Dr. Ramirez,

I am a 34 y.o. from Massachusetts. I was on Depo for >10 years. Nov 2012 my GYN suggested I stop taking Depo and get the Mirena IUD. My Mirena was inserted in Nov 2012 and removed in April 2013 because I started to have side effects including hair loss. My TSH was checked in April but was normal. My doctor then started me on Apri BCP but due to increased side effects including breast tenderness and swelling my doctor stopped the BCP 3 weeks into my 2nd pack. I was not started on anymore birth control at that time. After 3 month my cycle did not start. I informed my doctor who stated this was normal and told me to continue to wait. In Sept 2013 I broke my Navicular bone in my foot. By Nov 2013 there was minimal healing with the foot and still no cycle so my doctor decided to try some testing. She again checked my TSH and it was normal. She then did a Progesterone 10 challenge test and there was no cycle. She then tried Estrogen for 30 days while adding 10 days more of Progesterone starting on the 20th day of taking Estrogen. Still no cycle. So she then checked my FSH and it came back 178. I went to see a Reproductive Endocrinologist in Jan 2014 who did a full work up including FSH, TSH, Estrogen, Progesterone, Testosterone, Fragile X, Prolactin, Vitamin D and AMH. All the test were normal except for the FSH and AMH. FSH was >178 and AMH was <0.3. In April 2014 my primary MS started me on Ortho Tri-Cyclen Lo at my request to see if it would induce a cycle. My FSH in April 2014 was 128. In June 2014 after taking 2 months of BCP my FSH on the 3rd day of cycle was 19. I continued BCP for 2 more months. I did not restart my pack for August 2014. A week after my pack was due to start my FSH was 111. I want to know could me FSH and AMH be a results of my ovaries being in a "sleeping state"? Do you think I would benefit from a stronger BCP to flood my ovaries with Estrogen and Progesterone to hopefully start them back working properly? Should I speak with my doctor about maybe starting Clomid to try to stimulate my overies? I have never been pregnant and now me and my boyfriend is read to start our family.

Hello Shirley from the U.S. (Massachusetts),

Since you have seen an RE for this problem, I am sure that he/she has given you a diagnosis, so I hope this is not redundant.

The elevated FSh level is an indication that your ovaries have stopped working.  There is no such thing as a "sleep" state (or if there is, we don't know about it), so the only diagnosis that can be given is "premature ovarian failure".  This is also know in lay terms as "premature menopause".  This is a condition where the ovaries stop functioning at an early age.  We don't know why this happens but recent research from Stanford shows that there is a specific hormone that turns the ovaries off.  They have developed a counter hormone to block this and have been successful in stimulating patients in order to get them pregnant.  This is in the research stage at this time.  It is probably the only option that you have and I do know that they are recruiting patients like you for their study.  If this is something that you are interested in, you should contact Dr. Steven Nakajima in the Reproductive Endocrinology Division and Clinic at Stanford University.

If your ovaries don't work, no fertility medication can get your pregnant, including Clomid.

The reason why your FSH declined with the birth control pill is because the BCP made it go down.  That is artificial and therefore does not mean that it caused your hypothalamus to work.  The ovary is still shut down in that environment and the birth control pill is just over-riding the natural physiology.  Once you stop the pill you go back to your natural environment.

Other than the Stanford study, the only other good news I can give you is that I have had patients that became spontaneously pregnant with POF.  Basically what happened is that one cycle their ovary worked and they ovulated.  Luckily, they were sexually active and hit the right time so they got pregnant.  There are also cases in the literature where the ovaries suddenly started working again, although these are exceptions to the rule.  So there is some hope that you could turn up pregnant as well.

Sorry for the bad news but I hope that clarifies things for you.  If you have any further questions, please feel free to contact me directly by my email below.

Good Luck,

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

Monterey, California, U.S.A.

for additional information check out my blog at 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.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at if you are interested in continuous access to me.


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Edward Joseph Ramirez, MD, FACOG


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.


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.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

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

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

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