Comments on IVF Authority: Ovarian Reserve: An Overview (A Guest Post by Drew...

Thanks for sharing. Geoff Sher

2011-12-06T14:43:59.332-08:00

Thanks for sharing.

Geoff Sher

Hi Dr. Sher: What would you say to a 39.5 year-ol...

2011-10-13T19:36:32.088-07:00

Hi Dr. Sher:

What would you say to a 39.5 year-old-woman with the following day 3 results:

FSH = 7.14 miU/ml
Estradiol = 39.5 pg/ml
LH = 7.5 miU/ml
AMH = 8.13 ng/ml
Inhibin B = 92.9 pg/ml

AFC = 9 in one ovary and 12 in the other.

My doctor wants to re-run the test because the AMH level is out-of-whack. She said it indicated advanced PCOS. I've never been diagnosed with anything and have always had regular periods. Do you think there is major cause for concern, or that something simply went wrong with the initial testing?

Dr. Tortoriello responds: 1. Can that one egg, wh...

2011-08-15T11:07:18.487-07:00

Dr. Tortoriello responds:

1. Can that one egg, which ovulated, be a genetically abnormal egg? YES

2. Can any or more of those in the troop which eventually die, actually contain an euploid egg? YES

3. In an IVF cycle, are all the follicles that grow & develop, upon FSH stimulation, from the antral follicles from that month/cycle? YES; SOME ARE TOO SMALL TO BE NOTED THOUGH AT THE ONSET OF THE CYCLE BUT LATER ACCUMULATE FLUID AND ARE VISIBLE.

4. Will doing IVF repeatedly (3 cycles & beyond) cause ovarian reserve to decline more rapidly, esp in already DOR women? NO; YOU LOSE WHAT YOU WOULD HAVE LOST ANYWAY

Thanks for your question. Both Dr. Sher and Dr. T...

2011-08-11T10:33:40.326-07:00

Thanks for your question. Both Dr. Sher and Dr. Tortoriello are currently out on vacation with limited or no internet access, so their response may be delayed.

Admin

The ovary, as miraculous a structure as it is, is ...

2011-08-10T20:57:58.128-07:00

The ovary, as miraculous a structure as it is, is unfortunately very wasteful. Every month it calls forth from within itself a troop of immature eggs, only one of which is destined to ovulate. All the other eggs that were recruited will die, a process called atresia.

Dr Sher,from this blog entry, I have pasted above some content. And I have a few questions.

Every month naturally in a woman's body, a troop of eggs are recruited and only one matures and ovulates.

1. Can that one egg, which ovulated, be a genetically abnormal egg?

2. Can any or more of those in the troop which eventually die, actually contain an euploid egg?

3. In an IVF cycle, are all the follicles that grow & develop, upon FSH stimulation, from the antral follicles from that month/cycle?

4. Will doing IVF repeatedly (3 cycles & beyond)cause ovarian reserve to decline more rapidly, esp in already DOR women?

I hope you caught the meaning of my questions. I am trying very hard to pose them in such a way that you know what I am asking. Thanks!

Hi Dr. Sher, I just found your blog article. I u...

2011-05-24T12:24:50.884-07:00

Hi Dr. Sher,

I just found your blog article. I understand that AMH can be drawn anytime in your cycle BUT what about if you have a large ovarian cyst? I have a 5 cm functioning cyst seen yesterday (was 1.9 cm prior going ahead and starting a clomid/menopur/IUI cycle that was cancelled). Apparently the meds stimulated it to grow so it is now 5cm. My doctor wants me to do CD2 labs including FSH, Estradiol, and AMH. CD 2 will be within the next 3-4 days and I'm assuming the cyst will still be there by then. Will the presence of this function cyst affect the AMH level as well?

Hi N, Given the number of antral follicles on you...

2010-07-20T16:21:43.134-07:00

Hi N,

Given the number of antral follicles on your one side...it is likely that the other side is equally productive and that all is normal in your case.

Hi Mou, Of course it is possible. It all depends ...

2010-07-20T16:20:26.180-07:00

Hi Mou,

Of course it is possible. It all depends on the cause of the hormonal imbalance.

Geoff Sher

I just found this post and am wondering what a &qu...

2010-07-15T10:55:11.080-07:00

I just found this post and am wondering what a "normal" AFC would be for a 38 1/2 year old. I have 8-10 on my left. (Right ovary can not be found using ultrasound and is thought to be "out of eggs" or hiding)

Hi Dr, My age is 27. Recently diagnosed with Comp...

