Diminished Ovarian Reserve

[curiouscat6]

Hi ladies,
I'm in desperate need of support... I'm 33 and aside from a surgery to remove a large cyst have been pretty healthy most of my life. After 6 months of TTC and light brown spotting before AF, I went to see an RE. He took some blood tests and did an ultrasound and told me I now have diminished ovarian reserve. My AMH came back at 0.38. I'm devastated--he thinks my surgery stripped my ovary back in the day and I have scar tissue. I have a normal FSH--5 and LH--4, but the amount of available eggs I have left in my ovaries is low and I found out I have a blocked tube on my left side--my right is okay. I'm so gutted. The doctor kept pressing IVF my hubby was shell shocked now he says he doesn't want to do anything until November.. I know I'm losing time and likely won't have success naturally.. since I'm also still spotting 7 days before AF. any advice?

 

[_Nell]

Hi, I have DOR too, I'm 31 and have no idea why I have no eggies left. I found out at the end of March while having my spotting investigated that my AMH was shockingly low. My antral follicle count confirms this.

My FSH and LH are ok too, my E2 is usually though this month it is elevated (a sign of DOR too).

I also have spotting 7 days before AF - there's a really friendly group of gals on here for that, most are just at the point of investigations but obviously i've found out mine is due to DOR really
https://www.babyandbump.com/ttc-gro...eek-before-af-every-month-anyone-else-51.html

Can I ask why November? Is it just to give him time to come to terms with the idea of IVF?
Are you in the UK? I hear good things about the Lister clinic in London for those with poor AMH, perhaps another consult with your DH just to discuss your options might help things sink in for him?

 

[curiouscat6]

Hi Nell,
He was so shell shocked when he found out and got angry--thinking the doctor was lying... He still thinks we can get pregnant naturally even though the odds are against us... He just can't seem to come to terms with the severity of the idea and said he doesn't want to start with drugs or anything else until nov.--that will give us 5 months of trying naturally. But with my AMH I'm terrified of losing time... My DH thinks that since my right side isn't blocked and the ovary looks good that it's fine but I don't agree and we've been fighting constantly.. any advice?

 

[_Nell]

My DH was the other way, it was me that was all doom and gloom initially.....even IVF was a 'waste' of time to me then (It isn't I was just super pessamistic!). My DH was all just 'oh it'll be fine' and I worried he didn't grasp the enormity of the diagnosis.
I felt incredibly anxious after my diagnosis, but felt better when I started to put the treatment wheels in motion I coped better

I can't remember which article I used but I found one via google, explaining DOR, what it meant, the options etc (few mention trying naturally tbh) and gave him just 1 article to read - perhaps you could even say it has come in the post from your clinic if you think it might anger him that you're pushy. My DH didn't want to consider the internet and would only listen to a FS, at that point I had only been seeing my gynae and I knew DOR likely meant IVF....I needed him to be prepared for that.
He also though IVF was super scary and really it isn't (well not for him!), just costly.
If your DH disbelieves the Dr's advice, how about suggesting a 2nd opinion to give you both peace of mind......he might take it differently hearing it from 2 people.

The FS we saw was very honest, we don't have time. He said if I was his daughter (and his daughter is the same age as me) he'd suggest IVF, then IVF shortly after baby 1 if I want to try have baby 2!
But your DH isn't 'wrong' some people do achieve a natural pg with DOR, but I do believe they are the minority and for me I just want to feel I've given myself the best shot, plus my cycle is a little off already with the early O, LP spotting and cramping I get.

I'm opting to do thing a little oddly. I'm having 1 cycle of IVF, to see how i respond and to assess my egg quality (a BFP will be a bonus!) if it's a BFN but I responded ok/had good eggs then I will feel I can relax a little and will probably try naturally a little longer.

I've only just started IVF this week, it already doesn't look great as my 'normal' fsh is oddly high this cycle apparently due to my high estradiol. It seems luck isn't on my side.

(((hugs))) not wanting to be dismissive of other infertility diagnosis but I do think DOR/POF sucks the most as you have the added pressure of time

 

[curiouscat6]

Thanks so much Nell. I really appreciate your support. My husband seems to believe that because AMH is new it's not reliable... so he doesn't put much stock in the number. My spotting seems to concern him the most.

The RE we went to was horrible, he didn't explain anything and just pressured us to do IVF... I understand now why he did that but he needed to be more clear. Now my DH is angry and confused and wants to wait until November before getting a second opinion and starting treatment. For now, he just says he wants to try naturally until Nov.

I cope better when I have more info so this waiting is going to be torture. I went behind his back and made a second opinion apt for september and when he found out he was so MAD... we've been fighting constantly and he says I'll have to go alone..

I just feel so down and hopeless...

My estridol is 82, my FSH 5, LH 4--so what does that mean that our estridol is so high. is that why we are spotting? does it mean we have bad quality eggs? I'm just so needy for answers...

