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Detected with day 2 FSH level of 9.4. What are the chances of conceiving? Any medical solution? - Online Doctor Chats

Date : 01-Mar-2013
User rating for this question
Very Good Posted in: Infertility Problem
Answered by

General & Family Physician
Practicing since : 2005
Answered : 1745 Questions
User:My Wife aged 29 trying to conceive as been detected with a day 2 FSH level of 9.4. My doc says this reduces her chances of conceiving. Is there any medical solution to this.
User:Hello doctor. I am in need of a doctor who can help me with questions on infertility
User:Are you an infertility specialist
Doctor:I am general physician
Doctor:and I believe I can help you within my expertise.
User:what should i do to get into a chat with an infertility specialist
Doctor:Infertility specialist are not available on live chat. However
Doctor:you can discuss with them
Doctor:by posting your query through ask a specialist.
User:ok. I will do that separately
User:i will get your view as well
User:I am aged 30 and wife 29. We have been trying to plan a family for the last 2.5 years.
User:We have undergone 4 cycles of IUI and 1 IVF cycle which had to be cancelled
User:My reports showed my sperm count at 38 million
User:and my wife had a day 2 FSH level of 9.4
User:which according to the doctor is high but not very high
User:In all four IUI cycles my wife underwent a follicular study and it showed there were follicles growing in her ovary
User:however under the IVF cycles - despite the stimulation protocal she did not have a single follicle growth
User:we are baffled how this can happen
User:my treating doctor said that my wife will have to opt for donor eggs
User:however we are surprised to hear that after a single cancelled IVF cycle
User:we are wondering what went wrong. My wife is under tremendous trauma after having heard this.
User:Do you think such a thing is possible
User:or is it that a first IVF cycle is not a good enough basis for reaching this conclusion
User:Would you be able to guide
Doctor:When was the FSH level done?
User:FSH was done in the cycle previous to the IVF cycle...on Day 2 to her periods
User:She was put on Ovral G for downregulation before the cycle and then the cycle commenced with GNRH injections
Doctor:There are few reasons to find lack follicles. However when FSH values are under 15 and previous follicular studies showed normal follicles
Doctor:I am not able to find any reasons why there shouldn't be any follicles now.
User:which is why we are surprised.
Doctor:GnRH is commonly used drug to enhance follicle production and growth.
Doctor:Do you have the reports of the tests with you?
User:Is it possible that the follicles got completely exhausted due to the 4 IUI cycles
User:I dont have it ready at hand. but i may be able to answer if you have any specific questions
Doctor:Do you have the list of drugs used for stimulation protocols during her earlier IVF's?
User:She underwent only 1 IVF during whch she was on GNRH
User:during IUI she was on letrozole
User:and strangely in all 4 IUIs her follicular study showed follicles which also used to rupture after sometime
User:now shockingly in IVF it showed no follicles
User:Any feedback doctor?
Doctor:Both letrozole and GnRH have been used to stimulate growth and development of follicles.
Doctor:Unless there have been suppression of FSH, which is very unlikely with use of these drugs
Doctor:I do not find any reasons theoretically to explain the absence of follicles now.
User:Yes. I am aware. and my doc says GNRH is very powerful and if despite GNRH there is no follicle growth it means my wifes ovarian reserves are absent and we should opt for Donor eggs
User:i have some specific questions to which i need your answer
Doctor:It would be a good idea to recheck FSH levels again after discussing with an infertility expert.
Doctor:it might give us a clue as to what may have went wrong now.
User:Q1 - Based on your experience - is it possible in a womans body that she may not produce follicles in one odd cycle but do so in subsequent cycles
Doctor:There have been few cases where experts opted for donor eggs when the quality of eggs produced were not upto expectations.
User:Q2 - Is it possible that the follicles which were observed during IUIs could be follicles without any eggs inside them
User:Q3 - What would you suggest - is there any merit in trying one more cycle of IVF before we start thinking of Donor eggs or given the observation in the last cycle it may be worthy to straightaway go for Donor eggs
User:I need your response on the 3 questions i have posed above.
User:I am under a state of tremendous mental stress and any help from you will be most welcome
Doctor:1. Failure of ovaries to produce follicles is termed as ovarian failure.
Doctor:This usually occurs after menopause.
Doctor:However there have been few cases where they have been premature failures.
User:however can there be an odd cycle which fails while the subsequent cycles become normal
Doctor:During infertility treatment such conditions are due to prolonged use of GnRH, or due to multiple ovulation induction previously.
User:my wife used GNRH in only 1 cycle..
User:my question is do we have hope that this was an odd cycle which did not work and is it possible that a subsequent cycle may perform normally
Doctor:It is very, very unlikely to find such events happening with what you report.
Doctor:This however can be confirmed by repeating FSH and other hormone again.
User:i will do that but have u seen cases of a womans cycle having an odd failure ....lets say she was just having a an off cycle but otherwise things are normal
Doctor:2. If the size of follicles were normal and more than 10 to 12 mm in size and if your doctors were to find ruptured follicles earlier,
Doctor:I do not feel they were false.
Doctor:3. Without a proper examination and review of the test reports, it would be difficult for me to predict if donor eggs are really need.
User:i appreciate
User:Last 2 concluding questions
Doctor:I wish you to take an second opinion from an infertility expert here.
User:Q1 - Can there be follicle growth without eggs inside
Doctor:An experienced infertility expert would be able to give you more conclusive answers on the last query.
User:Yes, so you mean yes to Q1?
Doctor:There have been cases where follicles grow without good eggs.
Doctor:however in such cases we find very less follicle rupture.
User:ok. And secondly as a physician you may be treating women...have you come accross any case where a woman has an odd off cycle..i mean whe is normal but just one of the cycles did not generate eggs ...
Doctor:If your doctor did document rupture of follicles on follicular scan, the possibility that the did not have an ovum (egg) is unlikely
Doctor:If we can document that the cause for failure is ovarian suppression probably due to any of the drugs used or due to other causes, it is possible that we can reverse this phenomena.
Doctor:However it might need a repeat evaluation of the hormone test which are already done.
Doctor:I again suggest you to take an opinion from the infertility expert to confirm this.
User:Thanks that answers most of my questions. Just one last Q - Is an FSH reading of 9.4 for a 29 year old female extremely high.
User:or is it high but not a complete writeoff
Doctor:FSH values depend on an individuals age and the day of cycle.
User:She is 29 and it was Day 2 fsh
Doctor:Values of above 15 mIU/m on day 3 are considered high and associated with fertility issues.
User:so 9.4 is not that bad i would think?
Doctor:Your wife's value are not bad.
Doctor:I would however like to comment that high FSH levels are associated with failure of follicles
Doctor:hence it would not be a bad idea to repeat them.
Doctor:Have you followed what I suggested?
User:thanks. I will probably give it another shot and hope to be lucky this time. Thanks for your help. I will repeat her test and also pose my questions to an infertilty specialist on the site
Doctor:Thanks for consulting me.
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