ABSTRACT: Although the transfer of fertilized donor oocytes is the most efficacious mode of conception for infertile women with hypergonadotrophism associated with incipient or apparent ovarian failure, there are many individuals who, for religious, ethical, or personal reasons, would prefer to try to conceive with their own oocytes.

The three cases presented here represent extremes to date for (i) highest serum FSH concentration in a woman with incipient ovarian failure (n = 2), and (ii) the oldest woman with apparent overt ovarian failure (n = 1) to have successful pregnancies. All three cases were treated for only a short time with pharmacological dosages of ethinyl oestradiol with luteal phase support with progesterone.

The peak FSH (mIU/ml) in cases 1 and 2 was 143 and 127 respectively. The precedents set in these cases can help physician-patient consultation when patients inquire whether there is a certain critical FSH concentration above which pregnancy is not possible or an age over which successful pregnancy could not be achieved even if ovulation despite ovarian failure was possible.

First case: A 36-year-old gravida 1, para 1 presented with a 3-year history of infertility. Her estradiol was less than 20 pg/ml, her FSH was 143 mIU/ml. Conceived 2nd cycle, delivered vaginally at full term.

Second case: A 35-year-old woman presented with primary infertility and oligomenorrhoea. FSH of 22 mIU/ml, estradiol was less than 20 pg/ml. She had a successful full-term delivery.

Third case: a 45y old woman, last menstrual period was 6 months previously, FSH of 35. She delivered a full-term healthy baby.

Read more: Human Reproduction, Vol. 15, No. 8, 1709-1712, August 2000© 2000 European Society of Human Reproduction and Embryology

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TODAY'S BOOK SUGGESTION:
3 Steps to Fertility
by Marina Nicholas

-- The world of infertility can be complex and daunting.

This book helps couples navigate the world of infertility treatment and tells them how they can maximize their chances of conceiving by following the three essential steps—gaining a full understanding of what conception entails, completing the necessary fertility tests at the appropriate time, and choosing the treatment that will improve their chances of having a baby.

Each infertile couple is unique, and what suits one couple may not suit another.

Some may be more comfortable first looking into complementary therapies while others will opt for immediate in-vitro fertilization.

With detailed information on assisted conception techniques, all possible tests, and how diet, ovulation tracking, hypnotherapy, reflexology, acupuncture, and herbal medicine can improve one's chances of having a baby, this book will help all couples find the right approach for them.

It also will ensure they are both better informed and more open to all forms of treatment as they embark on their journeys to parenthood.

Paperback: 160 pages
Click to order/for more info: 3 Steps to Fertility

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I was lucky enough to organise a Dr Check consult because I am in Australia, and also thinking of (maybe) cycling with him if things don't work out here at my clinic. I found him to be very helpful and patient with my questions, and although our discussion only lasted for 90 minutes - it began at 10.30pm his time and I wasn't the last one he had to speak to so he's clearly very very dedicated!

FSH: Cornell 2005 study said once someone's FSH has been above 15 (even once) then they must use donor eggs. He doesn't believe this and has had plenty of success encouraging women to try both naturally and with minimal stim cycles.

He said once you can achieve a 6-7-8 cell embryo then 65% of the time it should work if you are under 35 and if you are over 35 then 38-42% success (in the absence of other factors such as immune issues). A normal live pregnancy rate for someone 41-42 should be 20% per cycle (without distinguishing FSH as normal or abnormal).

WHY LOW DOSE STIM: He believes a high dose stim regime doesn't fry our eggs, but it does somehow affect implantation and this leads to lower success rates.

HOW DOES LOW STIM WORK: their premise is you don't add FSH on high FSH, i.e. they like to use estrogen to bring down your FSH if it is elevated. After this, he likes to let your own FSH drive your follicle growth - so whether or not they add FSH, and how much, is driven by your own levels during your cycle.

ANTAGNOSIST VS AGONIST: although there are some published studies suggesting lower success rates for an antagonist cycle, he believes these were earlier studies and it is no longer the case. He believes there are benefits to an antagonist cycle in that it is easier.

ESTROGEN PRIMING PROTOCOL: while he was the first to introduce estrogen to lower FSH before a cycle, he's not in favour of the full EPP because it means a whole month (while you're 1st on BCPs) is lost, ie. it takes two months in total, and seems to be wasting time.

BACK TO BACK CYCLES: this is case by case, but generally where there is no risk of hyper stim, then it should be OK.

ANY DIFFERENCE IN DRUGS: in their experience (and no studies have been done to confirm), very high doses of GONAL F seem to have had the lowest pregnancy rates. However when you use low doses it doesn't seem to matter whether you are using Gonal F, Follitism or Bravelle - they are all essentially the same ... He does seem to prefer Cetrorelix vs Ganerlix (sp?) though for antagonist cycles.

