Diminished Ovarian Reserve

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I haven’t posted about this yet because there was just too much going on these last few days with all the will-the-embryos-make-it drama. Plus, I didn’t want to drag the embryos down with my negative diagnosis.

Anyway, after my first IVF, my doctor suspected that that I had “some level of diminished ovarian reserve,” but she didn’t sound convinced. Well, let me tell you, she is convinced now. After this riot of an IVF cycle, I have now officially been diagnosed with diminished ovarian reserve (or DOR as it’s commonly known, because the infertility world hearts their acronyms). This basically means that although I am 37, my ovaries are somewhere in their 40s. I’m thinking maybe like 42 or 43? Here’s the weird thing, though. My DOR is a sneaky B. There are three tests they use to determine if your ovarian reserve is low: FSH, AMH and antral follicle count. The first two are hormones. And the last one is how many follicles you have at the beginning of your cycle. My FSH, AMH and antral follicle count are all normal! So my ovarian reserve should be fine as well, right? But I don’t respond well to the IVF medication, I don’t make a lot of eggs and the ones I do make are poor quality. So, boom — secret diminished ovarian reserve.

What does this all mean? Basically, it’s not good. No infertility diagnosis is good, let me be clear, but this one is extra-special fun because the only way to fix it is to turn back time. Will the 23-year-old Tanya please come forward? I’d like some of her eggs. What’s that? It’s not possible, you say? Ok, fine.

Turns out I lost my time machine, so here are our options:

1. My doctor suggested another fresh IVF cycle with a new protocol. She didn’t seem all that hopeful that it would work, though. We are extremely lucky that we have infertility coverage, so this is financially the best option for us. An exercise in futility? Maybe. Even still, this option is not off the table. We could also check out another doctor in our network, but I already feel that mine is the best in the area. It’s for sure worth looking into again, though.

2. Get second opinions. We are definitely pursuing this. We plan on contacting the following:

Dr. Braverman: He’s a reproductive endocrinologist. I already know I have one immune issue because of my elevated anticardiolipins, and I just have a nagging feeling that there are some other immunologic conditions going on here.

Center for Human Reproduction:  DOR is their specialty.

Colorado Center for Reproductive Medicine: All-around bad-asses in the IVF world.

The one problem with this is that these places, awesome as they may be, are out of network, which means that we likely couldn’t afford them anyway. If we’re going to break the bank, it’s going to be for something that’s more of a sure thing. Even still, I think I’d regret it if I didn’t hear what they had to say.

3. Domestic infant adoption. I haven’t talked about this at all here, but we’ve already been researching this one pretty hard-core. I know it’s not an easy road, at all, but I believe that in the end we would have a sweet baby to love.

Neither adoption or fancy fertility doctors are cheap. We could pretty much do one or the other and that’s it, end of story. What will we do? I have no f*cking clue.

Right now I’m going to cry my eyes out and some drink wine.

Lots and lots of wine.

59 thoughts on “Diminished Ovarian Reserve

  1. Oh hon this really sucks. I am so glad you are seeing some second opinions though just knowing what a difference it has made for me mentally. I am sure others will have other ideas.There is a whole bunch of stuff out there that focuses on “poor response” to the stims (I usually just skim past it as that’s not me – just seem to have fucked up eggs) so I am sure one of your second opinions will have some badass info on it all. Hugs. A diagnosis like this blows. You did have a pregnancy with a “normal” embryo though so that’s cool. It CAN be done. Don’t give up yet 🙂 Although adoption is also a worth option and beautiful way to expand your family (virtually impossible here). xxx

    1. Glad I re-read this just now. I’ve been feeling pretty hopeless for like a week straight. You are right, the second opinions will be good. I’ve scheduled two for the second week in May. The third one I’m not sure if I will contact after all, as their big thing seems to be DHEA and CoQ10 supplementation, which I already talked to my doctor about and she’s fine with me taking and she gave me the correct doses to take. She says she doesn’t recommend it to her patients because there is not a enough hard data to support it, but she is fine with me doing it and doesn’t think it can hurt. I think if anyone can help me it will be doctor Braverman. I really do think that there is more going on immune-wise for me than just the high anticardiolipins. He writes a lot about silent endometriosis and I’m pretty convinced I have this. My sister had silent endometriosis, and it was only after it was accidentally discovered and subsequently removed that she had a successful IVF. We’ll see. I wish money wasn’t a factor in all of this!

