Infertility
Options
DOR/poor responder ladies
I have a few questions, if anyone knows the answers.
I know that a high FSH level indicates there may be ovarian reserve issues. However, am I correct in the fact that even if one has a normal FSH, they can still suffer from DOR?
Also, and this is a question I need to ask my RE but does anyone know if there is a correlation between DOR and poor egg quality issues or are those 2 separate problems?
*P/SAIFW*
TTC since 1/08
Clomid, 2 IUIs, 4 IVFs, FET
7 losses
This discussion has been closed.
Re: DOR/poor responder ladies
I think FSH is just part of the picture. It seems like it is usually elevated when there is a significant ovarian reserve issue, but not always. You also need to consider AMH, antral follicle count, response to stims, and embryo quality.
I think there is a correlation between low ovarian reserve and poor egg quality, but it's definitely not a perfect relationship. Some people have both where others just have one of these issues.
IVF#1 Oct 2009 (CCRM) - BFN
IVF#2 March 2010 - Poor response/cancelled
DE IVF#1 Aug 2010 - BFN
DE IVF#2 Dec 2010 - Transferred 1, 2 frozen - BFP!
TTC#2 FET Jan 2013 - Transferred 1 - BFP!
This. I think embryo quality usually comes from egg quality and egg quality is usually more related to age then anything else. And age and DOR go hand-in-hand obv., so that's probably the connection. I know there have been a few really young women on the board (20s) who've had DOR and haven't had egg quality problems to go w/.
TTC in 2008. Stage II/III endo, Hashimotos hypothyroid, low morph (3%).
2 cycles Clomid/Ovidrel/TI/Crinone=BFN.
IUI #1 - 4 Follistim/Ovidrel/IUI/Crinone = BFN.
IVF #1 - Antagonist w/ ICSI 4/10. 17 retrieved, 5DT of 2, BFN
IVF #2 - Long Lupron w/ ICSI 6/10. 15 retrieved, 3DT of 2, BFFN!!
Lap 7/21/10
IVF #3 - Clomid/Antagonist w/ ICSI 10/10. 14 retreived, 3DT of 3, BFP 10/20 but m/c. No HB 11/15/10 - D&C 11/17/10.
FET - 2 blasts, 1 survived the thaw. Transfer 2/19. Beta #1 3/1 375, Beta #2 3/3 885, Beta #3 3/8 4261, Beta #4 3/11 9005. U/S 3/8 1 sac 1 yolk, U/S 3/16 1 heartbeat 114bpm!
James born Oct. 24th 2011 via c-section at 38 weeks!
Surprise BFP - Jack born April 28, 2013 via VBAC after PTL at 33 1/2 weeks!
Ditto JM, but you also have to take FSH with E2 in mind. FWIW except for a few elevated levels, mine seem decent but I'm on more aggressive protocols than my numbers would indicate. When it comes down to it, it doesn't matter what your numbers indicate, it's how you respond to meds that count.
Regarding DOR, EQ is mainly an age issue. EQ issues can manifest in other ways, but in general they're not related.
ETA : AMH can indicate your response to meds and OR, with the bonus of no fluctuation in values over short periods of time. A much better test, but your clinic can only use AMH correctly if they regularly use this test in determining protocol.
I agree with all of this. My FSH is only borderline high at around 11 and my AFC is also borderline, yet I was always a poor responder to high doses of meds. In addition, the eggs that were retrieved never went on to make good quality embryos. In my case, my RE said that my poor response to stims definitely indicated both DOR and a quality issue.
11/11/11 = 5 years. Woah!
Thanks ladies. My RE says my FSH is well within normal range (I didn't get the number) but based on my poor response to high doses of stimulation drugs, she thinks I have DOR. Someone my age (32) should be getting more eggs than I am able to produce. I have accepted the fact that I likely have DOR.
She also thinks I have egg quality issues. She bases this on the fact that I miscarry by 5 weeks with each pregnancy. She thinks the embryos (likely b/c of an egg quality issue) cannot develop beyond that point. It's not that I don't believe her. It's just that I have a hard time accepting that since the embryos we get are high quality when transferred or frozen.
My FSH was 7.1 and my AMH was rock-bottom. My first RE didn't even think I had a problem because he only checked my FSH and never did antral follicle count. My 2nd RE said my FSH was slightly higher than it should have been for my age so he did more tests (AMH and follicle count).
Whether or not high FSH corresponds to egg quality seems to be pretty controversial. Some doctors say it correlates while others say that your age is a better predictor. I am waaaaaay too young (31 at the time) to have the AMH that I have (even now, 1 week away from my due date I still don't want to admit my test result, it was that devastating to me when I found out). I failed my IVF (had 1 embryo, it looked pretty good but didn't take) and got pregnant naturally 2 cycles later. During the IVF I had 3 follicles and 2 of them (from the same ovary) were either empty or had such a horrible egg that it wouldn't even come out (I'm now convinced that my left ovary is depleted). The right one looked good and we know that in the natural cycle I ovulated on the right. I also had a probable tubal issue on the right that may or may not have been improved by laparoscopy (3 months before the IVF).
I hope it's OK for me to be posting here. I really feel for anyone facing DOR especially at a young age. I went through it and got a miracle but I will never forget how I felt when I was diagnosed.
I guess my point is that while I have severe DOR, I may not have a quality issue. This is my 1st proven pregnancy and I've made it to 39 weeks. I have a *suspected* chemical back in 2009 but no proof. I don't think failing 1 IVF with 1 embryo really suggests anything about egg quality -- it unfortunately fails plenty of times even in much better circumstances.
yes, i believe high FSH can indicate there's a reserve issue but it can fluctuate too. I think AMH is a more advanced technique but don't quote me on that? i think that's why RE's like to test FSH, AMH and AFC and then use all 3 of those results to diagnose. FSH is only 1 indicator.
As for DOR and poor egg quality i think it's explained that if you have DOR you may not have alot of eggs to choose from so you may have less of a chance of getting a good quality egg.
These are all my fears b/c my first FSH was 15.6 but the next cycle it was 7. something so it was a big difference. my AMH came back in the normal range for my age, mine was 1.52 but AFC was borderline w/ only 11. and this cycle i only had a total of 7. but i got a +hpt today so i'm hoping and praying we got a good egg!
GL!
I have had very similar experiences (re: early miscarriages). Because of my history, my RE recommended either PGD/PGS or DE. We went with PGD this time around. I know not all my M/Cs were caused by chromosomal abnormalities (1 def. was, 1 def. wasn't and 2 are unknown) but I am at higher risk for them given my quality issues.
11/11/11 = 5 years. Woah!
I got excited when I saw your subject line because I can finally participate around here. How sad is that?!
From my experience, FSH is only one indicator, but the AMH and AFC will give you a better idea of what you are dealing with right now. For example, my FSH was within normal range, however my AMH is 0.1 (out of 7.0). No bueno. Ask your doctor to run at least FSH and AMH.
After 5.5 years of loss, heartbreak, and empty arms, our dreams were fulfilled through the beautiful, selfless gift of adoption. We are amazingly blessed!
Blog About Us | Blog About RPL/IF/Adoption