Get a second opinion?

[Lynn2010]

Some background info: I'm 39. Have a 2 1/2 year old son. Always had regular periods. Miscarriage the cycle right before I conceived my son. When decided to try for 2nd child, I was surprise that Clear Blue Fertility Monitor showed I was only ovulating every other month. Referred by OB to reproductive specialist. Was shocked with FSH of 18.6 and AMH of .17, which she said gave us about 1-2% of natural conception, so she recommended donor eggs. Took a couple of months to research and think about it. Decided to search for a donor while doing a couple of rounds of IUI, since that was covered by my insurance but donor wasn't. Right before IUI, found out I was pregnant. 13 week nuchal scan and CVS showed T21 and severe cystic hygroma, giving almost no chance for the baby's survival past 20 weeks. We terminated shortly thereafter.

While we're still dealing with the grief of losing our baby, we are also confused about what to do next. We question the donor egg recommendation since we got pregnant shortly there after. Could the lab results be wrong? Should I get retest? And even if the tests are right, should I still get a second opinion, especially since there's another clinic in town that has a more robust egg donor program with better results.

Thanks.

[Scott Roseff MD]

I'm so sorry to hear about your loss...

The incidence of trisomy in pregnancies increases as a woman's age increases. I would presume that would be somehow related to "the age of the egg". While I can't say with certainty, it may be possible that high FSH and low AMH levels can indicate "older eggs", and older eggs generally have a lower chance of fertilization and higher chance of a failed pregnancy.

Does this necessarily mean you can't get/stay pregnant with eggs from someone who is 39 years old with a high FSH and low AMH? No, it doesn't - But the odds of "success" may be diminished overall....

Have you talked to your RE about DHEA? Acupuncture? Have you had Fragile X testing? These modalities may be helpful for women with diminished ovarian reserve.

Hope this helps,
Dr. Roseff in Florida

[Lynn2010]

I was told based on the CVS results that the T21 diagnosis for our baby was completely random and not genetically related. Therefore, our genetic counselor did not recommend us for further genetic testing. She told us the odds of having another trisomy baby was the same - 1/100. She did not know the odds of another severe cystic hygroma.

I had also heard, maybe incorrectly, that high FSH and low AMH was indication of low quantity - not quality - of eggs, although I recognize that the quality of my eggs declines as I age.

My RE had recommended accuputure, which I was going to do when I found out I was pregnant. There was no discussion of DHEA. So, I'm trying to determine if I need a new RE for a second opinion. Because I feel like I was rushed into the egg donor route without adequate testing and discussion, so now I have doubts about my RE. Also, when I choose this RE - who I really like - I didn't know at the time that we might end up on the egg donor course, and now having done some research, I realize there's another practice in the area that has what appears to be a better program for egg donation.

So, does it seem like a fair course of action to pursue a second opinion from another RE? Because I am just heartbroken and want to get settled on a course of action, if for no other reason than to make me feel better.

Thanks.

[Scott Roseff MD]

By all means, I think it is helpful to consider a second opinion, especially when egg donation has been suggested as the best or only course of action. It certainly can't hurt...

Dr. Roseff in Florida