Menopause and IVF

iVillage Member
Registered: 06-16-2003
Menopause and IVF
4
Wed, 06-25-2003 - 2:25pm
Can anyone answer this:

My sister-in-law, who is 44 years old, is TTC her 2nd child. Her doctor told her that she may not ever have an AF again because she is entering menopause. On the other hand, she is going through In-Vitro Fertilization for the second time (the first didn't take). Is it possible to get pregnant through IVF when you are entering menopause?

iVillage Member
Registered: 03-27-2003
Wed, 06-25-2003 - 5:31pm
Well 'entering menopause' and being menopausal are two different things but are on a continuum with peri-menopause at the start end and menopause at THE end. There is a long period of time before actually entering menopause where there is a possibility of concieving BUT it is an individual thing. I was peri-menopausal with my FSH fluctuating on CD3 from 5 on one cycle to 23 on another cycle and yet did get pregnant at age 46 after about 1.5 years of fertility treatments. Normal FSH levels should be under 10 on CD3 and E2 should also be in normal ranges. One can tell clearly where one is along the way by a simple blood test on cycle day 3. Your sister should ask for a blood test on CYCLE DAY 3 to test for FSH (follicle stimulating hormone) and E2 (estrodial). If her FSH is very high (above 20) and her E2 is also very high or extremely low then she is indeed well along the menopausal continuum and has a decreased chance of getting pregnant. Because FSH can fluctuate (like mine) she may want to get it tested over a number of cycles to see what her average level is. If she DOES have fluctuating FSH then she should ONLY do IVF on cycles where her FSH is under 10. An FSH of around 40 is considered menopausal and if this is the case then she is probably tossing away her money doing IVF. The thing I picked up on is that she is not having regualar AF. If this is so then she definately needs to get her FSH/E2 levels checked to see if it is because she is now very near menopause OR if there is some other reason. Hope this helps!

iVillage Member
Registered: 06-23-2003
Wed, 06-25-2003 - 9:01pm
Hello

I am 46 and trying to conceive. This is first child for husband and I. My FSH level was 9 at day 3. Estradiol is

very good. Husband checks out good also. Doctor will not do IVF because of my age. He gave me clomid. Will that work. We want a child desperately. What fertility method worked for you at

age 46. Thanks for the help...pat
iVillage Member
Registered: 03-27-2003
Thu, 06-26-2003 - 5:00pm
I know completely what you are going through having been there myself. Your FSH/E2 levels are pretty good .... I am not sure how much you know about all of this fertility stuff so if you are new to this then I would STRONGLY suggest that you check out the TTC Over 40 website which I put together... the link is at the top of this board. Also on the first page of the website you will see the link to the new TTC Over 40 Board which is much more active than this one. You may want to check it out as well.

Now... to your question.... keep in mind that many of the fertility treatments were designed for younger women who were having trouble concieving and so many of them focus on increasing conception. This is the case with IUI and especially with IVF. IVF is not the be all and end all of answers ... especially for women over 40. The most frequent cause of not concieving for women over 40 is egg quality. You may have already heard this talk but we ARE born with all the eggs we will ever have and as we get older we have fewer eggs. The eggs we DO have also decrease in their ability to fertilize properly or divide properly once they are fertilized. However, each egg has its own 'best before' date and so not all eggs decrease in quality at the same rate. So, you will have a mix of good eggs, poor quality eggs and so-so quality eggs. The trick is to MAXIMIZE the number of eggs you produce each cycle to try and get one of those GOOD EGGS, make sure that you are getting a good LH surge to release all the eggs and then to time your bd at the correct time to maximize the chance of fertilization.

Clomid and other fertility drugs are designed to help increase the number of eggs you have per cycle. CLomid has some negative side effects so you don't want to take it over a long period of time. Also, with doses of clomid of 100mg or 150mg you should also do IUI. I actually got pregnant my very first cycle of using clomid but sadly at 8 weeks there was no heart beat. Other women have certainly gotten pregnant using clomid and it is always a good first step. I would STRONGLY suggest that you be monitored to check the size of your follicles. Follicles are considered mature when they reach about 18 - 25mm. At that point I also suggest that you have a trigger shot to force O and then bd the day of the trigger shot and the next day too. This will ensure that your timing is right on! The reason monitoring is important is to see how you are responding to the drugs to adjust your dose or to change medications.

After a coupld of clomid cycles I moved on to injectibles which can be taken over a long term. It is VERY IMPORTANT that you chart your cycles by taking your basel body temp each morning. Also it is VERY IMPORTANT that you get your CD3 FSH/E2 measure every cycle and ONLY do stims on good cycles. I also did one IVF cycle because it was all I could afford ... it did get fertilization (+ve pregnancy test) but I had a very low HCG level and nothing happened. So, my approach as I stated was to maximize the number of follicles per cycle and I did this by taking injectibles (gonal-F 4 vials/day), monitoring my hormone levels and follicle growth, doing a trigger shot when my follicles measured between 18 - 25mm and bd'ing the day of the trigger and the next day. This is how I conceived our son... my FSH on that cycle was 9.5 and my E2 was within normal ranges. I often thing that IVF is pushed as THE answer on women over 40 and so if the option is not available or it doesn't work then they think it is the end of the road. This is NOT the case. The challenge for women over 40 is more likely to find a good egg and then things will work out for them selves. Make sure, since you have not had a child before, that both you and your husband have no other medical impediments to getting pregnant! Again... hope this is helpful and please check out the website!!!

~ Pat

Avatar for carolbc2003
iVillage Member
Registered: 03-29-2003
Fri, 06-27-2003 - 7:04pm
Pat,

Just to add a different opinion. Before you rush off to do alot of drugs and/or procedures, do a little (or a LOT) of research on this stuff. There is another school of thought that Clomid should rarely be given to women over 40 -- especially if you are ovulating on your own already. It can screw up your cycles for quite a few months afterwards and -- especially when you are over 40 -- you don't want to waste a lot of time.

Please read the articles at www.easternharmonyclinic.com. There is a good one on egg quality that addresses the special issues of women over 40. Also check out the website called www.fertileheart.com. That also has alot of info and discussions with women who are using a lot of natural methods to enhance fertility -- either alone or in conjunction with medical procedures.

Hope that helps.

Carol