Ghost and others -- what would you do?

[Brooklyngirl]

Hi everyone,

I had my doctor's appointment today. We went over my last disastrous cycle (microdose lupron and estrogen priming). Nothing whatsoever developed and my estrogen didn't rise at all.

He said he would consider doing another cycle with just the EPP as my AMH is 1.1 and my FSH is 3.27. However, given my age (43) and my inability to produce many eggs (at most 11, but none fertilized; I have had at most 2 embryos), he gave me only a 5% chance of success.

Donor eggs, on the other hand, give me a much greater chance of success.

Ghost, given my age and history, do you think the 5% chance of success is about right?

Ladies, any thoughts? The idea of going to donor eggs is difficult, but then again . . .

Many thanks for any advice and for previous advice.

[Brooklyngirl]

I forgot to write that the MDL supressed me, surprise surprise.

[Ghost]

Hi everyone,

I had my doctor's appointment today. We went over my last disastrous cycle (microdose lupron and estrogen priming). Nothing whatsoever developed and my estrogen didn't rise at all.

He said he would consider doing another cycle with just the EPP as my AMH is 1.1 and my FSH is 3.27. However, given my age (43) and my inability to produce many eggs (at most 11, but none fertilized; I have had at most 2 embryos), he gave me only a 5% chance of success.

Donor eggs, on the other hand, give me a much greater chance of success.

Ghost, given my age and history, do you think the 5% chance of success is about right?

Ladies, any thoughts? The idea of going to donor eggs is difficult, but then again . . .

Many thanks for any advice and for previous advice.

MDL seems to be pretty tricky. It saves money, but can backfire.

5% is the national average for your age group. Your ovaries seem to be a little healthier than average for your age, in terms of numbers, so probably your chances are better than that. Egg quality is an open question, but it's usually declined at age 43.

I like that your RE is not over-inflating your chances. I hope he is leaving the choice of using donor eggs up to you.

[Brooklyngirl]

Hi Ghost,

Thank you for the reply, but can you explain? What does it mean for ovaries to be "healthy"? Does FSH have anything to do with egg quality, which seems to be my problem? Is there anything to measure that?

And yes, the RE is allowing me to make the decision. Frankly, with limited funds and a low chance, I am leaning to egg donation. THe odds are simply so much better, despite the loss of a genetic connection with any possible baby. But how great would it be for this to finally work!

Many thanks!

[Ghost]

Hi Ghost,

Thank you for the reply, but can you explain? What does it mean for ovaries to be "healthy"? Does FSH have anything to do with egg quality, which seems to be my problem? Is there anything to measure that?

And yes, the RE is allowing me to make the decision. Frankly, with limited funds and a low chance, I am leaning to egg donation. THe odds are simply so much better, despite the loss of a genetic connection with any possible baby. But how great would it be for this to finally work!

Many thanks!

I meant it sounds like your ovaries can produce more eggs than the average for your age group. That's a good sign.

But I can only guess about the quality of those eggs. FSH is not a good indicator of egg quality.

I suspect your chances of success are better, perhaps much better, than the average for your age group. Can't be sure of that. But even if they are better, your chance of success still won't approach that of an egg donation cycle. But egg donation cycles are expensive.

[riogirl71]

Have you considered embryo donation?

[Brooklyngirl]

Thanks for the replies.

Clearly a low FSH didn't mean much in my case. The largest number of eggs I had was 11 and not one embryo was viable. The smallest number was 4 with only one embryo. So, Ghost, FSH can't tell us much about quality, right? And there must be other factors too, like my no longer elevated TSH. Is that correct?

I haven't considered embryo donation as I would like my partner to have a genetic connection to any child that may result.

[Ghost]

Thanks for the replies.

Clearly a low FSH didn't mean much in my case. The largest number of eggs I had was 11 and not one embryo was viable. The smallest number was 4 with only one embryo. So, Ghost, FSH can't tell us much about quality, right? And there must be other factors too, like my no longer elevated TSH. Is that correct?

I haven't considered embryo donation as I would like my partner to have a genetic connection to any child that may result.

When the eggs don't fertilize, it's usually the eggs that are the problem, but not always. Your partner has good sperm? Did you use ICSI?

Donor embryo is a bargain compared to donor egg, but you are correct about the genetic link.

