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.

Giving meaning to one's own suffering - a real life story !

This is a beautiful e-mail I received from a reader of my blog (now my friend).  I wanted to share this e-mail with you all for two reasons: her life is so inspirational; she found a meaning in her life after her irreplaceable loss, and she has used her pain and suffering to shape her destiny for the better; she has also asked me a very soul-stirring question - “What is your memorial to your children?” This is a very thought provoking, life-changing question. Thanks a lot ‘H’ for your kind e-mail; for your willingness to reach out to me; for sharing your story and your wisdom with me. I hope many who go through suffering as a result of infertility will get the courage to infuse meaning to their life when they read your mail. 

Manju I am delighted to have a message from you!

I am sometimes not sure if people gain comfort from another person sharing their own story with someone whose loss is still so raw:  only 3 months for you.  I will for now just share some basic information about my story.  I am of course very happy to share more and answer any questions you have if you think it would help and enable you to move forward.  Please do not read on if you feel it might be too painful.

A few years ago, I had a career, had been married 10 years and had been trying to conceive for many years.  After a little help I became pregnant and my boys were due in January 2002.  My boys arrived at 20 weeks and my life fell apart.  Today I am single, a paediatrician and about to start another chapter of my life.  So how did I get here you might be thinking? I was so distraught by how I was treated by the medical profession whilst losing my sons; I thought I can do a better job than that.  All this pain and emotional turmoil has to be for a reason:  I needed to turn a negative into a positive.  Somehow, even at my relatively advanced age of 35 for a student, I managed to get into Medical School and my aim was to be an obstetrician.  Being in another part of the country was a new start; my studies distracted me from being buried in a world of sorrow.  People did not know me in my new city, they did not know my story and they did not treat me any differently. I could choose to share my pain only with those I chose and those who cared.  I was not plunged into awkward situations with people who barely knew me plus those who did know me most of who did not know what to say to me.  I initially went back to my career.  It was tough.  People would come into the store where I worked and could see I was no longer pregnant and thought I had my baby.  Other people, even those I would have considered friends outside of the work place sometimes crossed the street to avoid me.  In the UK a 20 week loss is considered a miscarriage; in Australia it is considered a stillbirth.  My medical notes recorded it as a miscarriage.  Many people in the UK see a ‘miscarriage’ not as stillbirth.  I am not considered a real mother by the majority.  You and I know this is not true. 

During my time at Medical School and I had to do an Obstetrics & Gynaecology rotation study where I have to work in wards.  It was emotionally more than I could manage.  Although much to my surprise I enjoyed paediatrics and this had more to do with the types of personality possessed by those doing the job. I had no experience of live children and could not see what I had to offer.  For my Foundation Training, 2 years basic junior doctor training, I chose a rotation which had 4 months paediatrics to confirm if this was the right direction for me.   Now I am a Paediatric Registrar and I have 4 more years to become a Consultant Paediatrician.  At the time I lost my sons I could not work out why: why me, why this pain, what a waste of emotion, what have I done wrong, why some are people so awful, thoughtless and outright unkind.  I still struggle with how I was treated by the medical profession and it is that which hurts me the most even to this day.  I had put my trust in them and they have let me down.  If I had been treated promptly the outcome for one of my boys may have been different.  I was robbed of that chance by people I placed my trust in.  I could, and can, cope with the pain of losing my sons and my dreams but not with being denied a chance of getting the right treatment. 

 It was my determination to do things in a different way, to be a different doctor than the lady consultant I first met that fateful weekend, which lead me to Medical School.  I did not become an obstetrician. I became a paediatrician and that is my memorial to my sons.   What will be your memorial to your son and daughter?

Is your blog your memorial or is there more in you?

I would love to have another message from you and to read your blog posts again when you feel stronger. 

She is a great example of a person who has changed her life for better using her pain and suffering; she has proved that attitude is all that what matters in life. She had two options in front of her: to get depressed, bitter, angry and lose all hopes in life, or, to use the pain she underwent to become a better human. She chose the latter and that is what has made all the difference in her life.

What will be your choice when going through a suffering – to get bitter or better?

Pray for Ellie

Dear friends,

Today morning I received this comment from Dana. I know Dana and Rani for quite sometime now and was heart broken to see his message. Below is the message :

"Hello Manju, I still think about you quite often and, recently, even more so. It seems our trajectories have been so similar in the past, so much so that I was fearing that our recent IVF pregnancy might tumble into the same pitfalls as yours. Sadly, a few days ago, it did. Our little girl was born at 24 weeks, just barely into viability, and she's struggling in the NICU.

I remember you once told me I should start a blog and I didn't see how I could find enough thoughts or words for it. Now, they are spilling out like a fountain, so I started one after all.

Maybe its not the kind of thing you should be reading right now, but if you would like, it is here: 

http://letterstoelliesmith.blogspot.com/ "

Please pray for Little Ellie and her parents ! Three months have gone since I lost my little ones. Dana's message has triggered lots of memories that I try to keep suppressed within me.  Whoever reads this post please show your support to them with your kind message. Every kind word will bring a lot of solace to the parents. I really wish Ellie beats all the odds and turn into a healthy little young one.

About us : We are doing fine. We are in India on a break. The warm sun and the love we receive from our loved ones has eased our pain a lot. I smile as usual, enjoy all the worldly pleasures (I didn't think I will be able to do so three months ago), I am quite happy. Time is a great healer and fortunately our brain forgets all the pain quick enough leaving only the scars. Scars don't pain as much as a raw wound. What will happen if the wound remains raw always - no one will survive adversity ! The end result of all we went through is : myself and my husband enjoy a better relationship, I am able to take in happiness even better, I am very, very thankful for all my blessings. If I have to mention the negatives too, we don't have our children, don't have a job, don't have a home - I had everything three months ago ! Life is a mystery and is too beautiful with its uncertaininty, only we must learn to enjoy it :)

Our journey to have a little one continues. I am not going to stop following my dream but haven't decided yet which way to a baby. I believe that the fear of losing is much worser than the loss itself. If I worry about suffering and loss I can never pursue my dream. If I stop following my dream, my life will cease to have a meaning. We are planning for the future and I am happy that we still have a chance to do so !

Love,

Manju