Dear Dr. Ramirez,
WOW!!!! I am so glad I found your blog “Women’s Health & Fertility“. You have given lots of great information that is very straight forward. Thank you for that. There are many sites out there and the more you read, the more unreasonable they sound. Here is my question: I am 44 years old, never had kids, and now I want to start a family, and I live in Florida. I did the Fallopean tube test (yes they are clear)and here are the results of my blood work from Jan. 2010 and March 31, 2010: 1st test=FSH 17.59, AMH=0.32, Estradoil=35,March test: FSH=5.1, estradoil=142, AMH=0.2. My RE said I had a few follicles. He STRONGLY recommends donor eggs. He did advised if I want to try Ovidrel and try for natural pregnany he said to go for it, however he said he does not believe with my results I will be successful and he thinks I am wasting my time.
My question: Is it a waste of time to try fertility drugs? Would I be wasting my time begging him to try and retrieve some of my eggs? He never even suggested that. He came highly recommended and I really don’t know what to do. I would really like to try my eggs first instead of paying $40,000.00 the first time around for donor eggs. You have seen your share of patients and I am asking you if you had a client at age 44 with these results, would you make ANY attempt to use her own eggs?
I thank you very much for reading my question and I look forward to seeing your opinion.
Sincerely, S. from the U.S.
Answer:
Hello S. from the U.S.,
You have a dilemma that is shared by many these days. I keep seeing the average age of my patients increasing. There are two factors to consider with your results. First, the variations in results, namely the FSH levels, are natural occurrences as a woman ages. Some would attribute these to a “pre-menopausal” stage, where the ovary starts to show some fluctuations. We worry when the FSH level is above 10, and especially if it is above 15 (menopause is a level of 20), because it is a sign that the ovary may not respond to stimulation well, despite normal function. It doesn’t mean that you can’t retrieve eggs, or that you can’t get pregnant with your own eggs, it only means that if you go through an IVF stimulation, you may not get very many eggs. In fact, you may not have any embryos to transfer at all.
Of course, this can vary from cycle to cycle, as your tests have shown, and studies confirm that, because of this variation, even poor responders or low responders, still have the opportunity to become pregnant. Because of this, I don’t deny my patients the opportunity to try, or to at least have the comfort that they tried. Remember, the bottom line is that it only takes ONE good egg/embryo to become pregnant. The difficulty is finding or getting that one good egg and as a woman ages, that one good egg becomes more and more scarce. That is the second factor, that I call the “age related egg factor.” Egg quality deteriorates with time, leading to less and less good eggs, hence lower and lower pregnancy rates. IVF tries to overcome this factor by stimulating the ovary harder to get more eggs out in the hope that there will be a good egg in the group. It is merely a chance and statistical issue based on numbers. For example, if you were rolling a dice and you wanted the number two. It can take several rolls before you get the number two but eventually you get it. IVF is, in a sense, rolling the dice to find that good egg because the ovaries give us whatever eggs they are going to give. We cannot tell them what eggs to give us. However, if the ovaries don’t stimulate well and you don’t get lots of eggs out, then your chances of finding that good egg diminishes. In my example it would be the same as if you were only able to roll the dice two or three times, then the chances of getting the number two go down statistically. Then, you may never get the number two.
What your doctor advises is because he doesn’t want you to spend lots of money and see you fail. He wants you to have the best chances of pregnancy in the fewest attempts, and so, he recommends donor eggs. On the other hand, many of my older patients don’t want to give up the hope of having a genetic child or don’t want to have tried at least once with their own eggs. So I justify it to myself, that I have given the best counsel that I could, but my role is to help my patients achieve what they want in the best way that I can. If what they need is to try multiple times with their own eggs or convince themselves that they gave it their best efforts, then so be it. I am not there to tell them what to do. I only advise and am their advocate.
There IS a pregnancy rate at 44 years old, albeit a low one. It is NOT zero, so there is an opportunity to become pregnant. I have not had a pregnancy over the age of 43 in a woman using her own eggs, but have had many many patients try. I look forward to the first patient that becomes the exception to the rule for me, just as the 43 year old patient I had recently did! So, you do have a chance, just know that multiple tries with your own eggs will cost a lot more than one try with donor eggs, and your chances of pregnancy are significantly lower, but not zero. Ultimately, YOU have to make the choice. The New York Post reported last year of a woman that delivered a child conceived at 49 years old using her own eggs, but she had to try IVF many, many times over two years. I strongly admire her perseverance, but most patients cannot afford that nor have the emotional energy or resilience to do that. Only YOU know if you do or not.
I hope this helps, and good luck,
Edward J. Ramirez, M.D., FACOG
