33yo + high FSH

Hi, I had my day 3 FSH taken and it was at 11.6.  Also, my progesterone was low (12) and my prolactin was high (52).  I am 33 yo and my husband and I would like to get pregnant.  A pelvic ultrasound showed only 1 follicle on each ovary.  The diagnosis of "diminished ovarian reserves" is pretty depressing.  What are my chances of conceiving naturally, if at all?

What causes it and is there anything that can be done, or is this it for us?  Should we just progress immediately to IVF, as recommended by the RE?
Any thoughts/comments would be helpful.
Thanks!

[Elaine Brown, MD]

Hi!
If you were my patient, I would work up the elevated prolactin level.  I would make sure that your thyroid levels were normal, and I would consider doing an MRI of the pituitary gland.  With that accomplished, I would consider treating you with Parlodel or Dostinex to see if the prolactin would come down.  I would want to repeat the FSH level--wondering whether it would come down too.

Because your ultrasound also confirms a somewhat diminished ovarian reserve, I would want to use "big guns", or strong medications to induce your ovaries to work.  If there are no other indications for IVF (such as tubal factor, etc) it might be possible to do IUI instead of IVF.  IF you take this approach, have a goal firmly in mind--such as we will try this 1-3 times and then move on.

Your diagnosis doesn't mean that you can't conceive, it only means that you might have a poor responsed to the medications that thay will use.

Oh, and one other thing--don't forget about donor eggs--you could become a very happy mother within 10-11 months if you decided to pursue this option.

Good luck!
Dr B

[trying43]

Hi, Im not a dr but I can tell you my experience.  I had fsh level of 12.4 and progesterone level of 10.  I am 36. My OB said I would have to have IVF.  I went to an RE who did a lot of bloodwork including an AMH test which was .7. (on the low end for my age but she wasnt worried about it) She also found I had endometriosis and a polyp in my uterus.  After surgery to remove those, my fsh dropped to 5.5 and my progesterone went up to around 12 so she did a course of injectible meds(follistim, novarel) and pills letrozole and estrace, and progesterone supplements, I also took fish oil, vitamin e, calcium, vitamin d, folic acid, and a multi vitamin(sounds like a lot lol) and the first cycle of these meds worked.  I am now 18 weeks today.  I dont know that you should jump straight to IVF because there may be other things that can be done first or other causes of your fsh levels being elevated.  Have you had an HSG test done to check your tubes?  I also had this done along with the endo. and polyp removal.  Seems like so many drs. want to go to the expensive route instead of trying other stuff first.  Hope this helps and good luck to you.  

[allie235]

Thank you for your response.  My TSH went from 1.58 (2 months ago) to 3.58 (last week).  I do have Graves Disease and had RAI 7 years ago and I am on thyroid replacement.  My endocrinologist did increase my Synthroid.  The RE things the elevated prolactin was due to the TSH.  I also had a AMH and that came back at 0.7.  I was told that was "normal".  I'm not sure if the progesterone of 7.2 was due to the FSH/DOR or if it is due to the TSH.  Also, I did have a sonohysterogram done and everything checked out normal.  

My RE has suggested a hybrid (oral + injectable) and 3 rounds of IUI.  I'm a little nervous about these due to the potential side effects.

Thank you for your response.

[allie235]

Congratulations!  Thank you for your response.  I did have an HSG done about 4 years ago and everything checked out fine.  I also had a sonohysterogram done last week and that was normal.  My AMH came back at 0.7, which they said was normal.  Is that low?