Elevated FSH

[cinnamonstick]

Hello! Thank you for your time.

I am sorry to say I just had my FSH checked after about 3 1/2 years. BEFORE (last IVF three years ago) FSH was 7.6 at the CCCT. Highest marked in about 5 FSH testings.

NEW stats:
FSH - 11.6 (only checked once and told they wont check it again)
E2-43
Count - Left ovary 12. Right ovary 7

I didnt expect three years would raise my FSH that much! I was cought by surprise. Is this normal to go up so fast? I was 33 1/2 years old at that time and will be 37 in July. About 3 1/2 years.

Does this lower my chances for IVF success? I was told 50/50 before this came back.

We plan to only put back ONE embryo at 5 days (arcuate uterus cant risk twins).


I am very worried with this new FSH level. My clinic likes to see "under 10". I was told it is not toobad...especially with my AFC but....that it is not good news overall.

I always stimmed well in the past. 75/150 were my IUI/IVF doses 3 1/2 years ago. 10 eggs/9 fert. 14 AFC at the start of that past IVF.

I expect my RE to up my medication. Anything else to consider? Wheatgrass? DHEA? Lose 10 lbs (5'4/158 BMI 27).

How about BC's before IVF. I prefer 4 weeks of ACTIVE --better timing for the ER etc. Too long?

Thanks for any information. I am pretty upset and shocked with this new discovery of my FSH.

[Dr Jeffrey Fisch]

An elevated FSH level means the brain is working harder than normal to make eggs and that these eggs may be more fragile. However, since egg quality is determined at ovulation there is still a decent chance you can make a good egg in a future cycle, even if you have had trouble in the past, (which you haven't). We suspect you may have developed an oversensitivity to the male hormone component in the medications, which we believe predisposes the eggs to divide their chromosomes abnormally. For this reason we recommend limiting the amount of Menopur, in favor of pure FSH, like Follistim or Bravelle. We have actually developed a specialized approach to treating women like you that may improve your chance of getting a baby. Contact me directly and I would be happy to review your case with you in more detail.

Jeffrey Fisch
jfisch@sherinstitute.com

[cinnamonstick]

We suspect you may have developed an oversensitivity to the male hormone component in the medications, which we believe predisposes the eggs to divide their chromosomes abnormally. For this reason we recommend limiting the amount of Menopur, in favor of pure FSH, like Follistim or Bravelle.


I am confused. I have not used any stim. medications for over three 1/2 years (since my last IVF in Feb. 2006)?? Can you please clarify??

Thanks!

[Dr Jeffrey Fisch]

Yes, but if you do use medications in a future IVF attempt, I would be concerned about exactly which medications you were to take. We would recommend avoiding things that would tip the balance toward male hormone dominence at the level of your ovary. For this reason we do not recommend DHEA.

Jeffrey Fisch

[kiran19]

Harmone imbalance and midcycle bleeding and pregnancy after 40

Hi Doctor,

I am 42years old and have been TCC for over 1year with no luck.

Below are the details of my harmones tests done so far:
FSH - this was taken at three different occasions on day 3 and are as follows:
day 3
FSH- 12.20mIU/mL in June 08
FSH- 2.81mIU/mL in Dec 08
FSH- 12.70mIU/mL in Jan 09
LH- 20.75mIU/mL in June 08
Estradiol E2- 33.70pg/mL in June 08
Prolactin- 17.11ng/mL in June 08
Estradiol E2 - 117.83 in mid cycle in July
TSH- 7.13uIU/mL in June 08

This was done in Dec 08
Total Triiodothyronine(FT3) 1.92pg/ml
Total Thyroxine( FT4)0.87ng/dL
Thyroid stimulating hormone(TSH) 5.30uIU/ml
I am taking 25mg of thyronorm.

My questions are as follows:
1)Kindly review my above harmones and adv what other harmone tests need to be done to find out why I am having mid cycle bleeding since Jan 09.I got an ultrasound of the uterus taken and it showed the uterus is normal so I guess they rule out fibroids,polips and endo, am I correct in my assumption?

