Unfortunately, we often see young women in our office who have been told elsewhere that they must or should do donor egg because they are predicted to produce a smaller than average number of eggs. However, we have had reasonable delivery rates without using donor eggs in these women. When we looked specifically at women 38 and under who were very poor responders, our delivery rates were still in the mid to upper twenties. Therefore, it would take roughly two cycles for these women to equal what the average woman did in one cycle but most would eventually deliver. All of these women fell below most centers’ accepted standards for retrieval. That is, their cycle would have been cancelled without retrieval anywhere else. It is extremely rare that we can tell a young woman that she is unlikely to deliver with her own eggs. Young women can conceive even if they do not produce as many eggs as the average woman. Ultimately, age is the best predictor of pregnancy.
Success comes down to the normality of the eggs produced. By normal, we mean genetically normal. In a 34 year old with few eggs, or high FSH, or low AMH (see below) most of the eggs produced will be normal. In a woman in her 40s with a normal number of eggs, and normal FSH, and normal AMH the majority of eggs are abnormal. To get deliveries in the 40s you need lots of eggs. To get deliveries in the twenties to at least the mid 30s you just need some eggs or even one egg.
While even in this group most women who will conceive do so by the third cycle, we have had many patients who have persisted with deliveries out to cycle number 9. Many of these deliveries were from single egg collections. We have had several twins from two and three egg collections.
For the woman in her 40s this is much more difficult. To get around the increase in abnormal eggs we simply need more eggs. In the poor responder this would take many more cycles. Despite this, there have now been deliveries from IVF reported up to ages 47 and 48.
We would also point out that the cost of donor egg IVF cycles continues to climb at astronomical rates. Much of this is due to competition for donors and fees generated by matching agencies. For the same or less money many of these women could deliver with their own eggs.
What are predictors of pregnancy?
1. Age. There is no better predictor.
2. Antral follicle count (AFC). This is a count of small follicles (cysts containing eggs) which can be done at any time of the cycle but tends to be easiest during your period. Counts of 10 to 19 are considered normal, 8 or 9 are borderline, and 7 and below are reduced.
3. AMH (anti-Müllerian hormone). This blood test is almost as good a predictor as the AFC. Firm limits have not been determined. A level below 1.0 is clearly low. We have had delivery with undetectable AMH up to age 38.
4. FSH. FSH is considered a very poor measure of ovarian reserve and is rarely done now. It is only of value if abnormal. A normal FSH tells you little.
5. "Dynamic testing.” The most common (there are several) is the CCCT, clomiphene citrate challenge test. These tests are of no additional value and should not be done.
Every individual couple will be evaluated to determine best estimate of their chance of delivery.