High FSH, Low AMH

The Donor Egg Conversation – my eggs were the butter knife

Photo by Daniel Reche on Pexels.com

Something I often see in fertility groups are feelings of anger and frustration over being offered donor eggs or the suggestion to go down that path by a fertility doctor. I was there at one point. My doc was very straightforward which is one of the many things I loved about her. I didn’t want sugar coating, and ethically she had to tell me what was likely to be the easiest and most cost effective path to my desired end, a baby. But it hurt. I cried a lot.

She suggested I think through what I needed to do to close the door on my own eggs. I think she meant, how many cycles am I willing to go through, how much money can I spend, etc. I took it a little further and researched like a mad woman and thought through which protocols I wanted to try and if response was good on X protocol, I will do it Y times, etc. I was going to do one more cycle with a lower dose protocol to see how I responded on less meds since that would stretch my money farther, take the summer off and start down the path of trying the protocols in the fall. I got incredibly lucky and got pregnant with my twins that first lower dose cycle. Overall I spent a good 6 weeks mulling over the donor egg conversation.

I have thought about those conversations a lot over the years. I think several things may play a part in how we come out of them feeling and I hope with this post to help someone gain some perspective that helps them not feel anger, disappointment or defeat.

First, let’s look at why they bring up donor eggs to start with. When I was processing the donor egg conversation, I was putting together a shoe rack. I needed tools like a Philips head screwdriver and rubber mallet or hammer. I was thinking, what if I had only a butter knife? It may be possible to get the job done with a butter knife, but it would take longer and would have made it ridiculously hard.

(We’ve all used a butter knife for a screwdriver, right?)

I thought of the tools my doctor had to get me pregnant – eggs, sperm, medications, procedures. If I take away those tools from her, how is she supposed to build a baby? In this case, the more eggs you have, the easier it is to find a good one and get pregnant. I thought of my pitiful response to meds and my 2-3 eggs per cycle and I realized that my eggs were the butter knife. They may work, but it is going to be a lot harder. This isn’t my doctors fault. She offered me the Philips screwdriver. She explained that the screwdriver would increase the chances of building a baby, would likely decrease the time it takes to build and would very possibly lessen the cost to build the baby by doing less treatments overall. I had to make the choice between taking the screwdriver and the butter knife and she was doing me a great service by explaining that choice.

As much as I call my doctor a magician, she truly isn’t magical. Doctors only have so many tricks up their sleeves, and each trick requires tools. Offering donor eggs is compassionate and ethical. The doctor has to look at the patient and make the call on when not mentioning donor eggs would be unethical. If the patient is 25 and has low amh and poor response, because their egg quality at that age is still likely good, maybe not offering donor eggs right out of the gate is ok. If the patient is 40 with low amh and poor response, it would be completely unethical to cycle her over and over and never offer the donor alternative. In many cases, offering the screwdriver while agreeing to work with the butter knife is the right thing to do.

Now lets think about the conversation with the doctor.

Did you hear what they said? For me it was like what I imagine being told you have cancer is like. It was a shock and I felt a little like I was having an out of my body experience. I knew she was still talking but I wasn’t able to hear what she was saying, let alone focus on the words. Sometimes people walk away feeling like the doctor said there was no chance of them having a baby with their own eggs, period.

I would be shocked if any reproductive endocrinologist said to anyone that their chance of conceiving with their own eggs is 0, since no one actually knows that. There are natural surprise pregnancies every single day, even in women who thought they were well into menopause. Doctors by training know not to talk in the definitive. They may say you have a UTI, but then follow it with, “this antibiotic should kill it.” What they are probably quoting when they give you a chance of getting pregnant is a statistical chance of pregnancy using all the tricks up their sleeve. They may base this on their own practice data or maybe some published study, something likely based on age and the # of eggs you historically retrieved or are likely to retrieve. They aren’t saying this to discourage you. They are saying this so you can make an informed decision. They tell you this so you can factor that in when you are choosing how to spend the funds you have available.