      1. Yeah my new Dr said that some huge % of women don’t even know they had endo. I am looking forward to my op to be honest so we can rule it in or out either way. We have cancelled our appt with CCRM for now as we are trying a lot of new things with this new clinic. They will be our next step if we don’t have success here but something tells me we will. Follow your gut hon. If you really do think there’s more to the immune stuff then have it investigated for sure. As my new Dr says : we are now in the business of ticking off boxes. It’s so true. So go tick off the box. So sorry you have been feeling hopeless. Please don’t. Diminished eggs doesn’t mean shit ones and it doesn’t mean none. You have had one before. You can have it again. I truly believe it. Too bad this whole shamozzle has to cost so much though, I totally agree! Xx

  2. Take it from someone who has been told she has severe DOR and will need donor eggs then three cycles later had a miracle son with her own eggs– this is not as dire as you think. That being said, I am completely open to adoption and have always wanted to adopt and would go that route but my husband is not there yet. Thinking of you through this turmoil. It’s always the hardest time. Well- tied with all the waiting.

    1. Did you have to switch doctors at some point? My doctor said that if my next IVF is just as bad or worse than this last one, we will be having the donor egg talk (she did not readily volunteer this info, I had to pry it out of her). So I guess if the next one is a bust, I might have to switch clinics if I want to keep going? I don’t know dude, that feels like so much pressure on the next cycle! My heart is just so sad right now. It’s been a week already, but it still feels like I got this diagnosis yesterday. I don’t feel any closer to making any sort of peaceful decision.

      1. I know how crushing it feels. I have bouts of desperation that I don’t have enough eggs left to have another baby but my current RE is very steadfast that the eggs don’t diminish much month to month but rather over long periods of time so he says even if one cycle doesn’t work- you have the same odds the next cycle. My AMH is .6 and I have usually 5/6 resting follicles and my RE is still confident that if I keep trying it will happen. I have found that changing up protocols has really helped. I think you should be ready to switch if your current one says you need to move to donor. Sounds like they may be in it for better overall patient success numbers or they just don’t have as much fight as you need. I would set up another consult with a different clinic for a few days after this next cycle. That way you have a plan B and a new game plan of you need it. After this next one ( or maybe I have two more in me) we may actually try to get into CCRM. I am doing the mini or soft IVF though so it is minimal drugs in hopes for better quality over quantity. Sending you a big hug. Please just keep the faith that this will eventually work. I truly believe for someone in our situation it comes down to perseverance. Hugs.

    1. That’s a very good way to put it: getting worse before it hopefully gets better. I really, really hope it gets better eventually! I had a drink (or three) for you last weekend. 🙂

  3. This week has been the week of bad news. I’m so sorry, hon. This stuff just sucks. The annoying optimist in me says at least you have options, but ultimately, it just sucks. Praying you are guided to the best options.

    1. It really does suck! And you are also right that at least I have options. I keep telling myself that over and over again. As much as my heart hurts right now, this is not over yet!

  4. Ugh. Well, “silent” DOR is certainly a terrifying concept. Great, now you’re on to infertility diagnoses that nobody’s ever heard of before! I’m so sorry you’re having to go through all this. It’s good that you’re being hopeful and considering domestic infant adoption — we’ve been doing some research too, but I so completely get that it’s not a cure for infertility, it’s just a cure for childlessness. I really hope that a different protocol might work for you — can you afford to go for a consult with one of the heavy hitters, and bring back new ideas to your RE? In the meantime, go have that glass of wine. It’s the weekend (finally)!

    1. Yeah, I think that’s what I will do — go for a couple of consults and then go back to my RE with anything interesting. While I wait for those consults, I might do another IVF cycle. Who knows, though–the thought of doing another one makes me sick right now, but I still have another few weeks to decide.

  5. Ughhhh. No fun. Not fun at all. I’m convinced your bad boys still have since umph left in them, regardless of the diagnosis. Like mamajo said…you might very well surprise yourself. You had a lot of stressful shit going on last cycle and that rarely is a precursor for success. That sounds a lot like my second attempt, after the first mega fail. A new perspective and a new or tweaked protocol – sounds exactly like my third attempt – may be all that you need. Have another glass for me, will ya? Lots of love from the great white North. Xx

    1. I had many, many glasses for you! I hope a new protocol will do the trick. My doctor wants me to start another round in the cycle after this one. Gulp. The thought of it right now makes me sick, but we’ll see how I feel in a few weeks!

      1. Oh good! You never know until that day rolls around. Go with your gut. I thought before my 3rd round that I would take a much longer break, but then all of the sudden one day I felt ready and I washed nothing to do with waiting even one more day. You’ll know.

  6. I have DOR too- where my afc and fsh are normal, but my amh is .6 – *point* six. Legitimately. They tested it twice because at 26/27 it’s terrifyingly low. I know how that diagnosis feels. It’s like an infertility pedestal that you get slapped up on and it’s too high to jump off of but man do you try. But DOR doesn’t mean no more options- it CAN be fought.

    CCRM is an excellent clinic to deal with DOR and IVF, it’s where we were referred if our last round hadn’t taken, and is probably where we’ll be for baby number two (though at that point my body may be kaput on the egg front). They have a very aggressive regimen, and literally throw everything they have and the kitchen sink at you. With DOR, it’s aggressive or go home and CCRM won’t lie about that, which is one thing I really liked about them!

