Cycling with High FSH and Poor Ovarian Reserve
Working with Doctors and IVF Clinics with a Diagnosis of DOR
Dec 20, 2008
When PJ, the New York area creator of highfshinfo.com, was diagnosed with DOR she was not given much reason for hope. “My first reaction (I’m sorry to admit) was one of resignation,” she wrote in an email. “If the doctor said that our only options were egg donation or adoption, then I believed him. My husband, on the other hand, was infuriated and was willing to go to the ends of the earth to get second, third, infinite opinions in order to fix the problem.”
Many women with a diagnosis of diminished ovarian reserve are told they do not have many eggs left, or that they have bad eggs, and are advised to consider egg donation or adoption. A woman should always consult with a fertility specialist familiar with her case, but if there are no other contributing factors to her infertility (such as blocked tubes) it may be possible for a woman with DOR to conceive naturally or with intra-uterine insemination (IUI) or in-vitro fertilization (IVF) using her own eggs. Most doctors recommend IVF to maximize the chances of success. Even so, it can be a struggle to find a “high-FSH-friendly” IVF clinic.
The Challenges of Finding a DOR/High FSH Friendly IVF Clinic
“Most clinics won't even see you if you have elevated FSH - they will immediately tell you 'Donor egg', no matter what your age, no matter what your FSH level,” said Chris, a 35-year-old Illinois woman diagnosed with DOR after a high FSH level of 45. “This was especially important for me, because most will not let anyone with an FSH of over 20 do IVF - period.”
“The reason for this,” she added, “is usually because infertility is an industry - a competitive industry. High FSHers don't respond well to the medications (which are comprised primarily of more FSH) and so these patients lower the success stats. Clinics don't like that. I'm sure glad that cancer centers don't work that way, or a lot of people would never even get treatment.”
Working with High FSH Friendly Clinics and Achieving Pregnancy
There are some exceptions. PJ provides a list of high FSH friendly doctors and clinics on her website. Chris, now pregnant with twins after four IVFs, received treatment at the Fertility Center of Illinois. Another popular choice is Sher Institutes for Reproductive Medicine (SIRM). Dr. Drew Tortoriello, medical director of SIRM Manhattan, wrote in an email that high FSH and poor ovarian reserve are common. “I daresay that the majority of patients that are out there have DOR as either their sole problem or in combination with others,” he wrote.
Dr. Tortoriello said the chances of achieving pregnancy with DOR are hard to predict since each woman’s case depends on a lot of specific factors, one being age. “A younger woman with the same elevated day 3 FSH level as an older woman will usually be expected to have an easier time getting pregnant because the percentage of her eggs that are chromosomally normal should be higher,” he wrote. “Even in the very worst case scenarios (premature ovarian failure), one can expect a 10% lifetime chance of having a baby, but this does not serve as a great comfort to the woman who wants a child now.”
SIRM offers several protocols for women with diminished ovarian reserve. Although SIRM also offers access to egg donation, Dr. Tortoriello said, “I view donor egg IVF as a last resort, albeit a very effective last resort, that should not be utilized to the exclusion of innovating treatments for women with DOR to get pregnant with their own eggs. We must as physicians grow intellectually and clinically through research to meet their medical needs and preferences.” As PJ writes on her website: "If you have high FSH, don't give up on your own eggs until you feel it's time to give up."
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