FSH levels and fertility

[weezystifo]

I have been doing workup to have a tubal reversal done.  I have undergone two sets of blood tests.  My first set showed an FSH of 5, an E2 of 97 and an LH of 2, my second set showed an FSH of 4.8, and E2 of 145 and an LH of .9.  These tests were all done on day 3 of my cycle.  My doctor is concerned that my E2 is elevated and wants to do a Clomid Challenge test, but other doctors I have talked to seem to think a good FSH on day 3 is enough to at least try and still concieve naturally.  The doctor I am seeing specializes in IVF and he is really pushing IVF w/donor eggs.  I am 42, have 4 children already, no problem conceiving in the past, but had a tubal ligation w/hulka clips in 1989.  I am now remarried and would like to have a child with my husband.  I have done alot of research and realize at my age donor egg is my best bet, but I would like to at least give natural conception a try.  What do you think my chances of conceiving naturally are?  Thank you

[Suze-ee]

Oh my gosh - I would love you have your FSH level!  It's terrific!  I went through the barrage of fertility testing at 36.  My FSH was just over 9.  10 is considered borderline by the lab that ran the test.  The fertility specialist said that means I'm running out of eggs, and the lower the number, the better.  However, she stressed that the test only shows the quantity of eggs, not the quality.  So even if you have a good FSH level, it doesn't mean the eggs are good quality.  And as I'm sure you know, the quality of eggs decreases as you age.

[weezystifo]

thank you for the comments, where could I get more information on quality, or finding out about the quality of my eggs.  like I said the doctor I am seeing is very pro donor IVF, and I feel like that makes him have a biased opinion, and I want to find a doctor who would give me some honest numbers as to what I should do, also someone who would be willing to work with me at least for a year to try and conceive naturally before resorting to IVF

[Suze-ee]

I saw a fertility specialist, and of course my usual OB/GYN.  Both were knowlegable about where those numbers should be.  You must have a regular gyno, right?  Make an appointment with him/her.  Maybe the fertility doctor you've been seeing stands to gain some extra money from IVF.  I don't know what an E2 level is, or that other test you were concerned about, sorry.

[Suze-ee]

I should mention - at the fertility clinic where I went, I know there was a cut-off age where they simply would not do IVF with the woman's own eggs.  That cut off age would be close to yours.  I remember it's in the low 40's.  Again, it's probably because the store of eggs left is thought to be not very good quality.

[nurse12hr]

While I don't know much about the specific ranges you are talking about, there are other things to consider at your age.

Namely, your high risk of Downs.

Here is a table:

Incidence of Down Syndrome with Increasing Maternal Age

32- 1/725
33- 1/592
34- 1/465
35- 1/365
36- 1/287
37- 1/255
38- 1/177
39- 1/139
40- 1/109
41- 1/85
42- 1/67
43- 1/53
44- 1/41
45- 1/32
46- 1/25
47- 1/20
48- 1/16
49 1/12

So there are lots of issues.  I am certain you have already considered this, but just bringing it to the forefront in case there is someone else reading this in a similar situation.  It may take a year or two to conceive after the reversal, too, so be aware your risk is rising sharply.  

There are also increasing risks to you with advanced maternal age.  I know your doctor has already discussed them.  

Best of luck to you, whatever you do decide.