Hello doctor, My husband and I recently underwent an IVF cycle and it failed. Originally, my husband has a problem with 1% morphology. But, now I a have poor ovarian reserve. I am 39 years old and my AMH was .24. However, my FSH was 5.5 last time. AMH was not repeated. I was stimulated with the maximum dosages and only produced three eggs which all produced embryo's (I do not know the quality, only that one had progressed normally by day 3). We did a day 3 transfer. On the second day after the transfer, I had what I can only describe as scab-like discharge about the size of a tear. One the sixth day, I finally left the house and started to resume so level of normal activity (no heavy lifting) and that afternoon I had a very bright red urine flow like a small amount of blood pass when I used the bathroom. I thought that it might have been implantation bleeding, but clearly not. I want to try IVF again, but I am afraid of the same results. In doing research, I found a book that suggests many environmental factors such as BPA and phthalates can play a part in egg quality, quantity and affect the sperm as well. The book suggests waiting three to four months prior to beginning IVF to get the full effect of supplements recommended as well as let the harmful chemicals leave your body. My questions are given my numbers, in your opinion, will my number of eggs change drastically while waiting or should I be normal? Should I retest my AMH before making this decision? Also, is there any way for me to preserve my eggs (not menstruate) until the month before the IVF procedure. My thought was to take birth control pills for three months (and not take the sugar pills). Is this safe? Can it be done? What are the repercussion? Finally, Based on our numbers, would you recommend that we use donor eggs instead of trying another cycle? This time around will have to be the last as we do not have any money after this one. It is critical that we make the right decision.
Hi. Looking at your case history, (attachment removed to protect patient identity) it would better to go for donor eggs. Ovarian reserve decreases with age and retesting for AMH (anti-mullerian) is not going to affect the outcome (increase ovarian reserve), so no point in retesting AMH. By taking OC (oral contraceptive) pills continuously, you cannot halt a decrease in ovarian reserve (loss of eggs). Menses is just an indicator of loss, actually a woman loses 400-600 eggs per month irrespective of whether she gets menses or not. What you see on ultrasound is just loss of dominant follicle, the loss of those 600 follicles cannot be seen, it can be perceived indirectly by decrease in AMH, increased requirements of hormone injections during IVF (in vitro fertilization), reduced number of eggs retrieved and low pregnancy rate. One more effect of advanced age would be increased risk of Down's syndrome in the baby if you try with your own eggs. So considering your advanced age, low AMH, poor response to stimulation, low number of embryos formed in the last cycle and increased risk of Down's syndrome with own eggs I would suggest to go for donor eggs.