Fertility Topics Explained from the Experts at SFS
CASE REPORT #1: Advancing age, Diminished Ovarian Reserve (DOR) + Male Infertility Geoffrey Sher MD Case History: Mary D. (42y) and her husband, Chris (43y) recently had a SKYPE consultation with me. The couple had been trying to have a baby for 1.5 years. Maria had been pregnant when she was 19 years of age and had an abortion without any subsequent complications. Aside from having had her gallbladder removed laparoscopically in 2015, she otherwise had an unremarkable medical history. Her family history was positive for high blood pressure (her mother and father); coronary vascular heart disease (her father) and Type II diabetes (her mother). A recent annual physical examination was absolutely normal. This included a PAP cervical smear and a mammogram which were both negative for malignant disease. Maria was tested for the number of eggs she still had left in her ovaries (ovarian reserve) by ich by way of her blood antimullerian hormone (AMH) level which was low at 0.2ng/ml (normal is >2.0ng/ml). This, and her markedly elevated basal follicle stimulating hormone (FSH) measurement of 29MIU/ml, (normal =<10MIU/ml) confirmed that she had severely diminished ovarian reserve (DOR), and that her ‘biological clock” was rapidly running out of time. A previously performed dye X-ray test (HSG) as well as a saline ultrasound examination (HSN) both indicated that her uterus was normal and her Fallopian tubes were open (patent). Chris had a reduced sperm count of 11 million per milliliter (normal is >20million per milliliter) with only 10% of his sperm being motile (normal = >40%), indicating moderately sever e male infertility. His blood FSH and testosterone levels were both in the normal range, indicating that it was unlikely to be a reversible problem. Maria had undergone five (5) failed attempts to conceive using artificial intrauterine insemination (IUI) after taking clomiphene (Clomid/Serophene), an oral fertility medication. Thereupon she twice underwent in-vitro fertilization. In her 1st IVF attempt, she used a modest dosage of injectable Fertility agents Follistim + Menopur). Five (5) eggs were extracted from her ovaries and these were fertilized through the injection of husband’s sperm directly into her eggs (intracytoplasmic sperm injection -ICSI). Two day-3 embryos were transferred to her uterus. The cycle was unsuccessful. In her 2ns cycle placed on a “low dosage” regime of fertility agents (i.e., Mini-IVF) using oral clomiphene + a low dosage of injectable gonadotropin (i.e. 75U Follistim). In this cycle, 3 eggs that were extracted. All failed to fertilize using ICSI. The couple sought advice how they should proceed: Analysis: There are several issues to consider.
MOST IMPORTANTLY: TIME IS OF THE ESSENCE HERE!! ADDENDUM: I intend to follow this couple and will report on their progress as treatment is implemented.
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