2)Since I bleed for 3-5days in mid cycle followed by my periods 9days later , period lasting from 4 to 8 days, I would like to know if I am ovulating in my short cycle of 23days and incase I do get pregnant, will the mid cycle bleeding hamper implantation?

3)I do understand age and ovarian reserve diminishing and that IVF with doner eggs is best but I am only interested in a baby with my own eggs so please advise what is the best way to proceed to have a baby?
Would IUI with laterozole and Follicular monitoring be a good and cheaper alternative?

I look forward to your replies to my queries.

Thank you
Kiran

[Dr Jeffrey Fisch]

We need to get your TSH under 2.5. This will probably mean a small dose of Synthroid. With a high FSH level at 42, there is a high chance of making an abnormal egg. You still ovulate, but you do it early so the egg isn't fully developed. This is why the cycles are short. If you really want to give your eggs the best chance, you should consider IVF using our specialized approach called agonist/ antagonist conversion with estrogen priming. If you contact me directly, I would be happy to review your case with you in more detail.

Jeffrey Fisch
jfisch@sherinstitute.com

[kiran19]

IVF w/AACEP percentage of success in older women

Hi Dr Fisich,

Many thanks for your prompt reply.

1) I would like to know what is the percentage of success for women above 40 doing IVF with AACEP protocol verses IVF w/o AACEP protocol ?

2)I am already taking 25mg of thyronorm ( synthetic thyroid harmone), in your openion, is this sufficient dosage or I need to re evaluate with my doctor?

Thanks/Kiran

[Dr Jeffrey Fisch]

Our data found about 30% delivery in the 38-42 yo group, all of whom were given a less than 5% chance of geting a baby from IVF. The two groups have not been compared side by side prospectively.

Jeffrey Fisch

[Dr Jeffrey Fisch]

Check the TSH, we like it <2.5.

Jeffrey Fisch

[cinnamonstick]

Jump in question? My TSH was just checked at 2.8 and RE said it was ok. I am reading 1-2 is best level. IVF set for late June/July.

Do I bother seeing an RE and getting the 2.8 lower or is it OK enough? Thanks

I worry about Synthroid (trying to adjust the levels) while doing IVF and won't want to delay my IVF any more than June/July to "adjust my thryoid" levels..meaning if they put me on a low dose I would hate to swint hyper and have to deal with all that while doing stims for IVF.....if you follow?

leave well enough alone since "borderline"? Or persue small dose of synthroid to get it a tad lower? I am also rechecking TSH in two weeks per my request.

[kiran19]

Ref A/ACEP

Hi Dr Fisch,

Thank you for your reply to my earlier questions.

I have got HSG test done 2days ago and my fallopian tubes are clear so I was thinking I should try with IUI before I plunge into IVF.

Ref A/ACEP protocol- Please advise if this is used only during IVF or this can be also used during IUI?

Also if GIFT is better than IUI since my tubes are open or IVF is better than GIFT.

Thanks in advance
Kiran

[Dr Jeffrey Fisch]

1. Recheck the TSH in a couple weeks. If still above 2.5, I would start a small amount of Synthroid.

2. AACEP is best for IVF. The low success rate form IUI doesn't make the expense of the medication worth it.

3. IVF works much better than GIFT/ ZIFT. Hardly anyone does these any more.

Jeffrey Fisch

[kiran19]

thanks

Hi Dr Fisch,

Thank you for your prompt reply.

Regards
Kiran

[kiran19]

lowering FSH

Hi Dr Fisch,

I have been adv by my RE to do the below to improve the FSH.

1.Yoga
2. Acupuncture
3. DHEA, 25mg thrice a day.
4. Take wheat germ daily

I would like you to adv if the above really helps in lowering the FSH.

Thanks/Kiran

[Dr Jeffrey Fisch]

There is no evidence any of these things will improve egg quality. In the case of DHEA we are concerned it will make things worse.

Jeffrey Fisch