QuestionQUESTION: Dear Dr Ramirez
I was treated for lymphoma (non-hormonal cancer) in 2007 at the age of 30. As a consequence of the chemotherapy, I was left with premature menopause. This has left my partner and I devastated. I'm currently on a waiting list for egg donation (which in the UK is extremely long - between 1 and 4 years). However, I am confused for a couple of reasons. First, do I have premature menopause or premature ovarian failure? What is the difference (if any) between the two?
Secondly, I've read in a newspaper article recently about a lady in a similar situation who had ovarian stimulation which resulted in good quality eggs being produced.
Is this a possible option for me? I assumed that I would have to go down the egg donation route. Please note that prior to my cancer treatment I had totally regular periods. I have no children and so don't know whether I was fertile, but had no reason to be overly concerned. Can you please advise whether ovarian stimulation could be an option (in addition to egg donation)? I feel totally confused and a bit let down that the various specialists I've seen haven't even mentioned it. Is it because it's overly risky, e.g. in terms of future cancer risks? I'd be grateful for your views so that I can push my doctor accordingly. I'd just like to do this in an informed way!
I look forward to your response
Kind regards
Jackie
Newcastle under Lyme, UK
ANSWER: Hello Jackie from the U.K.,
Premature ovarian failure is defined by the lack of menstrual cycles and an FSH level greater than 20. Is that what you have? If you have those two factors, then it is unlikely that you could become pregnant with your own eggs, because the ovaries have quit working, and you would need to use donor eggs. However, chemotherapy usually does not cause the ovaries to shut down. It can damage the eggs so that you are rendered infertile but that is an unknown without doing IVF.
At this point, I think you need to have your FSH levels rechecked to know where you are. If the level is greater than 20, then ovarian stimulation is not an option because the ovaries will not respond. If your levels are less than 20, then you certainly have the option to try ovarian stimulation.
I hope this answers your questions.
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 facebook and twitter with me at @montereybayivf
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QUESTION: Dear Dr Ramirez
Many thanks for your quick response. You have helped clarify things for me. I'm unclear as to how the lady in the newspaper article managed to produce eggs if she also had POF (although i believe she only produced 3). Maybe there is more to it than i realise.
I have got an FSH well over 20, so understand there is no chance of my own ovaries working. My FSH was measured quite some time ago, so I may ask for it to be retested given that POF is sometimes temporary. I'm on a low dose HRT - would this skew the results of my FSH?
It is useful to understand that I have premature ovarian failure rather than menopause.
Many thanks and best wishes
Jackie
AnswerHello again,
Yes, there are reported incidences of pregnancies with POF. We suspect that is because the ovary will turn on periodically and if caught at that time, pregnancy can ensue. I personally have had a patient achieve this, despite an FSH level of 34.
I would recommend that you have your level retested. You would need to go off the HRT because the brain will sense the estrogen level and adjust the FSH output accordingly, thinking that the ovary is making estrogen. This will down-regulate FSH production i.e. make the brain produce less and artificially lower the FSH level in your blood.
Merry Christmas,
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 facebook and twitter with me at @montereybayivf