There is a clinic in Atlanta that has built up a bank of frozen unfertilized eggs from "ideal" donors. That way, one donor cycle can serve 2 or 3 recipients, and it brings the cost down quite a bit. They claim good success rates with it.

[Brooklyngirl]

Hi Ghost,

My partner has low morphology and low-ish motility and count. The RE thinks that the sperm is fine for ICSI. If we do go with donor eggs, I may ask about using some donor sperm just in case.

The RE said the manner in which the embryos failed to develop (between day 3 and day 5, the 2 embryos (out of 11 eggs) became a disorganized mass of cells) suggests that it is egg quality rather than a sperm issue. In addition, I simply don't produce a lot of eggs. My last cycle at the highest stims only netted 4 eggs.

How does this jive with such a low FSH and a decent AMH?

Thanks!

[Ghost]

Hi Ghost,

My partner has low morphology and low-ish motility and count. The RE thinks that the sperm is fine for ICSI. If we do go with donor eggs, I may ask about using some donor sperm just in case.

The RE said the manner in which the embryos failed to develop (between day 3 and day 5, the 2 embryos (out of 11 eggs) became a disorganized mass of cells) suggests that it is egg quality rather than a sperm issue. In addition, I simply don't produce a lot of eggs. My last cycle at the highest stims only netted 4 eggs.

How does this jive with such a low FSH and a decent AMH?

Thanks!

11 eggs is an excellent response in your age group. 4, not so much.

It sounds increasingly like donor eggs are the best choice.

Some clinics are using growth hormone to improve egg quality, and androgens (DHEA, testosterone) to increase the number of eggs. Maybe they work, I just don't know.

[Brooklyngirl]

Thanks for addressing all of these questions, Ghost. Do you think the better FSH has to do with certain changes (30 lb weight loss, synthroid to get the TSH down, metformin, DHEA)?

The 11 egg cycle was over a year ago, so I assume things have gone down hill from there.

It's hard to lose the genetic connection, but I have been reading up on epigenetics, so that makes things a bit easier.

Any thoughts on what to do to make the egg donor cycle successful in terms of meds, supplements, etc?

Thanks!

[Ghost]

Thanks for addressing all of these questions, Ghost. Do you think the better FSH has to do with certain changes (30 lb weight loss, synthroid to get the TSH down, metformin, DHEA)?

The 11 egg cycle was over a year ago, so I assume things have gone down hill from there.

It's hard to lose the genetic connection, but I have been reading up on epigenetics, so that makes things a bit easier.

Any thoughts on what to do to make the egg donor cycle successful in terms of meds, supplements, etc?

Thanks!

The DHEA might have something to do with declining FSH. Perhaps it improves ovarian response, or maybe it's because those extra androgens are converted into more estrogen, which would suppress the FSH.

What was your E2 when your low FSH reading was made? An elevated E2 will suppress the FSH. I should have asked this before.

Donor cycles are pretty reliable. I would not take anything unless the doctor recommended it.

[Brooklyngirl]

Hi Ghost,
I don't know what the E2 was, but I was on the EPP so perhaps that had something do with it?

A month before the cycle, my regular endocrinologist made me go off of the DHEA as he thought it was too elevated (I was on it for around 3 months). I didn't check it right before I cycled, though.

Anyway, regardless of what happened, the cycle was a big fat failure. If I do cycle with my own eggs again, the RE wants me on only the EPP.

But, I probably will go with the egg donor, for the financial reasons and for the emotional ones as well (I really want it to work!).

Again, many thanks!

[karenvancouverisland]

if you're determined to try again with your own eggs (and i wouldn't blame you for that), why not try a different protocal that's also good for low/poor responders- like a no suppression, antagonist only protocal, and taking dhea first...

so here's what worked for me: no suppression, started stims on day3 (after AF)- used 450ui daily of gonal F, around day 6 antagonists were introduced to prevent premature ovulation... and i took dhea for 7 weeks prior to stims.. this type of protocal is often used instead of EPP... for what it's worth..

all the best to you

[Brooklyngirl]

Thanks for the advice. I would insist on no suppression, if I were to do it again. However, given my age, I don't think that I have time to go back on the DHEA.

And of course, there is the cost, both emotional and financial (though if I won the lottery tomorrow, I would go for it!)

So I am still not sure what to do!

But thanks anyway!