Saturday, January 08, 2011

Patients with poor ovarian reserve - flogging a dead horse ?

For many IVF clinics, the patients which cause the most distress are the ones who are poor ovarian responders. These are patients who have poor ovarian reserve - and are often heartsink patients, because no matter what we do , it's very difficult to get them pregnant !

It is possible to get them to grow eggs and make embryos - and this actually makes the matter even more complex. This often creates false hopes - if I can make eggs and embryos, of course I can get pregnant ! All I need to do is to get the embryo to stick !

Unfortunately, there is no easy answer, and every patient needs to look into their own heart to resolve this personal quandary for themselves. While we are very happy to aggressively superovulate these patients, I feel using expensive and unproven treatments ( such as growth hormone injections , intravenous immunoglobulins and IV intralipds ) are difficult to justify !

What makes a complex situation even more confusing are the anecdotal success stories which litter the internet ! It's hard to separate the wheat from the chaff, and since hope springs eternal in the human breast, many patients are willing to "give it one more shot " !

From a medical point of view, using donor eggs is the most efficient way of solving the problem - with a very high success rate. Unfortunately, it's also the one solution which is hardest to come to terms with ! The question you need to ask yourself is simple - what's most important for me ? Do I want to propagate my own genes ? Or do I want to have a baby ?

Need help in making a decision ? Send me your medical details by filling in the free second opinion form and I'll be happy to guide you through your options, so you can make the best decision.

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