    Right now, have some wine. Have the whole bottle! Treat yourself and be kind! It sounds like you have a good plan going forward- and lots and lots of people who have been there, here supporting you!!

    1. Thank you so much for this comment — it really helped me to hear from a fellow DOR-er, especially one that is pregnant! I have a phone consult with CCRM on the 12th. I’ll let you know how it goes!

  7. So sorry to hear this. I know it’s frustrating and disappointing. I love your list, and I’m HUGE fan of CCRM. Even if you don’t decide it’s right for you they will give you a (brutally) honest evaluation of your chances of success. It would be worth the call as you evaluate things. Ask to be on their cancelation list and you might be able to get the initial phone consult even earlier.

    1. Thank you! I have an appointment with Dr. Surrey at CCRM on 5/12. After making an appointment, the confirmation email said that you cannot switch doctors after the initial appointment. So now I am wondering if I should have researched doctors a little more before scheduling. Eh, oh well. I hope you are doing well with you now-complete family! It was lovely of you stop by and comment, as I’m sure you have your hands full right now!

  8. I’ve been following your embryo development the past few days and I’m so sorry you had to go through that. It sounded very similar to our last cycle (2nd round) and although we transferred 4 poor quality embryos on day 3 I knew in my heart they very likely wouldn’t have made it to day 5. We don’t have coverage and due to my non-secret DOR and poor quality are much more hesitant to do a third IVF round, and more likely to put the funds towards an egg donor cycle in the future. For now it is wine time for us both! Thinking about you!

    1. Ughhhh, I am so sorry that we have a shite second cycle in common! Donor eggs sound so luxurious to me right about now — no stims and you just get a (most likely) completely healthy blastocyst placed in your uterus. Heaven. Haha. I go back and forth between donor eggs and adoption all the time, but since I don’t have the greatest track record with miscarriages, I’m thinking adoption will win out in the end. I’m glad that you have a plan going forward as well — I’d love to hear about your donor egg journey, if that’s the route you end up taking.

  9. We used CCRM and absolutely loved them – very straight up with you about chances, AND very good at what they do. Definitely worth a phone consult at least.

    Good luck finding which path is right for your family. ALI is such a bitch. *sigh*

  10. I’ve been following your blog for awhile but rarely comment. My husband (of 10 years) and I are trying to get pregnant and have never used birthcontrol (besides avoiding during fertile times the first few years of our marriage). I’m 35,going on 36 in a few months, and came across your blog when looking into Fertile Heart info online. I recently posted about Randine Lewis and have since started getting treatment from her daughter, Theresa Johnson. My period is transforming with the accupuncture, herbs and diets recommendations (ie. no more clots, no more pre-period brownish ick, no cramps). So, when I read your blogs and think about your root canals, sugar cravings and emotional ups and downs I can’t help but wonder if Chinese medicine could be a missing link for you. I’m not saying it will help you two to make another beautiful angel, but I’m confident it would help with getting you healthier, stronger and more grounded. Here’s Randine’s website:
    http://www.thefertilesoul.com/randine-lewis-infertility-cure.php
    She’s got a tab for finding a practitioner who’s doing what she does. Good luck with everything and remember to always choose “Hope Street” even if you don’t feel like walking down there at the moment.

    1. Thanks for your thoughtful comment and thank you for following my journey. I haven’t posted about this in a long, long time, but I actually have been going to acupuncture weekly for the last four years! During IVF cycles I go b-weekly. I have also taken herbs on and off as well. I love traditional Chinese medicine. Unfortunately, it did not fix everything for me, but I do find it to be a great piece of the puzzle, along with the Fertile Heart work (which I have been slacking on lately). I checked out Randine’s site. Those retreats look interesting. Have you ever been to one?

      1. I just figured out how to check this 🙂 I haven’t been to a retreat, but they do sound like they could be very powerful. I can’t decide if I’m glad (that you’ve been doing acupuncture) or bummed (that you’ve been doing it for so long and it hasn’t fixed everything) 🙂 Ultimately, I’m glad and I do feel like it is a great piece of the puzzle. It’s so tough wanting to make a baby and not being able to. We’ve just started on the journey (of really wanting to start our family) and it’s slightly frustrating to get my period every month. But I do feel like I’m getting stronger and more emotionally stable, so I try to stay focused on that. I just read your most recent blog about the consults with the two new doctors. It sounds like they have unique perspectives on what may be going on with you guys. I so hope that they help you find the key that unlocks the baby making door for you guys and if not there are definitely babies out there that need your loving 🙂
        We’re still waiting to pursue the western route, going to give the TCM a chance a while longer yet.

