QuestionHello! I'm a 34 years old, with one daughter, 6 years old. I've been trying for 2 years to conceive again, with no success. 16 months of TIC, 3 cycles of 50 mg Clomid with TIC, 3 cycles of 50 mg Clomid with IUI. All Clomid cycles resulted in 1 - 2 follicles that were larger than 18 mm.
A Clomid challenge test (100 mg) showed FSH of 9.7 (10 is my lab's cut off), and AMH of 1.1 (1 is my lab's cut off).
I'm concerned that my low numbers mean low "quality," as well as semi-low quantity. I do not want to be in a situation where I'm "forcing" something that nature just did not intend to happen.
My next logical step is to try gonadotropins. Since I responded well to the Clomid, I'm concerned that this next step is moving into the "forcing" arena.
Am I increasing my chances of forcing a "low quality" egg to fertilize by using the gonadotropins (and therefore a higher chance of chromosomal abnormality), or are the chances of a "high quality" egg the same, independent of the drug used to induce ovulation (in other words, dependent only on my intrinsic egg quality)?
Thank you for any input you might be able to give me!
Michelle
(Writing from Ohio)
AnswerHello Michele from the U.S.,
The elevated FSH is an indication of low ovarian reserve but does not measure or indicate low egg quality. There is no way to measure egg quality at this time. What it shows is that the ovary is not picking up FSH from the blood stream as readily as it should. That is an indication of how well you will respond to FSH stimulation and nothing else. It is important to fertility experts because it can also be a measure of your timeline. With time, your ovary will become more and more resistant and eventually reach the point where we will not be able to stimulate the ovaries at all. At that point, if you were to proceed to IVF, your chances would be lower, because part of how IVF increases the chances is by obtaining lots of eggs, and in some cases, you might have to resort to donor eggs. FSH is the hormone in fertility medications (gonadotropins) that stimulates the ovaries to produce multiple follicles. It is the same hormone that your brain produces to stimulate the ovaries to ovulate each month. I have multiple posts on my blog discussing ovarian reserve. 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
