41 Yr. Old Iranian Woman With Mixed FSH Results: Remember, FSH Levels Are Not A Measure Of Your Fert

Question:

Hi! I am 41, with a 22-day cycle. I got married 8 months ago and had a miscariage at very early months (1st month). Then, my doctor prescribed me clomid and letrozol which resulted in production of several eggs. however, I did not get pregnant.My last FSH test result at 21th day was 4.7, while its level at 3rd day (i.e. four days later than my FSH test at 21th day) was 35.5!

I am too much worried about this high level of FSH. What are your recommendations for FSH reduction and get pregnant?

thanks! M. from Iran.

Answer:

Hello M. from Iran,

I am surprised but glad that you are able to search the web, since many of us believe your government has tighter controls. Let me clear something up first of all. The FSH level is only valid for interpretation if it is done on cycle day #2 or 3. I would recommend that you have it repeated because the results you cited don't make sense. The FSH is a measure of ovarian function (or ovarian resistance). This is mainly important to determine how well the ovaries will respond to stimulation. It is NOT a measure of fertility.

However, if the CD#3 FSH level of 35.5 were correct, that would indicate that you are in menopause and your ovaries would be shut down. You would no longer be having periods and you would have menopausal symptoms such as hot flashes. Your ovaries would not respond to stimulation with Clomid or Femara. Yet, you mention that you were able to "produce several eggs" while on Clomid. That is why I don't think that your FSH level is correct.

From a fertility point of view, we want the FSH level to be less than 7. It is of some concern when it is between 7-10, which indicates that there may be less time for the ovaries than we suspected and that the ovaries might be more resistant that expected, and it is of great concern in the level is greater than 10 because that means there is significant ovarian resistance and a shorter time line. Once the level is 15 or greater, most fertility specialists will recommend using donor eggs.

The biggest hurdle that you are facing, in addition to ovarian function, is your age. Your chances of pregnancy with simple Clomid treatments is 2% per month of trying and with IUI is 5% per month of trying. I would not recommend this at your age. I think that time is of the essence, so that you don't lose the possibility of having a genetic child. For that reason I would recommend a more aggressive treatment plan, which would be to proceed directly to IVF. That would give you a 50% chance of pregnancy per month.

Good Luck and thank you for your question,

Edward J. Ramirez, M.D., FACOG
Executive Medical DirectorThe Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.

Twitter with me at @montereybayivf, and follow me on Facebook at http://bit.ly/9Iw9oV