6 failed iui attempts, where do I go from here?

[kylee149]

I am 41 yr old female with a fsh between 6 and 7, amh .4 and with a luteal phase defect (I bleed like a period right after ovulation).  I have done natural cycle iuis with estrogen for the first 4 cycles, and estrogen and progesterone supplementation for the 5th and 6th cycles.  The first 5 cycles, the estrogen did not work well, and at some point I would start to bleed in the luteal phase.  6th IUI was better with the progesterone, but I had some light bleeding on day 11 and 12 after IUI, which i thought was implantation bleeding, which then stopped.  Along with the bleeding, I had uterine cramps that lasted almost 2 days.  (again, i thought it was implantation cramping).  But just today, I learned NOT pregnant.  So disappointed.  I know my age is against me, but so is my weight (i am very thin). I have been told I have a hormone imbalance which is proving very difficult to correct.  Plus, I wonder about my egg quality with that low AMH level.  My doctor refuses to do FSH injections because she said it would be too hard on my body of someone of my weight.  She won't do clomid because she said it would thin the lining and make me bleed more.  So, I guess that means I really can't have IVF either.  Is there anything else I can try at this point?  I don't have a lot of options.  Just thought I would ask before moving to adoption.  Thank you!

[MorticiaA13]

Hi, i dont have the problems you do but struggling to get pregnant as well. Just wanted to wish you the best of luck, try seeing a reprod. Dr and also to try chiropractor as well. The adjustments could help relieve pressure on nerves that work in that area. Good luck

[kylee149]

One last question:  can you safely do IVF with the bleeding problem I have?

[kylee149]

Thank you.  I am very well aware that my fertility window is closing, and that is why I am doing a reassessment at this point.  I am seeing a fertility specialist.
Do you think I need drugs like Clomid or Femara, with my normal FSH?  I know the idea is to produce multiple eggs with the hope of finding one good egg, but how will these drugs alter my own normal FSH value? Do you think the problem with me is the hormone imbalance, egg quality, or a combination of both?  I feel like my doctor is shooting in the dark since we do not know what is wrong with me and since I have that very bad luteal phase defect, too.    

[Elaine Brown, MD]

Hi!
If you were my patient, I would recommend that you seek the advice of  a fertility expert--or a second opinion if your ob/gyn doctor is a reproductive endocrinologist.  You need to move VERY quickly because of your age, but you have a low FSH which could change any time.
If there was any way to convince you to try IVF, I would--but it might be a lot of money with no results.
One option that your own doctor might be willing to try is Femara.  It has similar effects on the ovary--to stimulate ovulation, but the SE to the uterus are not as pronounced--in other words, it might not thin the lining as much.
Even if it does thin the lining, I'm not sure why your doctor wouldn't supplement with progesterone at that point in time.
I would definitely follow ovulation with ultrasound, and would consider a trigger shot of hct to help with timing of the IUI.
Good luck!
Dr B