2010-07-14T02:34:41.835-07:00

Hi Dr,

My age is 27. Recently diagnosed with Complex OV Cysts on both ovaries. I have hair growth on my breast and cheek. period irregular. sometime miss it. gained bodyweight approx 82Kg. Do i have any hope of getting pregnant? please advise.

Given your nyouing age and the fact that it is age...

2009-12-23T11:05:35.499-08:00

Given your nyouing age and the fact that it is age and NOT%b vFSH that affects egg/embryo quality, you could well have a chance still. BUT time is the issue. I suggest you call 800-780-7437 without delay and set up a phone consultation with me. It is gratis.

Happy Holidays.

Geoff Sher

Hi Dr. Sher, I just turned 28 years old and was to...

2009-12-21T20:01:59.192-08:00

Hi Dr. Sher,
I just turned 28 years old and was told I have high fsh (tested only once which came back at 27) I also had my AMH tested and that came back extremely low. I wasn't given the exact number, but for some reason .1 is ringing a bell. Am I out of hope? What would you recommend? Thankfully my husband has good count, motility, etc.

Please contact us for a free telephone consultatio...

2009-10-13T18:19:48.999-07:00

Please contact us for a free telephone consultation (see the invite at the top of the page).

Geoff Sher

Dr. Sher, I was diagnosed withe endometriosis two...

2009-10-12T12:13:18.840-07:00

Dr. Sher,
I was diagnosed withe endometriosis two years ago at the age of 29. I'm 31 now with 6 unsuccessful IVF trials. My body only responds to Pureagon, producing 1 to 2 follicles i have a high Fsh level, and was wondering if this a case you would take on?

Thank you for your kind and prompt response. I did...

2009-09-21T18:51:03.699-07:00

Thank you for your kind and prompt response. I didn't know this. I will call.

Brigette

Of course we would be willing to accept you. Remem...

2009-09-21T14:37:17.247-07:00

Of course we would be willing to accept you. Remember, it is NOT the ovarian reserve (as indicated by FSH,AMH,inhibin B etc) that determines egg quality.It is age and the protocol used for ovarian stimulation that determines egg quality. The eggs of women with DOR require a much more individualized protocol of stimulation.

Please read other blogs on this site regarding factors that affect egg/embryo quality.

Also feel free to call 800-780-7437 for a free medical telephone consultation with me to discuss, if you wish.

Good luck!

Geoff Sher

I was diagnosed with DOR at age 32. I am now about...

2009-09-21T14:09:08.277-07:00

I was diagnosed with DOR at age 32. I am now about to turn 35. I have had 3 unsuccessful IVF's in upstate NY. I had a positive pregnancy test on my second but my levels were low. My most recent cycle only yielded one embryo. I am debating on whether I should move forward with another IVF. I know my FSH is high but I have not received any other testing that you refer to in your article. Would SIRM consider me as a patient? Also, does SIRM use a woman's endometrial lining to develop a culture for the embryos and if so, does this add any benefit for women with DOR?

Dr. Tortoriello responds: Diminished ovarian res...

2009-09-10T09:15:11.488-07:00

Dr. Tortoriello responds:

Diminished ovarian reserve is a possibility; not even PCOS patients maintain their high output forever. However, no one indicator of ovarian reserve is perfect; it is better to get a few tests done to get a more comprehensive overview. Regarding your AMH level, it does appear to be low for a woman with presumed PCOS, but the value is not consistent with poor ovarian reserve by most facilities standards. Also, the specific AMH assay used by different facilities can differ and one lab's 0.6 can be higher in another lab. It is important for your facility to compare their AMH values to patient outcome so they can counsel you appropriately. If your doctor scans your ovaries and they still have many small antral follicles (at least 7 per ovary), then your ovarian reserve should not be a big issue.

- Dr. Tortoriello

Thanks for posting this - could you comment on low...

2009-09-09T21:15:52.715-07:00

Thanks for posting this - could you comment on low AMH, PCOS and response to oral meds like clomid or femara? I was diagnosed with PCOS 2.5 years ago, conceived twins on our first clomid cycle last September (but lost them in the second trimester) and have been unable to conceive since the miscarriage. I respond to both femara and clomid (50 mg) with 1-2 follicles. This last month out of the blue, I ovulated early on my own and an AMH test came back at 0.6. I though AMH for PCOS patients was supposed to be high? All of a sudden I am facing DOR in the span of a few months. Is this possible or likely? What is my prognosis give my response to clomid/femara?