By: Dr. Adam Fechner
Many women come to our office after being told they need to use donor eggs to get pregnant. Some are sent by their gynecologists after testing shows they may be in early menopause. This condition, known as premature ovarian insufficiency (POI, formerly ‘premature ovarian failure’ or POF), is defined by menopause before the age of 40 and presents when young women stop getting their periods and testing shows hormone levels elevated into the menopausal range. This condition can be caused by certain genetic diseases or can have an autoimmune etiology. In some cases, patients can go into menopause as a result of cancer treatment, such as chemotherapy or radiation, which can be toxic to the ovaries. However in the majority of cases we never find a clear cause.
For some women with ovarian failure, the ovaries may periodically and briefly resume functioning, so spontaneous conception can occur in around 5% of women. Unfortunately, however, there is no way to predict if or when this will happen, so properly timing intercourse can be very difficult. For this reason, an egg donor does represent the best chance for conception in women with premature ovarian insufficiency or for women over 40 who are in early menopause.
For other women, however, the question of whether to use an egg donor is much less clear cut. Patients frequently come see us for a second opinion because they were told by another fertility doctor they need to use an egg donor. These women still get regular monthly periods, but their hormone testing shows that their ovaries are not functioning well (they are told they have ‘diminished ovarian reserve’). Some of these women are in their late 30s or 40s when we expect the ovaries to start to slow down. But many of them are in their 20s or early 30s and the results are quite unexpected. In many cases these women are not even offered a trial of treatment using their own eggs; they are only told they need to use an egg donor and to return when ready to proceed.
Why aren’t these women given a shot to conceive using their own eggs? When the ovaries have slowed down considerably, the chance of conceiving with any sort of treatment is significantly reduced, and a diagnosis of diminished ovarian reserve suggests that the ovaries would not respond well to stimulation (a necessary part of any IUI or IVF cycle). For this reason, many fertility practices will deny IVF to any patient with abnormal ovarian reserve testing, even if the hormones are only slightly elevated. In part this is to save the patient from spending her resources (time, money etc) on a treatment that has a low chance of success. However, this is also sometimes done by fertility clinics trying to protect their ‘numbers.’
IVF success rates are published online and are used by many patients to select a fertility practice. If doctors allow all of these ‘bad prognosis’ patients a shot at IVF, their success rates wouldn’t be as high, but by denying care they may be robbing these patients of their best chance at conceiving using their own eggs. These women may ultimately need donor eggs to get pregnant, but if there is even a small chance of success with her own eggs she should be offered the opportunity.
For women who are not actually menopausal or in ovarian failure, the most important thing to keep in mind is that abnormal ovarian reserve testing does NOT mean you can’t get pregnant. It is one of the many pieces of information we use to design a treatment plan, but it should not be used to deny care in an effort to preserve high success rates.
