Question

Question

16 Aug 2006

Diminished ovarian reserve/fsh

Hi Dr, thank you for reading/responding to my question.

I am 33 years old and have been trying to get pregnant with a 2nd child for the past 3 years. In 2003 a gyne ran some test to discover I was insulin resistant, 2 months on Glucophage and I was pregnant only to have a miscarriage at 6 weeks.

I then changed gyne's, seeking treatment with Dr Chris Sevenster (who I believe is a excellent Gyne). We triend 5 IUI's with Fertomid and Pergonal - all unsuccessfull. Last year I did 1 Gift and then 1 IVF with Fertomid and Gonal-F. The Gift produced only 1 egg also the IVF. With the IVF the egg matured until blastocyst stage but still no pregnancy. At that stage I weighed 92kg still taking my Glucophage.

Last year August I went for a Gastric Bypass losing 40kg up to date. I don't have an insulin resistance problem anymore thus not taking Glucophage anymore. For the past 2 years I've been taking Stamino Gro on a daily basis. Had bloodwork done and all my levels are normal. This year again I again went for an IVF. My FSH was 8.2 on cd2. I again started on Fertomid and Gonal-F, this time on cd4. My cd8 ultrasound showed a few good follicles but by cd10 it looked like they didn't respond to the meds anymore. Dr Sevenster then doubled my Gonal-F injections. With the retrieval we only had 1 good egg and 1 that was of a lower grade. Still no pregnancy. Now all of a sudden I’ve had my last period 12 June and after about 10 home pregnancy tests, I’m very sure I’m not pregnant.

My question is if you think I should be thinking of giving up? I am not sure if I’m ready to consider donor eggs. Is there any other meds, etc which I can take, do you think I should seek a second opinion or do you think the treatment I received up to date is sufficient? I would really appreciate your opinion.

Regards
Ilse

Answer 1

Answer 1,268 views

Fertility expert

01 Jan 0001

Dear ilse

Thank-you for this interesting question. In my opinion you have thus far had a reasonable approach to the problem but without the details of your stimulation cycles at hand, I cannot make a fair comment. However, the fsh of 8.2 on cycle day 2 is not very significant. However, it appears that the stimulatory protocol used thus far is sub optimal and I would recommend a change to a more aggressive ovulation induction program. My advice would be to use what is called a mid luteal down regulation protocol (long protocol) and to use high dosage of gonal F from the beginning (e.g. minimum of 300iui). In my experience this would probably give you a much better synchronisation aswell as a far better response to the stimulation.

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