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Fertility / Infertility (Expert Forum)
Decreased Ovarian Reserve, but NOT ready to have kids now...
Answered by
Elaine Brown, MD - Pregnancy, Gynecology
Elaine Brown, MD - BLOG
Billings - MT
Questions in the Fertility/Infertility forum are answered by doctors affiliated with USF Health. Topics covered include fertility or infertility issues, egg quality, fertility drugs and side effects, fertility tests, genetic testing, in-vitro fertilization (IVF), ovulation, relationship issues, risk factors, sperm count/quality, and surgery.
Decreased Ovarian Reserve, but NOT ready to have kids now...
by QuestionsFrom23231, Jun 30, 2009 07:21PM
I discontinued bcp usage in 6/08 after approximately 15 years (I’m currently 33). By 12/08, my TSH levels were off and my endocrinologist had to lower my synthroid dosage to compensate for the lack of bcp. At the time of the Dec appointment, I was having little/no cycle. Once the med was adjusted, I started having cycles approx. 2 times/month (typically consecutive weeks- sometimes with spotting in between them). I also had spotting periodically throughout the month.
On 6/15, I went back to the doctor and showed her the schedule of my cycles. She tested my thyroid function again, but also tested my FSH/TH- also suggested I see my gyn to get an ultrasound to rule out fibroids (apt scheduled 7/15). My thyroid tests came back “normal”, but my FSH was 11 and my TH was 7 (my last cycle started around 6/5 but I had bleeding of various degrees until 6/16). I went back for additional FSH testing on 6/29 and the FSH was 7.7 so the doctor said pre-menopause may not be an issue, but ‘decreased ovarian reserve’ is. Because I would like to have kids in the future, the doctor suggested I explore having my eggs harvested. We agreed that I would think about it, but it’s unlikely I’ll do it. In the meantime, she suggested I go on bcp (Ortho Tri-Cyclen) to regulate my cycle.
My concern is whether long-term usage of bcp is potentially what has me in this situation to begin with… If the bcp usage has put me in this situation (pure speculation on my part) I would prefer to minimize future damage. The only other risk factor I can think of is that I had radioactive iodine in 11/07- not sure if that would have created this issue or not. Anyway, I had a friend who suggested progesterone instead of bcp. So, my question is- is there any validity to the idea of using progesterone instead of bcp? Are there any other therapies that would be recommended over using bcp?
Any insight that can be provided is greatly appreciated!
On 6/15, I went back to the doctor and showed her the schedule of my cycles. She tested my thyroid function again, but also tested my FSH/TH- also suggested I see my gyn to get an ultrasound to rule out fibroids (apt scheduled 7/15). My thyroid tests came back “normal”, but my FSH was 11 and my TH was 7 (my last cycle started around 6/5 but I had bleeding of various degrees until 6/16). I went back for additional FSH testing on 6/29 and the FSH was 7.7 so the doctor said pre-menopause may not be an issue, but ‘decreased ovarian reserve’ is. Because I would like to have kids in the future, the doctor suggested I explore having my eggs harvested. We agreed that I would think about it, but it’s unlikely I’ll do it. In the meantime, she suggested I go on bcp (Ortho Tri-Cyclen) to regulate my cycle.
My concern is whether long-term usage of bcp is potentially what has me in this situation to begin with… If the bcp usage has put me in this situation (pure speculation on my part) I would prefer to minimize future damage. The only other risk factor I can think of is that I had radioactive iodine in 11/07- not sure if that would have created this issue or not. Anyway, I had a friend who suggested progesterone instead of bcp. So, my question is- is there any validity to the idea of using progesterone instead of bcp? Are there any other therapies that would be recommended over using bcp?
Any insight that can be provided is greatly appreciated!
Doctor's Answer
by Elaine Brown, MD, Jul 01, 2009 03:01AM
, Jul 01, 2009 03:01AMTo: QuestionFrom23231
Hi!
Birth control pills don't affect the number of follicles in your ovaries. I personally find that very interesting. They don't affect your time to menopause, and neither does pregnancy/pregnancies. It would seem to me that if one was not ovulating, there should be more eggs "left over" but this is not the case.
One thing to consider is that there is an increased risk of breast cancer associated with long term ( greater than 10-15 years) use of bcps.
If you wanted to use progesterone instead, one of the safest/healthiest ways to do that would be the Mirena IUD. This device releases progesterone only locally within the uterus and not systemically. That way, it protects your endometrium (uterine lining) from building up without any systemic side effects. When you use the Mirena, typically your periods stop altogether, or at least dwindle down to a very minimal amount.
I personally don't like the over-the-counter progesterone supplements, because they are not regulated by the FDA, and the amount of progesterone that you get varies widely from day to day.
Another "good" progesterone is Prometrium. You could use that monthly to induce a withdrawl bleed, and it would hopefully help reduce the inter-menstrual bleeding. Finally, you could use the progestin only pill, but they are notorious for causing irregular bleeding.
I wish I could have harvested my eggs! You may really want to consider that, you never know how you are going to feel in 10 years!
Good luck!
Dr B
Birth control pills don't affect the number of follicles in your ovaries. I personally find that very interesting. They don't affect your time to menopause, and neither does pregnancy/pregnancies. It would seem to me that if one was not ovulating, there should be more eggs "left over" but this is not the case.
One thing to consider is that there is an increased risk of breast cancer associated with long term ( greater than 10-15 years) use of bcps.
If you wanted to use progesterone instead, one of the safest/healthiest ways to do that would be the Mirena IUD. This device releases progesterone only locally within the uterus and not systemically. That way, it protects your endometrium (uterine lining) from building up without any systemic side effects. When you use the Mirena, typically your periods stop altogether, or at least dwindle down to a very minimal amount.
I personally don't like the over-the-counter progesterone supplements, because they are not regulated by the FDA, and the amount of progesterone that you get varies widely from day to day.
Another "good" progesterone is Prometrium. You could use that monthly to induce a withdrawl bleed, and it would hopefully help reduce the inter-menstrual bleeding. Finally, you could use the progestin only pill, but they are notorious for causing irregular bleeding.
I wish I could have harvested my eggs! You may really want to consider that, you never know how you are going to feel in 10 years!
Good luck!
Dr B