 

[_Nell]

Hi,

Your estradiol is right where mine is, it's not crazy high but higher than 'normal'. It is thought that the high Estradiol masks or suppresses your true FSH - so in reality your FSH isn't 5 at all it's higher (no indicator of how much higher though!).
Higher estradiol is also an indicator of diminished reserve, basically because our reserve is low our body starts recruiting follicles earlier than other women, in the luteal phase of the previous cycle. Then when we get to day 3 of a new cycle our bodies already have recruited and in some cases a dominant follicle might already be visible on ultrasound. Because our bodies have done some of the work early our FSH looks lower than it should, but the estradiol gives it away.
All these signals together and in combo with the spotting indicate that whilst we might still have some eggs everything is slightly out of synch, ovarian dysfunction and it is likely that our bodies need something to boost or support our natural ovulation. Both our RE's said clomid would not be sufficient - but it does work for some and might be worth a shot for you to try in the 'gap' between now and november?

I know what your DH is saying about AMH, it is 'new' in the scheme of things but it has improved massivley from the early days back in 2008/2009. Unfortunately the internet doesn't date articles so you might find lots of outdated websites referring to it being unreliable (some don't even mention it at all for DOR and still refer to the old climid challenge test), new etc but the fact is a lot of RE's especially in the UK and Europe do put a lot of weight in your AMH score.

But your diagnosis hasn't just come from your AMH score, it has been confirmed by higher than normal Estradiol AND the antral follicle count, plus your lengthy spotting in the LP also points to DOR. Antral follicles are the resting follicles for that cycle, a fertile woman might have 15-20 on each ovary and we don't. The AMH measures the hormone secreted by those resting follicles (and all the primordial follicles that are waiting for the cycles ahead) it is therefore deemed more accurate than a 'snapshot' antral follicle count.

I don't think trying naturall for a full 12months is wrong, but I feel like you and feel better for information and action.

The thing is if a man gets a shocking semen analysis there IS stuff he can try without doctors, diet and lifestyle changes that will improve results as he is continually making new sperm. When a women gets a poor state of play on her ovarian reserve there is very little she can do, what she has is what she has - she can only focus on the quality (v few real studies support but DHEA, CoQ10, royal jelly and bee pollen).

I see no problem with seeing the 2nd RE alone in september, to discuss you current situation. You will have an opportunity to ask more questions and discuss options even if you aren't mutually ready to proceed to treatment. You might also get an indicator of any other tests needed before treatment so that when November comes around you are ready to go straight for treatment with injections or IVF or whatever.

Sorry for such a long post and apologies if i'm repeating what you already know. I think it's the idea of IVF that scares men, IVF is something that happens to other people, not 'us' is how it feels. People also equate IVF as something you try as a last ditched attempt after years and years of trying, but with DOR it doesn't work like that as IVF is what you do to try make the most of ALL the follicles from that cycle while you still can.
IVF can also buy you time, it may not give you a baby first time around but you may be lucky enough to be able to harvest and freze some eggs/embryos for future use.

 

[curiouscat6]

Hi Nell,
Thanks so much for your feedback and support. The first RE we went to didn't tell me anything about my hormone levels, he just pushed IVF so it was unclear and very frustrating. I am going to a new ob-gyn next wednesday--i'm not sure she's going to know much about treating DOR but I'm hoping she can help in some capacity.. Just so I have something to go on what kind of treatment are you currently receiving? progesterone? something for estrogen supression.. I just feel so helpless right now...

 

[_Nell]

I saw 2 RE's and both said the same for my options, I had been off the BCP for 12months now, but only 7months of well timed TTC....

Injectibles to improve my ovulation (this would then sort out my spotting in the LP).
They suggested if I tried this to also do IUI. We have no spermy issues but injecting and monitoring a cycle is quite an effort so you might as well make sure the sperm gets to the right place too.
OR
IVF. Both recommended this over IUI if we could finance it as the odds are better and there is a possibility I might get enough embryos to freeze for a future use too.

Both suggested clomid wasn't worth trying......though I have seen people on this forum get pg with DOR and clomid.

As far as I know there is no treatment as such for DOR, it is what it is .
What they can do is try to get you pg as fast as possible and use injectibles to try to control your messed up cycle/hormones.
It is unclear with DOR just how long people have before their reserve is depleted and ovulation/periods stop......you might have years and you might not.

I was given progesterone by one RE to just stop the spotting (but not fix the reason why) for that cycle while I decided what I wanted to do treatment wise.

_____

I decided to go for IVF, the success rates aren't great but I know I will feel i've tried all I can by 'having a go'.
I'm on day 4 of my injections (which aren't as bad as i'd feared). It doesn't look like it's going to be straightforward for me and I'm at risk of my cycle being cancelled (I have 2 follicles growing crazy fast and the others not at all) but I knew that might happen.

Feel free to private message me if I can help in any way