Calling on the infertility brain trust!

September 24, 2010

Hello, friends! I have not really been present on this blog, but I have been reading your blogs and thinking of you. On a recent vacation in Turkey, my husband and I visited a teeny church built on what is thought to be the last home of the Virgin Mary. I lit a candle for you all and prayed for my infertile friends in waiting.  You are still ever present in my thoughts and prayers.

If anyone still has this blog in your feed or stumbles upon it, I am hoping you might have some ideas for my sister.

My older sister has been trying to get pregnant for some time and has recently been diagnosed with diminished ovarian reserve. I do not know what her numbers were, but the doctor told her they were lower (or higher, as the case may be) than normal for her age,  36 years old.

She has one three-year-old son who was conceived after about 10 months of trying. She’s been trying to have baby #2 for about a year. Her cycles are somewhat irregular, often short. Given her age, she did not want to mess around so she went to an infertility clinic.  Her husband was found to be in good reproductive health. I think her diagnosis was based on day 3 blood test levels.

I’m wondering what you all know about this condition and if you have any advice?

Here were the recommendations from her doctor:

1) Clomid, monitored. She said the doc did not make much of a case for this.

2) Injectibles. Doctor-man preferred this to clomid, said they could avoid some of the negative side effects (ahem, drying out). She has top shelf health insurance that would help pay for them, so cost is not really a factor.

He recommended doing IUI with the injectibles. But if her husband’s sperm are great, why do they want to IUI? Is it just because it makes a doctor feel more in control?

3) I think the next recommendation would be IVF.



  1. I don’t have any advice on this specific diagnosis, other than to say that she’ll be in my prayers. I’m sure there are other bloggers out there who will be of help, though, and I hope they see this 🙂

  2. I think this is a very, VERY typical RE. Run 1 blood test, on ONE CD 3, and go straight to ART.

    Too many women are told they have “bad eggs” based on this CD 3 # from one cycle. We have seen in our own NaPro clinic where women are able to conceive who had FSH #s REALLY high in the past cycles (sometimes even over 100!), so FSH can definately fluctuate from cycle to cycle.
    One of my own clients was 43, failed 2 IVFs before trying NaPro, and she is now about 28 weeks. Her previous REs told her she had old eggs, and bad CD 3 FSH. She had endo and adhesions which were successfully removed by a NaPro surgeon, and conceived the following cycle.

    Is there any way your sis can see a NaPro Dr? At the very least she should know that IUI is a silly recommendation at this point because a) they are basing its success on what, exactly? She has no reason to believe her DHs sperm are not able to get past her cervix, and b) IUIs can lead to a myriad of other problems, which for now, she is protected from with natural intercourse – the cervix is nature’s filter for abnormal and infected sperm.

    I hope she’s able to find a Dr who can treat her underlying illness.

  3. I really cannot believe there was that diagnosis based on one FSH test! That’s incredible. FSH does fluctuate from cycle to cycle. I have mine tested every month and it has never been the same in 2 years. There is also other tests for DOR as well as the need to test estrogen and progesterone (from my understanding of DOR).

    Personally, I think she needs a different doctor and more testing.

    As for the IUI with injections – I am not a fan of IUIs for many reasons, but in this case it sounds silly to even suggest it. IUIs were first introduced to combat (1) bad sperm (low motility and forward motion) and (2) hostile CM. Now, doctors just recommend it for ANYONE no matter what the condition is. There’s my soapbox and I’m off. However, you can still do injections without IUI. Some clinics call it “modified IUI” or something like that. You do the injectables, hcg trigger (all the stuff the same as IUIs), but instead do natural intercourse. I have done that for several cycles (pregnant off of 2, but m/c as I also suffer from recurrent pregnancy loss), but am now off of injectables. Just wanted you (and sis) to know you can still do injectables without IUI.

  4. RE’s love to make money. Why sit on your hands…? Ridiculos!

    It would be interesting to see how the clomid helps her….What does irregular cycles mean? What do you mean by short cycles?

    I would also look into post peak testing as well….

    I would defnitely start with Clomid and progesterone after ovulation on P3….But good luck getting the progesterone from an RE. Can she get out from underneath that RE.

    Just like an endocrinologist. When you have a thyroid issue that is the last person to see. When you have a reproductive health issue the RE is the last person to see…They all have money making agendas…I’m not a fundamentalist, I swear. I just like to be healthy! 😉

  5. I have seen some women that naturally have short cycles and some that are approaching premenopause and having shorter cycles. This doesn’t mean that your sister can’t conceive. If I were, I would seek out someone that will test her hormones for her entire cycle. I am thinking she has a short post peak (or luteal phase) and could benefit from progesterone or Hcg. Just a thought, though. She should have other hormones tested as well-testosterones, thyroid, etc. She should also be charting to see when her fertile phase is-it may be sooner in her cycle than she thinks. I had a client conceive on cycle day 6 and had shorter cylces. Please feel free to email me if you want more information.

  6. First of all I believe they have to repeat the FSH test. I would also thing all her other levels should be tested (including thyroid); if changes need to be made there, that should happen first, and then have the FSH drawn again. While in theory diminished ovarian reserve is forever (or, rather, always gets worse and never better), I have heard some stories of it improving. My FSH came down by about 10% for no apparent reason (though this did me no good and it is now even higher than before, into “diminished” territory, I believe). If she has endo or anything, taking care of the adhesions could possibly help…?

    Anyway, our friends the natural medicine folk have some theories about lowering FSH. I don’t know the details, but that’s the only branch of medicine that even offers a solution for it. (And IUI – yeah, I can’t imagine what use that would be. Stims, sure – but IUI doesn’t sound like it will help what ails her. It does probably involve a higher fee for the doctor, though, so that could be a reason.)

    Best of luck – let us know what she decides, if you can.

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