Infertility/Fertility/fsh amh ivf vs natural

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Question
Hi.
I am 41. my FSH is 7 and my AMH is 5.7   I had a miscarriage at 25 and then two healthy pregnancies.  With each pregnancy I got pregnant in the first month after discontinuing birth control pills. I am wondering if it is better to try to conceive naturally or with IVF. It may sound like a dumb question. I am also wondering if my numbers are any indicator of egg quality or just of how well they would respond to stimulation.  I am obviously very concerned about birth or chromosomal defects at my age. thanks in advance.

Answer
Hello Carrie from the U.S. (New York),

Your FSH and AMH are indicators of ovarian function and not egg quality.  There is no measure or test for egg quality and that is what is affected with age.  Based on the numbers, it seems that your ovaries are still in good condition and probably will respond well to stimulation with fertility medications.

In terms of your risk of genetic abnormalities, that is a risk you have based on age.  It cannot be predicted or prevented.  The only option that you have to significantly reduce that risk is to consider preimplantation genetic screening, which is done in conjunction with IVF.  In this procedure, the already developing embryos undergo biopsy at Day#5 and evaluation for the chromosomes is done.  This will tell you which embryos are normal or abnormal at that stage.  It doesn't guarantee a normal fetus (because there is still more development after that stage), but it significantly reduces the risk.  Your risk of genetic abnormalities would be the same if the pregnancy occurred naturally or via IVF, but in my experience, the risk is lessened via IVF because the embryo has to undergo a harsher process in order to achieve pregnancy.  In my 20 years of experience, I have only had three genetically abnormal fetuses out of many hundreds of pregnancies.

If you have not tried naturally, it would be worthwhile to try on your own for up to 6 months, but if no pregnancy ensues in that time, I would recommend quickly moving to IVF before you run out of time.

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.  I now provide personalized fee for service consultations/advice/direction via email and payable via Pay Pal.  If interested, contact me via my email at info@montereybayivf.com.  This service will allow you to have your own personal on-demand infertility expert  

Infertility/Fertility

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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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