Questions for Dr. Sher ~ Consult 6.15.11
• Why do I have Diminished Ovarian Reserve at such a young age? Is there any explanation? Does the fact that I’m young bode well for me? (vs. a 30-40 year old with DOR or does it matter?)
• What exactly does it mean to have elevated Antiphosphatidylserine IGM? Is this an indicator that I may have abnormal levels of Natural Killer Cells? Am I correct that this is an autoimmune issue? If so, what is the best treatment? My doctor doesn’t think it’s a very significant finding.
• Why do I have recurrent pregnancy loss? (6 early losses) Do you think it’s bad luck, chromosomal issues, or poor egg quality? My uterus and lining have always looked excellent. Do you think something could have been overlooked? Or is it most likely my eggs?
• Each time I’ve had a chemical pregnancy, my betas have only been in the single digits – is there anything significant about that? Why haven’t I ever had higher betas or surpassed 5 weeks?
• How long do you think I have before reaching menopause? I’ve been told early 30’s.
• I have been noticing some symptoms over the past year or so. I’m not sure if they mean anything. Acne, weight gain, excessive sweating, increased hair growth on face, hair loss, hot flashes, and night sweats. Are these signs that I’m pre-menopausal? Could they mean something else?
• I switched from tampons to pads over a year ago. I have been observing that my menstrual flow does not actually “flow”. Even on my heavy days, the pad does not become full at all. The flow only occurs when I use the restroom. Is this a problem? I wonder if I’m properly shedding my old lining?
• My first FSH level taken in 12/2009 was 11.6. The past 2 levels in 6/2010 and 1/2011 were 8. Shouldn’t my FSH be higher, considering that my AMH is very low (0.3) and my antral follicle count is also very low (6-7)? I would think it would be a good thing that it’s low? Does the fact that it’s lower mean anything?
• Should I have another AMH level taken (the first and only level was done in 1/2010)? Is this something that should be monitored more closely due to my diagnosis of Diminished Ovarian Reserve?
• I don’t recall ever having an FSH to LH ratio done on CD 3. Do you see anything in my records that I’m missing? Should E2 also be done on CD 3? How often do you recommend having CD 3 labs done?
• I haven’t had my progesterone levels checked consistently. Should it be checked every cycle?
• I had an HSG in 12/2009. It was completely normal and clear. Do you recommend having another one done? How often should this procedure be done?
• My mother has Endometriosis, but I have no symptoms. Do you think it would be worthwhile to have a Lap done?
• Are there any other tests or procedures that you would recommend? Are there procedures that can be done, not only for diagnostic purposes, but also to increase fertility?
• My current doctor recommends DHEA 25mg 3x day. Do you think it is helpful? Do you recommend any other supplements?
• I asked to be tested for vitamin deficiencies, but was not tested. Do you think it’s worthwhile to check? (Like Vitamin D for instance)
• What about Folate deficiency? How much Folic Acid should I be taking?
• What is your opinion on Lovenox and when should it be taken? My current doctor is fighting me on this medication. He thinks it should only be administered after pregnancy is confirmed, and no sooner. I can barely make it to the point of getting a beta done before I’m already losing the pregnancy. Can Lovenox help with implantation for women who have chemical pregnancies?
• Can steroids be useful for women with multiples losses? Do you prescribe it only with IVF, or do you also give it during IUIs or timed intercourse cycles? When is the key time to take it?
• Whenever I take an hcg trigger shot, I begin cramping and sometimes spotting once it begins to wear off. Are booster shots useful? What days and dosages would be most beneficial?
• I have only ever used progesterone suppositories (even with IVF). Are Progesterone in Oil injections better? If suppositories are okay, what dose is best?
• We have conceived 3 times with timed intercourse and 3 times with IUI. Do you think IUI is even worthwhile for someone with my diagnosis (and considering that my husband has no fertility issues)?
• I did 2 IVF cycles and have tried the Lupron Flare protocol and the Antagonist protocol. The Flare protocol did not work – my cycle was cancelled due to poor response and converted to IUI. The Antagonist protocol seemed to work pretty well. We even added Clomid because I respond so well to it. Would you use the same Antagonist protocol or do something different? Why do I seem to respond so well to Clomid? Could I take a higher dose of FSH?
• Do you think I could get more than 6 mature eggs, or is that probably the best case scenario, considering my low antral follicle count?
• How many embryos would you transfer for someone with my situation?
• Would you do a 3 or 5 day transfer?