38 and High FSH Level

[Anonymous]

I'm 38 and had an FSH level of 18 this cycle. I have one daughter who was conceived naturally (she's 15 months) but went to a fertility doctor 4 months ago b/c I wasn't getting my cycle regularly. The first cycle on chlomid my FSH was 6. The second cycle it was 10. This cycle it was 18. The doctor is now recommending IUI or IVF. Given my age, should I go straight to IVF? Also, is there anything that I can be doing (dietary recommendations or other) to lower my FSH?

Thanks for your help.

[Anonymous]

When I first started trying to have a baby at 38, I was diagnosed with high FSH, and my husband has poor motility so IVF was the best option. I was uncomfortable with the idea of fertility drugs because I have an aunt that died of ovarian cancer in her 30"s. We did natural cycle IVF at Dominion fertility and we were successful with our first try. Now I'm approaching 40 in a couple of months and we have not been able to conceive #2 ans we're condidering stimulated IVF or DE.

[Anonymous]

If you can afford it, I recommend going straight to IVF and make sure you are with a doctor that is FSH friendly and one that deals with high FSH patients and knows the protocols to use. Dominion is not FSH friendly unless you choose to do the natural cycle with them.
I personally recommend stimulated IVF. I have high FSH and got pregnant via IVF after several tries.

[Anonymous]

What's your antral follicle count? And amh? I think those things are important too. 5 months ago i was told my fsh was 21 and I have been pregnant twice since then, 1mc with no explained cause and currently 5 weeks. On my own too. Granted my age is on my side, but my afc was 18 So the fsh count didn't mean much to my dr
Good luck!

[Anonymous]

Granted my age is on my side,

This is a really important fact, though. Younger patients with high FSH tend to have much better success rates than AMA patients with high FSH.

OP, is your AFC pretty decent? If so, I think it might be worth trying a few cycles of IUI with injectibles first. I don't think clomid is nearly as successful in older women so I would go with injects rather than clomid. Even if you respond well to clomid, the success rates are better on injects for AMA'ers. There is a qualitative difference for some reason. Getting 3-4 follicles on clomid isn't as good as getting 3-4 follicles on injects when you are AMA. And it sounds like you've done 3 clomid cycles already? I would ditch the clomid. Time to move on. An injects/IUI cycle is a lot less intense than an IVF cycle (the injections are subQ, not IM, and are pretty easy after you've done it once or twice), and you can see how you respond to the drugs, which will be useful info if you do move on to IVF.

If you don't succeed after 3 or so IUI cycles, then I would move to IVF.

[Anonymous]

I lowered my FSH through diet. Found out via blood tests that I had a high egg sensitivity (was eating hard-boiled eggs in the am). Went on a largely dairy and gluten-free diet, and totally egg free. Lowered FSH by half in a couple of months.

[Anonymous]

I'm a dominion Fertility patient that has high FSH and I agree with the PP who said there are other important factors such as AFC and AMH to consider. My DH and I were successful with our first natural IVF cycle

[Anonymous]

OP here. Last cyle I only had 2 follicles. My estrogen level has always been very good. I'm currently a patient of Dr. Sacks and really like him. He suggested either trying IUI with the more intense medication for a couple of cycles or going straight to IVF. Thanks very much for all of your responses.

[Anonymous]

You're in good hands with Dr Sacks -- he is definitely high fsh and advanced maternal age friendly. I would try a couple of IUI cycles with injectables, to see how you respond, but then move to IVF if you're able to.

[Anonymous]

OP, I was in your exact same shoes - 38, FSH of 18, and a two year old conceived naturally. The hard part is that you can't know how you'll respond to the IVF protocols until you do several, which requires a lot of time, energy and money. Personally, I was a horrible responder - I would get a couple follicles and when I went to retrieval once I only had one egg. So for me, it would have made much more sense to spend my time and money doing a series of mini-IVFs, trying to get 2-3 eggs at a time, rather than waste it on IUIs (where I wasn't sure if the sperm was meeting the egg, and what happened after) and canceled IVFs (where I was spending 4K on meds to make 2 follies). Unfortunately, if you want to go that route you don't have choices in the D.C. and would have to travel (Cooper clinic in NJ, SIRM in NYC - don't do New Hope).

[Anonymous]

PP here. I should add that my antrical follicles averaged around 8-9 per cycle, so the various REs thought that I would be able to get 8-10 eggs per IVF. And SG's statistical modeling gave me a 40% of live birth, had I stimmed okay. So there are some women with these numbers who do well - you just don't know who.

[Anonymous]

SG gave you a statistical model that gave you a 40% chance...what total crap according to their published stats.

[Anonymous]

I don't know about that - none of the REs I consulted with suggested donor eggs (at the time). The fact that I had fairly recently had a child conceived w/o ART was considered (by all the REs I've seen) as a good indicator of future success.