Other options?

[tkdgirl]

I am 39, in excellent health with great FSH levels, etc. I do have stage 3 endo, but recently had surgery and everything looks good (including tubes). In 2006, I tried to conceive via IUI with clomid and had a chemical pregancy, but responded fairly good to clomid.

I've had two IVF cycles in the past year (one right after a lap/hysteroscopy), one resulted in a chemical pregnancy, the other a negative beta. Two other cycles were canceled, one to over suppression (long lupron) and another with low response with microdose lupron and gonal-f. The two complete cycles were with Menopur and md lupron with a ganerelix shot on day 9. I've had all blood tests for immune/protein deficiencies, which were all normal.

My issue is, why am I a poor responder? Both cycles produced only four eggs, all of which were great quality and all fertilized normally with great quality embryos. Yet, no pregnancy. We even tried DHEA but I had to stop due to bad side effects.

I'd like to do one more cycle but want to make sure I am doing everything I can in terms of stims, etc. to produce a fair amount of eggs.

[Dr Jeffrey Fisch]

The biggest issue is the age. At 39 it can be more difficult to conceive. We know you are at somewhat increased risk for Down's Syndrome or other genetic abnormality in your next pregnancy. Most miscarriage in the first 8 weeks, as well as biochemical pregnancies are caused by a bad egg. This doesn't mean all your eggs are bad, because egg quality doesn't get determined until ovulation. We think the specific stimulation protocol is critical to developing good eggs. Unfortunately, we cannot tell the quality of an embryo just by looking at it.

We think many women become overly sensitive to the LH (male hormone stimulating) component of the medication. We think this gives the developing eggs signals they are supposed to die. We think this is how endometriosis affects fertility, even when the tubes are open.We avoid the micro dose flare and the standard antagonist protocols, as well as protocols with a lot of Menopur or Repronex.

We have developed a different approach to stimulation we call agonist antagonist conversion with estrogen priming (AACEP). Our data was published in Fertility and Sterility in Feb 2008.

We may not be able to make more eggs, but it only takes one good one to make a baby. At 39 it can still work with your eggs, but I recommend trying something different than what you have done in the past.

If you contact me directly, I would be happy to review your case and our approach with you in more detail.

Jeffrey Fisch
jfisch@sherinstitute.com