Sometimes people say that the doctor won’t allow them to try with their own eggs. They believe the doctors are more concerned with their success rates than giving each person a chance. That may be true of a few doctors. What I believe is more often the case, is that if they truly don’t want to try cycles with someone it is because they feel sure they don’t have the tools to build the baby. Maybe their general population are PCOS or male factor and they have little experience with DOR. Maybe their clinic is in a location where they struggle to get embryology staff year round so have to batch patients, which basically is like when the butter knife bends – the tool you do have is even more ineffective. Maybe they are part of a health system or not in control of their prices, so feel you would be better served at a place that does mini cycles and banking packages where your money will stretch farther. It’s better to know how equipped the doctor is to handle your care before sinking time, heartache and money into it.

Some people react to the conversation about donor eggs as if it is no big deal. They love that they have that option, are not upset about the genetics and choose that path right away. Some choose it but mourn the loss of their own egg baby. For them, maybe the emotional toll of many failed cycles is just not worth it, but choosing that path is still a loss. Some women have seen negative test after negative test at home already and just want to be pregnant already. The doctor has no way of knowing whether you are going to be happy to move forward with donor right out of the gate or really want to try with your own until they have that conversation.

I believe most doctors who choose infertility for their specialty do so because they genuinely want to help people build their families. They go to school for hundreds of years to end up working long hours, weekends, holidays. They review lab results or call patients with directions while most are sitting down to dinner. They are busy and dedicated. They experience the pain of each failure right along with their patients and they feel genuine joy when they can celebrate a success. They look at us and want to solve our problem and it is a really hard thing for them to have to tell us that they don’t have a trick big enough to solve depleted egg reserves. The conversation is not just hard for you.

High FSH, Low AMH

Fertility cycles are like fishing.

An analogy.

Imagine your ovaries are a pond. The pond is full of fish, little useless guppies and nice big bass. When you are young you have tons of fish and most of them are bass, say 90%. As we fish (age), the total number of fish depletes as well as the ratio of guppies to bass. By the time you are 45, you have way less fish and most of the fish are guppies.

If the goal every time we do a fertility cycle is to catch a bass (a good egg), then it makes sense that the chances of catching a bass is going to be higher the younger you are and with the most fish you can catch.

What makes conceiving so hard when you have DOR, High FSH, low AMH, or just unexplained poor response to meds, is that each month when you go fishing, you only catch a few fish. If you are 25 and catching 3 fish, there’s a great chance 1, 2 or even all 3 of those fish will be bass, as your pond is still full of them. If you are 40, you may need to catch 15 or 25 fish to find a bass, and it may take you five fishing trips to catch 15 fish.

Low AMH, High FSH, and low AFC are all indicators that you probably won’t catch many fish each fishing trip. Some with great hormone levels still don’t catch many fish, and I have seen women with low AMH catch a good amount of fish (have a good response). Point is, they are just an indicator of response. They don’t tell you what your guppy to bass ratio is, etc.

Some women luck out and catch a bass on their first fishing trip, regardless of only catching one or two fish. Some women may go fishing 10 times, catch 30 fish and still not catch a bass! Sadly, in spite of all the medical advances out there, catching a bass is still largely based on luck.

When you consider all the things that go into a fishing trip – finances, emotional toll, relationship strain – sometimes we just can’t go fishing over and over and over in the hopes of finding a bass. Sometimes it may make more sense for you to move on to other options, like donor eggs, adoption, etc. This is something that only you and your partner can really know.

Bottom line, there is no lab test to tell you if you can get pregnant with your eggs. There is no magic number on a lab report that says you have all guppies. There is no way of knowing when you have a bass that is growing for ovulation. I believe all we can do is try to make our pond the healthiest environment possible; eat clean, take a good supplement regimen, exercise, get rest and hydration and try to manage stress, and hope that we find a bass OR we find our path to peace, whatever that is.