WHEN IS ENOUGH, ENOUGH? So long as you are producing nice embryos then even if you are over 40 years old, you have a chance of success with your own eggs. On the other hand, he is a pragmatist, so if you do want to increase your chances in any given cycle then donor eggs could boost success rates to 55%.

ABNORMAL FERTILISATION: I had a 3PN fertilisation on my last cycle and he suggested that it wasn't that my eggs are "suddenly old" but more likely a result of the protocol (very high stim of 900 Gonal F).

ICSI: in general he thinks arranged marriages aren't that good, i.e. your eggs probably know how to pick out the best partner better than we do. But he can see why in my case (where I only get 1-3 eggs) it might seem better to use it - even psychologically, because if you don't use ICSI and then they don't fertilise well you'd be upset (although the same could even have happened with it).

ASSISTED HATCHING: should definitely be done for older than 40 years, as the embryo is avoiding vital enzymes available to it on its way down the fallopian tube.

DAY 2 OR 3 OR BLAST: on Day 2 you can't hatch embryos so, for this reason, DAY 3 is better. On the other hand, on Day 3 some think the uterus is more sensitive/cramps more, so ... the only real advantage to blast is if you have lots of eggs and don't have a good freezing program ... on the whole, the best environment for them is inside you not in the lab.

IMMUNOLOGY: His background is in reproductive immunology. If you have NK Cells in your uterus, then they can have a protein that acts as a progesterone blocking factor and this can cause implantation problems. He thinks the studies show LIT can work, but it is hugely expensive and he thinks something like Intralipids (a free fatty acid from soybeans which can bind to the NK cells and deactivates them) works well too and is much cheaper ...

On the other hand, he doesn't think there are any tests which will reliably determine if you have got an NK Cell problem, so it would probably be best to just go off your history (ie, multiple IVF failures etc) ... Basically, he doesn't think anything else (like IVIG, etc) is needed and he wouldn't advocate them.

STERIODS: No good data to support the use of steriods (prednisone/dex) in IVF cycles. Doesn't think they are necessary.

HEPARIN: Only really helps people with implantation issues associated with APA. You can use it, but he doesn't really see a reason to do so.

MTHFR: I am homozygous, and he says it's quite common and heparin isn't really warranted - especially if you haven't got elevated homocysteine levels.

ASPIRIN: he hasn't seen any studies showing a difference in blood flow to the uterus or endometrial thickness based on aspirin. He thinks no aspirin (even low dose) is better.

VIAGRA/VAGINAL ESTROGEN: no good studies showing a significant difference in endometrial thickness with use of these, ie. wouldn't bother with them.

DHEA: he knows the Gleitcher (sp?) study showing higher implantation rates, but apparently it also showed higher miscarriage rates. Plus, he says it was a study on women around 30 years old where none of them had an FSH higher than 12. In other words, it's not convincing and he thinks pregnancy rates might be better without it.

ENDOMETRIOSIS: the studies are a little mixed. Some show no lower pregnancy rates in women with endo, some do. 2003 data showed IVF overcomes endo abnormalities, and 2005 studies showed endo does inhibit IVF success. If you have had multiple failed cycles without IVF then laparoscopy - a study showed 61% of women falling pregnant afterward vs 18% before. However, in my case where I have already had multiple laps for endo, he wouldn't advocate anymore.

HYDROSALPINX: I recently had my tubes removed due to hydrosalpinges (bilateral), and he said this is a good idea as plenty of research shows it impacts IVF success rates.

DIET/EXERCISE/SUPPLEMENTS: doesn't advocate anything special - regular healthy living etc ... don't have to give up exercise, sugar, meat or use only organic food etc etc etc.

GOLDEN EGG THEORY: the premise behind the high stim approach is the higher the better. The argument is our bodies are like a lottery - the higher the number of eggs achieved, the higher the probability of getting that one golden egg from the (presumably) bad lot.

Dr. Check feels our body knows how to identify the best of the eggs in our basket, and kicks out this one each month - so even if you use a low stim approach and get only 2 embryos, it's not necessarily a worse outcome than someone using high stim and getting 9 embryos ...

Source: Check Consult - Summary of Info - (Long)

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Abstract
Background: Effects of androgens on follicle maturation have been controversial for some time.

Here, we review the potential of their applications in improving human ovulation induction, based on human and animal data, reported in the literature.

Discussion: Selective androgens appear capable of improving early stages of folliculogenesis.

They, therefore, may represent forerunners of a completely new class of ovulation-inducing medications, which, in contrast to gonadotropins, affect follicle maturation at much earlier stages.

Read rest of article

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TODAY'S BOOK SUGGESTION
Making Babies the Hard Way: Living with Infertility and Treatment
by Caroline Gallup

-- A frank account of one couple's discovery that they cannot have children of their own, and their ensuing struggle through four years of fertility treatment.