  11. First, I am so sorry about your diagnosis. You must feel like you have the wind knocked out of you. Bless you. Second, I know it’s not an easy or possibly perfect solution for you, but if you decide to pursue the adoption route, I will be ready to welcome you to the club! Sending you love and clarity as well.

  12. I feel like I can so relate to your words and diagnosis. They still aren’t certain with me and want me try IVF again too. Wishing you strength as you move forward!

    1. I definitely has some (ok, many) glasses for you. My phone consult with Dr. Braverman in set for the week after next! The more I read about it, the more I am convinced I had silent endometriosis. I’ve been wrong before, though, but at the very least I’m glad I’m looking into it.

  13. So sorry you are going through this as well. I received the brutal DOR diagnosis four months ago after two early losses, and it shocked me. My AMH was 0.04! Blindly, I started grasping at straws. And one of them was acupuncture. I just started following this blog, so I sincerely apologize if I am talking about a road you have already been down. But after four months, and to my complete surprise, this past cycle I developed a natural follicle that was considered a “quality” size. Jury is still out on whether or not this will keep happening with each cycle, or if it will translate into a healthy pregnancy. But just wanted to share because I know how incredibly devastating the news is, especially when doctors say that there is nothing that can be done to change it.

    1. First of all, I am so sorry for your losses. Secondly, thank you for the acupuncture recommendation. I don’t really talk about acupuncture at all on here anymore so there’s no way you would have known about it, but I’ve been going to an acupuncturist weekly for the last for years. I do think it is absolutely wonderful. It obviously hasn’t cured my infertility, but at the very least it helps me to stay relaxed. I’m glad you have found it and that it’s helping you! I have one friend that didn’t ovulate on her own at all. She got fed up with fertility treatments, so she stopped and just went to acupuncture. After a few months of that she was ovulating on her own and she’s now the mother of a three year old! It really does work wonders for some people.

  14. I wish we did not have DOR in common, I am a few years older than you though so it really is not far. My numbers were confusing: FSH pretty good! AMH not great and Follie count could be better. Advice? I wish I had some to share, my fertility guy had a new drug plan had we had the money but I do not know it would make a difference. Adoption has crossed my mind too and in the UK it is not expensive but I know we would be highly unlikely to get a ‘baby’. Have you considered egg donor? I know here it would be more expensive than straight forward ivf and I can not get my head round it personally….that’s just me though and I would never say never. Stay strong. Love & Hugs xo

    1. I so wish we didn’t have this in common either! I have thought about donor eggs. It is twice as expensive here as a regular IVF cycle. I actually really like the idea of it, but I just can’t see myself spending all that money on a not-sure thing. I think about it all the time, though. You never know, maybe someday.

      1. Yes it is expensive here and my husband pointed out just like you that it is not a sure thing. I have learnt to never say never so maybe.

  15. I am so sorry – my heart just feels so heavy reading your posts right now when I know how badly you want this. I know it might seem insurmountable, but ANYTHING is possible. Do not give up yet. Have you been taking DHEA? Or does your clinic use it? It was discovered by a woman who took it after having almost no response to IVF, yet as the months (and future cycles) passed she produced more and more eggs and the doctors wanted to know what she was doing. Sorry – you probably know all of this already (I know I feel like I’ve read the entire contents of the internet on miscarriage and fertility sometimes and you probably feel the same way). Maybe a different protocol is what you need – not all of us are the same. Drink lots of wine (my favourite coping mechanism), have a few drop-out days and then maybe you will feel ready to tackle this with a fresh perspective. Thinking of you and so hoping you are okay xxx

    1. Thanks, Faye. Ugh, it’s more than a week later and I’m still waiting for that fresh perspective! I did ask my doctor about DHEA and CoQ10 last week. She said that she doesn’t typically recommend them as there is not enough hard data to support their effectiveness, but she is totally ok with me taking them, and she told me how much to take of each. So as of yesterday I’m taking 25mg of DHEA 3 times a day, and 200 mg of CoQ10 three times a day. We’ll see! I heard you need to take them for thee months for it to be effective. When I asked my doctor about that she said that the only time period studied has been 3 months of usage, which is why everyone says 3 months. But she says that there’s no reason to think that less time can’t be effective as well — it just hasn’t been studied yet so no one can say. We’ll see!

  16. I’m so sorry. We ultimately had to make the same decision because we pay for everything OOP. When it cam down to IVF or adoption, we chose adoption because we felt it was more of a sure thing. I was also 37 closing in on 38 at the time and my RE wanted us to do IVF within the year if we went that route. After that, she didn’t think we should try it. It’s a difficult and very personal decision to make, but if you want to talk adoption at all, feel free to email me. We are just working on completing our paperwork and will hopefully have our home study done beginning of June.

    1. Thank you! I love hearing from others that have chosen adoption, and what lead them to that decision. I am excited for your upcoming home study — June is so soon!

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