Dear Professor Winston
I listened to the interviews on BBC Radio 4 and Radio 2 with you and feel a glimmer of hope that someone can give me impartial advice. I have been told after two failed IVF attempts that my ovaries seem to be in a shutdown as they have not responded to the highest dose of two different IVF protocols. As I am resident of the Channel Islands I have to be advised by my local hospital as well as the private London clinic to which the hospital is affiliated to. Both seem to be suggesting different ways forward. The first is advising a donor egg; the other to keep pursuing IVF. I don’t want to rush into a donor egg decision, yet at the same time I don’t want to keep going through the stressful and very expensive process of IVF, without knowing whether it is really helping our chances. Please can you review my case and advise me on the best way to proceed; as I feel I am not receiving the full picture from my doctor as his hands are tied by the clinic.

I am 30 years old and have been trying for over 3 years to conceive. I have never been pregnant before. I have a regular 28 day cycle give or take, and bleed for approximately 5 days. I have no significant gynaecological symptoms and no past history or pelvic infections. I have had a laparoscopy which confirmed everything as normal. However my AMH level is at 1.6 and my highest FSH level was at 19.
My husband’s sperm results from Oct 2014 revealed a semen mobility of 8% whilst there were 4% with normal morphology and the count was 16.0 x 10^6/ml. no antibodies present in the seminal plasma but volume was low at 0.5mls, however we were told that this had gone back to a normal level when further samples were required for a series of IUI treatments.
We were advised to pursue treatment through IVF with the highest dose of Gonal F. I only produced 4 follicles with only two eggs extracted, neither egg fertilised as one of them was MI maturation and the other was GV. We tried for second round of IVF while on highest dose of Menopur and Cetrorelix but a scan revealed my ovaries were very quiet. The doctor said that my ovaries seem to be in shutdown and said that this cycle should be cancelled and other options discussed.
I had a call from the clinic that same evening; they said I should continue with the IVF as my last IVF also showed that my ovaries were slow at responding, which seemed to conflict with what my doctor was saying and my last IVF didn’t produce a good result.
I took the decision in my own hands to cancel it for that month as I was feeling very stressed. I know that my doctor would advise donor egg but the clinic is saying try IVF again. I have an appointment with my doctor to discuss the way forward in mid-October but would really appreciate hearing what you think, so I can go into that meeting feeling better informed. Thank you J.

Reply…

Dear J,

Both these suggestions are not unreasonable however I personally think your doctor is right. But I regret you are very unlikely to respond to IVF stimulation with an AMH this low and FSH levels this high irrespective of the amount of Gonal F you are given, or the protocol used. Even though you are only 30 years old the chance of a pregnancy after IVF with your own eggs must be not much higher than 2% (it would be less if you were older and, in any case it is likely to be probably lower given that your husband doesn’t have very favourable results) which is a huge gamble for so much money. Before taking a final decision though it might be worthwhile getting an ovarian ultrasound scan at the beginning of an unstimulated cycle, to see how many small follicle can be identified and to measure the size and volume of your ovaries.

I think I would be inclined to consider egg donation, if an egg donor can be found. Then at least, the main difficulty is only the sperm and your chance per cycle of treatment will rise substantially to around 25 – 30% – odds which are at least 15 times better, if not more.

Best wishes
Robert Winston

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