More on Ovarian Reserve

As a Reproductive Endocrinologist one of the toughest parts of the job is explaining things to patients that simply do not make sense and fly in the face of logic. A case in point: Several years ago I saw a patient that had been to another local clinic where she had spent over $70,000 on 4 failed IVF/ICSI attempts. She was 35 years old and not interested in donor sperm or donor eggs. Her FSH was 12 and her response to stimulation had been poor with 2 cancelled cycles. She had been told that ICSI was the only way the sperm would fertilize the eggs because of poor morphology. So she arrived with all of her records and put me on the spot saying she wanted to hear my opinion. Well, I thought that the sperm didn't look too bad so I suggested that if she was unwilling to go with donor egg or donor sperm that we could just give unmedicated IUI a shot but the odds were pretty long that this would work...

She was very motivated so we jumped right into a natural cycle IUI and 14 days after the IUI she came in with a look of disbelief and a positive home pregnancy test. Her betas rose appropriately and her pregnancy was picture perfect. She delivered a healthy full-term baby.

When she had a toddler at home she came back for a consult. I told her that we could try it again but not to hold her breath because she really had a miracle baby there at home. But as the unstimulated IUI was only $2000 she was willing to roll the dice. The next cycle we did another IUI and amazingly enough she had another positive beta and delivered another healthy full-term baby!

Last Christmas I got a card from her letting me know that all was well and shockingly enough she was about to deliver baby #3 conceived without any help at all...at 40 years old!

So the lesson here is that I never tell patients that they have no chance to conceive unless there are no eggs, no sperm or no tubes....other than that all bets are off.

So here is today's question from the book:

41. How do I know if IUI is an option for me?
IUI is a good option for many infertile couples. It can be performed in conjunction with a woman’s natural cycle or can be combined with the use of fertility drugs. IUI can also be effectively used in couples who have sexual dysfunction or infrequent coitus for either medical or nonmedical reasons. For example, some couples may have busy work schedules such that one or the other partner is frequently out of town around the time of ovulation. If the male partner’s sperm is obtained and cryopreserved (frozen) in advance of ovulation, the physician (or nurse) can perform an IUI and, ideally, facilitate pregnancy without the woman missing a menstrual cycle. The best candidates for IUI are those couples without tubal disease (female partner) or severe male factor infertility (male partner). Women with severe endometriosis or a history of pelvic adhesions are not good candidates for IUI. Although couples with male factor infertility can attempt IUI, the success rates are fairly low in such cases, and prompt consideration should be given to IVF (and ICSI) if pregnancy fails to occur after three or four attempts.