One in six couples worldwide seek assistance to conceive and 80 per cent of couples undergoing fertility treatment are currently unsuccessful.

Writing with humour and honesty, Caroline Gallup describes the social, emotional, spiritual and physical impact of infertility on her and her husband, Bruce, including feelings of bereavement for the absent child, the unavoidable sense of inadequacy and the day-to-day difficulties of financial pressure.

As well as telling her own moving story, she also offers information and guidance for others who are infertile, or who are considering or undergoing treatment.

Paperback: 240 pages
Click to order/for more info: Making Babies the Hard Way
Find it on Amazon: US | CDN | UK

Start reading Making Babies the Hard Way on your Kindle in under a minute!

Don't have a Kindle? Get your Kindle here, or download a FREE Kindle Reading App.

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February 2, 2010 — The European Commission (EC) has approved corifollitropin alfa subcutaneous injection (Elonva, Merck and Company, Inc), the first sustained follicle stimulant.

Corifollitropin is indicated for controlled ovarian stimulation (COS) in combination with a gonadotropin-releasing hormone antagonist for the development of multiple follicles in women participating in an assisted reproductive technology program.

Read more...



Recent Keyword Searches: think twice before touching fertility statues, can women over 40 get pregnant, examples of 49 year old women becoming pregnant, can you get pregnant with high fsh levels?, woman 49 pregnant with own eggs

Picture by Egahen
When couples decide they want a baby they want a baby now, or at least nine months from now. So when month after month of "TTC" (trying to conceive) goes by and "2WW"(two weeks waiting) gets you a "BFN" (big fat negative) on your home pregnancy test, you and your "DH"(dear husband) are understandably disappointed, frustrated and shocked. Eventually many couples seek help, have a fertility workup and get prescriptions for injectable fertility drugs as part of a treatment plan which may also include IUI (intrauterine insemination) or IVF (in vitro fertilization).

Full article: http://www.fertilityneighborhood.com/content/in_the_news/archive_1334.aspx

Picture by wtf-
The role of luteal phase estrogen in pregnancy outcome has been a matter of considerable debate.




Recent Keyword Searches: you can get pregnant over 40 naturally, possibilities of conceiving at 47 years old, how many women over 40 become pregnant, fertile 40's pregnant, how old is too old to have a baby

Found this post on Women Over 40 With High FSH:

Check out this info.: This info. is best suited for those of you who are self pay and could use saving a few bucks on meds. These pharmacies might also work if you have a drug program that allows you to purchase from any of these pharmacies.

I did a little research and found these to be the cheapest prices around. If you have a pharmacy that offers a better deal... Please post it so others can take advantage of it.

Overall Ivfmeds.com is the cheapest by far BUT it works best if you can order in advance so that you save $ on shipping costs.

Alexander Twin Pharmacy offers the best deals overall for a pharmacy in the U.S. and they include Free Shipping. I plan to use both of these pharmacies.

Below is a list of common meds and their prices along with the name and phone numbers of the pharmacies listed.

For many of us... Every penny counts! I hope this helps you save some money...

FYI...I'm not affiliated in anyway with any of these pharmacies

Cheapest Meds:

Bravelle:
Ivfmeds=20 vials =$619.00 or $669.00 depending on shipping timeframe
AlexTwin=20 vials=$720.20 free shipping

Follistim:
Ivfmeds=300IU=$226.50 or $276.50 depending on shipping timeframe
AlexTwin=300IU=$208.00 includes shipping
Apoc=300IU=$202.50 free shipping with $400.00+ purchase

Gonal-F:
Freedom=300IU $219.00 free shipping
(Freedom has a discount program where you purchase meds for two cycles and you get the average cost of meds for third cycle free)

Menopur .75IU vial:
Alextwin=$48.00 free shipping
Ivfmeds=$35.90 shipping costs depend on shipping timeframe

Ganirelix 0.25:
Ivfmeds=$60.00
AlexTwin=$69.00

Cetrotide:
Alextwin:$92.90 free shipping

Ovidrel: 250mcg:
Alextwin=$59.90 free shipping
Freedom=$69.00 free shipping
Apoc=$69.00 free shipping with $40.00+ purchase

Discount Pharmacysts:
ivfMeds.com
W-800-341-0464
F-800-258-4693
Shipping $39.00 or $89.00

Alexander Twin
W-877-750-7222 X3
F-609-585-1679
Free Shipping

Apocathery:
W-877-792-7684
Free shipping with purchase of $400.00 or greater

Freedom:
W=800-660-4283 X6

Source: http://www.network54.com/Forum/53068/thread/1197129820/Cheapest+meds+%26amp%3B+self+pay

Technorati Tags:pharmacy, drugs, ivf, freedom, bravelle, follistim, gonal-f, menopur, ganirelix, cetrotide, ovidrel, apocathery