Hi Dr. Ramirez,
I am 32 y.o. woman and have been trying to conceive for 3 years. All testing was normal, although FSH was 8.7.
My first IVF on a long protocol produced only 2 eggs and only 1 fertilized. I was diagnosed with DOR at that time (31 years old). I had 2 other failed IVF that produced 6-7 eggs but only 2-3 by day 3. I had a miscarriage after the second one.
My question is, are there any tests you would recommend for someone my age with DOR and failed IVF x 3? I never have enough embryos to get to day 5 blastocyst so I am not able to do PGD. Also, would you suggest a laparoscopy for unexplained DOR? I have a family history of endometriosis, but I have been told that a laparoscopy might further decrease my ovarian reserve. Thank you so much for your time, it is greatly appreciated!
Heidi from Ontario
Hello Heidi from Canada,
Certainly based on the numbers you have provided, your ovaries have not stimulated well. This could be "decreased ovarian reserve" and we also call you a poor responder. However, before giving you that title, I would need to see what kind of stimulation protocol you were one. Often the stimulation will be proportionate to the amount of medication taken. So if you were on a lower protocol, you would not get many follicles or eggs, whereas, if you were on a high protocol then you would have gotten more unless you were a low responder due to decreased ovarian reserve.
There are no other tests that I would suggest or recommend. If you puruse the internet, you will see tests such as AMH and Antral follicle count but these would only confirm what you already know, that your ovaries don't respond well to stimulation (again I am assuming you were on a high protocol). Laparoscopy will do nothing for you whether or not you had endometriosis. Endometriosis does not lead to poor ovarian reserve.
I'm a little baffled by your result of stimulation, however, because you are so young and your FSH is not that high. I'm wondering if maybe your doctor just didn't give you a high enough protocol?
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
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