question) and my face is starting to break out
again (acne). I'm thinking that maybe I'm experiencing post
pill amenorrhea. I went to get a discharge checked out and
was told that I'm entering an 'estrogen-making'phase by the
look of the cells. Have you dealt with cases similar to mine
that turned out to be post pill amenorrhea instead of peri-
menopause?
AnswerHi Again,
Because you are not menopausal, your ovaries are still functioning and you are still producing estrogen. That is not the issue here. The FSH indicates ovarian "reserve". That is like looking at your cars gas tank and seeing that it is close to empty. The engine still runs because there is gas remaining, but the it is running out. So, similarly, in your case, your ovaries are still working, it is just that it is slowly reducing in function. Once the FSH level gets to 15, many clinics will not allow you to do IVF with your own eggs (although I do). Once your FSH is above 20, you are in menopause and your ovaries are no longer functioning. Donor eggs will be your only option.
I hope that clarifies it for you.
Sincerely,
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
