DOR with MIS blood test

by Stephanie
(Brooklyn, NY)

Hi Amelia,
I turned 40 in May and I'm ttc for the 1st time with my husband. I've tried 1 IUI cycle with Clomid last year, charting, saliva tests, ovulation kits, FSH, Estradiol, Progesterone etc.

I recently took an MIS blood test to determine my ovarian reserve and was told it was diminished and should go right into IVF. This is with a very well known fertility clinic in NYC whose focus is heavily on IVF. While I'm not necessarily against IVF, donor eggs or even adoption for that matter, I would like to ttc naturally. More importantly I would like to deal with doctors who don't only speak doom and gloom.

I have had 2 cysts removed a while ago, one on each ovary. One was a chocolate cyst the other I don't remember. I have had ultrasounds to check for recurring cysts, fibroids, etc and I'm clear. I recently had an HSG also and my tubes are open. The left tube is questionable but appears to be open. My period is every 25-28 days for 3-4 days. The doctor said that there is still a slight chance with IVF since I'm still having regular periods. He also said that one reason why I might have DOR is because of the surgeries depending on what type of cysts they were.

Do you think acupuncture, lifestyle change, herbs could help me? Is all hope lost? I still have an iota of faith which is all I need because I already see "Myles" - my son :) - in my life.

BTW, my husbands sperm was last checked about this time last year and was normal. I will say that his urge to perform has lessened due to stress, financial issues and whatever other factors. Thanks so much for your opinion.
Brooklyn, NY

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MIS, MIF and AMH Tests for Ovarian Reserve
by: Amelia Hirota

Hi Stephanie,
I'm glad that you brought up this issue of the MIS testing. For our readers, MIS stands for Mullerian Inhibiting Substance, MIF stands for Mullerian Inhibiting Factor and AMH stands for Anti-Mullerian Hormone. These acronyms all measure the anti-mullerian hormone, which is a substance that is produced by granulosa cells in ovarian follicles. AMH is made in primary follicles after they advance from the primordial follicle stage.

It's important to remember that our true ovarian reserve are the primordial follicles. These are the follicles that we were born with and remained with us through puberty. The AMH test is measuring developing follicles. It's not actually measuring the remaining primordial follicles. It takes about 13 menstrual cycles for the recruitment of follicles from the primordial stage to ovulation. Many physiological factors, including hormone imbalances, can affect the recruitment of follicles.

In your case, it sounds there there have been hormonal imbalances with the cysts and fibroids in your past. These hormonal imbalances may be affecting the recruitment of follicles.

Your situation is extremely common. Most of my patients over 37 years old have been told that they have diminished ovarian reserve because of age, a Clomid challenge, a high FSH test or a low AMH test. I haven't found these tests to be terribly accurate and I do find that many of my patients that were diagnosed with DOR go on to get pregnant without drugs or IVF. I find that the FSH test, Clomid Challenge and AMH tests are really indicators as to how well you will respond to fertility drugs verses a true assessment of your inherent fertility.

So, I do think that it's not all doom and gloom for you. You're still young for a donor program, so I would give yourself a good year to balance your hormones, nourish these developing follicles and prepare your bodies (you and your husband) for a healthy conception. Since you live in NY, it should be relatively easy to find an experienced acupuncturist that specializes in fertility issues. I wish you the best of luck in your quest to bring Myles into your lives.

Sending Baby Dust Your Way,
Amelia Hirota, D.Ac.

Don't give up hope
by: Valerie

Hi Stephanie-

I was in NYC and worked with a clinic that administered the AMH test. I was 40 and diagnosed with low ovarian reserve in Dec. 07. I was told my best chances to get pregnant were in spring or summer of 2008.

My insurance would cover 1 IVF or about 8 IUIs. Although the doctor would have recommended IVF if I'd had more ovarian reserve, he didn't think it would necessarily work, since I might not yield enough eggs during the sole IVF.

So I went through 5 IUIs- 4 in 2008, 1 in 2009. I got pregnant (without Clomid) when I was 41.5 and gave birth at 42 in Dec. So don't give up hope for Myles. I'm sending lots of good hope your way!

Much sticky baby dust!

Acupuncture Helps, Too!
by: Valerie

I forgot to mention- I lived near an acupuncture school in SF and got inexpensive treatments, including some from grad students studying with fertility specialists. The treatments were also useful during pregnancy, including the herbs and diet recommendations.

In NYC for acupuncture I'd recommend Kimberly Salshultz who works with fertility issues ( I know cost may be an issue, so you could try Pacific School of Acupuncture near 22nd St/Broadway. It's low cost- about $20-25, but sessions do take a while, as students are supervised by doctors.

Much good luck to you!

40 yr old Diminished Ovarian Reserve with MIS blood test
by: Stephanie

Thank you Amelia and Valerie for your encouraging words. I will definitely check out the places you recommended. I am staying very positive and I will let you know when Myles is his way!

Had a son when over 40
by: S. X.

My friend was over 40. She had very low AMH, less than 0.05, and high FSH. She had tried acupuncture and herbs at Dr. Lu's office on Canal Street for a few months. Her son was born about eight months ago. He is very healthy.

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