I have very low AMH and high FSH, should I use my own eggs or donor eggs?

I come across this question very frequently.  I would really wonder how to answer this because the person who asks this question is trying to make a very important, life-changing decision, which will determine their fate. I will not have any idea about their personal circumstances too (their financial strength, family and social pressures so on).  Recently I received one such query and I answered it in the following way. Hope it helps some of you to decide.

I have very low AMH and high FSH (poor ovarian reserve) should I use my own eggs or donor eggs?

Let me explain using an analogy. You have a basket (ovary) with balls (eggs) which are of two different colors, green and red. Assume that green balls are good eggs and red balls equate to genetically defective eggs. You are going to play a probability game (IVF cycle) in which you are going to blind-fold your eyes (no way of selecting only genetically normal eggs) and pick balls from the basket. You win if you pick more green balls. A young woman with a normal AMH and FSH will have more balls in her basket (more eggs in ovaries) and you will have less balls (number of eggs in your ovaries will be less because of poor ovarIan reserve). The probability of getting green balls from your basket becomes less if you have poor ovarian reserve as a result of advanced maternal age (older women will have more genetically abnormal eggs when compared to young women). If you are of young maternal age, suffering with poor ovarian reserve, the number of balls you can pick from the basket becomes limited as the total number of balls available for selection is less too.The game gets too complicated if you have to pick up green balls with your eyes closed (there is no fool-proof technology to select only genetically normal eggs) and transfer the balls safely into a narrow mouthed container situated nearby you (this equates to picking up good eggs, fertilize it, grow it safely into embryos in the lab and transferring it to your uterus). Even if you are successful in picking up the few green balls (very few good eggs available) there are so many other variables which determines IVF success like:  the sperm should fertilize the egg; there must not be any inadvertent lab errors;transfer to the uterus should be perfect; and your uterus must be receptive enough; hence your chance of IVF success decrease drastically. But a young woman with a normal AMH and FSH will have a high probability of picking up more green balls from her basket (presence of more eggs and more genetically normal eggs too) and hence her chance of success is high (in IVF).  If you are extremely lucky you might pick up the green ball (good egg) in your first IVF attempt and if all goes well the embryo created out of it might implant and may develop into a healthy baby. Such miracles do happen but very, very rarely (because the probability of getting a genetically normal embryo is less in your case !) If you have money, patience and determination you can play the IVF game for 'n' number of times with the hope that it will click one day. You might find success in the next attempt with your own eggs or after 10 attempts or never ! Now you have to decide whether you will go by luck or by scientific evidence and knowledge!

Good luck for whatever you decide. If I were you I will put my knowledge first and try to have a baby with donor eggs. Any baby you love will be yours and by doing this you give your husband a very good chance for propagating his genes. There is a technology available to select genetically normal embryos but again you need more eggs and eventually more embryos so that it will be easier to find couple of good embryos from the cohort.

NB: If the woman who ask this question is of younger reproductive age (less than 35 years), her chance of success is better (only slightly) than a woman of advanced maternal age (35 and above aged woman). Her chance of success is slightly better because her egg quality might equal to that of women of her age.  But her success rate cannot equal to that of women of her age since she is running out of eggs and the chance of success is better in IVF if there are more eggs to work with ! What if, if the woman is of advanced maternal age but with normal ovarian reserve (good AMH and FSH value)? Unfortunately her chance of success is not any better than a woman of her age. This is because eventhough she has good ovarian reserve, with age, her egg quality declines irrespective of the quantity. So her chance of success will not be equal to that of a younger woman with normal AM H and FSH value.