Infertility/Fertility/inhibinB

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QUESTION: Dear Dr. I have 36 years old and i have 1 daughter. now as i want to try for another children the dr suggest to do hormonal test as check up. The result was good except for the inhibineB = 24 ng/ml i did the test on the 4th day of my menstrual cycle. My dr said it is very low and it is better to have injection to increase it and even after better to go to insemination as i have risk to have defect child. So please i need your advice.

ANSWER: Hello Danielle from Lebanon,

I would recommend that you go see a different doctor.  Your doctor is not giving you correct information.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate


---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Edward,
Thank you for your reply but i need to know does inhibinB shows the quality of my ovarian. If i have low result does it mean i will have high risk to have defect baby or higher risk to have mal formation baby. as i told you i did all the test on the 4th day of my menstrual cycle FSH: 4.19miU/ml / LH: 3.57mlU/ml / Estradiol: 50 pg/ml / prolactine13.41 ng/ml / InhibinB: 24ng/ml. So please i feel that my doctor is not govong me right information that s why i am asking your opinion.
Waiting for your valuable opinion.

Regards

ANSWER: Hello Again,

I'm sorry for being so direct with my previous answer.  I understand your worry.  There are many tests that have been developed to try to predict the outcome of IVF before doing it.  ALL these tests are INDIRECT measurements of various ovarian hormones, and by getting this information, the doctor might be able to predict who will be successful and who will not.  These tests include the Clomid Challenge test, Cycle day 3 FSH, LH, Estradiol, AMH, Antral follicle count and more recently the Inhibin proteins A & B.  I personally believe that they should be used only to the extent of the information that they give which is that they ovary may not stimulate well to produce a lot of eggs.  There is NO test that can evaluate egg quality OR quantity, although AMH is purported to do so.  The problem I see with these tests is that there are some doctors that are using them as a YES or NO test.  That is, they give them strict credibility, and if abnormal, tell the patient they will fail or should use donor eggs.  That can't be further from the truth!  It only takes ONE perfect egg/embryo to result in a successful pregnancy.  Whether your ovaries stimulate well and produce 20 eggs or 1 egg, the key to getting pregnant is having 1 perfect egg, so in fact, it does not matter how much your ovaries stimulate.  For that reason, I will allow any patient to try IVF even if their FSH is elevated, AMH is decreased or AFC is low (I don't use Inhibin at all . . . why use it?)  I have had many patients stimulate poorly with only one embryo to transfer and end up with a baby.  In nature you only have one egg at a time!  Of course I counsel my patients that their chances are decreased, because part of what makes IVF successful is a "statistical chance" or the increased number of eggs available that increases the chance of finding that perfect egg.

My recommendation would be to disregard the Inhibin.  Your FSH level is perfectly fine.  It does not "predict" anything such as miscarriage or genetically abnormal fetus, etc.  It is ONLY a TOOL.  It might indicate something about RISK, but it does not PREDICT, and ALL of life is a risk but in most cases, those risks never come to pass.  DISREGARD THIS TEST.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate


---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Edward,
Thank you very much for your explanation so as i understand the test is more for IVF but for me i don't know why my dr is pushing me for the IVF. the sperm test of my husband are great so with my hormone test in your opinion i can try to be pregnant normally without doing any injection to increase the quality and without thinking of IVF?
Regards

Answer
Hi Again,

I cannot answer that question without a complete review of your medical records and a complete history.  I don't know what other factors are being considered that would push you into IVF, but your blood tests alone are not enough to make IVF your only choice.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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