Hi Dr. Lee,
Your website is great! I would very much appreciate your advice, please.
Here is the background:
- At age 39, my new husband and I got pregnant on our first try. A beautiful Honeymoon Baby!
- Six months ago (I was 41 1/2), we became pregnant again without any medical intervention. We had tried for 6 months and finally “hit it” when someone gave us a tip about ovulation predictor kits.
- Sadly, I miscarried at 7 weeks. My period returned 4 weeks later.
- Now I am 42 and am seeking fertility help. Upon reviewing my diagnostic tests, I was surprised to find out my FSH levels were 28 and I only had 5 total eggs visible in my ovaries. This seems difficult to reconcile with the relative ease to which I’ve been able to get pregnant.

My question: My FSH test was taken 4 months after the miscarriage. Could the elevated levels and low egg reserve be due to my body still recovering from the miscarriage? I would greatly appreciate any insight you may have, as I can’t find any research about the impact of miscarriage on FSH levels and egg reserve.
Thank you so much!
Joanne

Dear Joanne,
An FSH level of 28 is not unusual at age 42. First of all, if it was not done on or near day #3 of your period, there is a chance it could be inaccurate. If it was done on the correct date, then it is an unfavorable sign. However, as long as you are still having regular menses, there is still a glimmer of hope. Every RE has their own “war story” of a patient with a high FSH who went on to have a baby. I can recall a patient who had a FSH of 27 who went on to have a healthy baby with her own eggs. The bottom line is that your age together with your FSH put you in a category of women who have a low possibility of spontaneous pregnancy, but while low, it is not entirely zero.

Now to address your question directly, the fact that you had a miscarriage just four months prior to that unfavorable blood test means that you still had the capability to get pregnant. The miscarriage itself would NOT be expected to affect the validity of the test. If anything, there might be a scenario where a recent miscarriage causes a falsely OPTIMISTIC result. Meanwhile, you would be wise to just enjoy loving your precious “honeymoon baby”, while you and your husband continue to get together randomly every 2-3 days. In my opinion, IVF would not really boost your chances enough in relation to how much it costs, but you could always discuss it further with your own RE or OB. Good luck!

The Chicagoland area reports increased interest from women wanting to be egg donors and surrogates, many of whom cite bettering their financial condition during this economic downturn as part of their incentive for wanting to do it. In contrast, in the UK, where they have banned monetary compensation for sperm and egg donors, there is a terrible shortage of gamete donors. No real surprise.

“I want to know how to get pregnant naturally.” This is a commonly uttered sentiment, even from patients who have already decided to take the time and money to come see me for consultation. You would think that by the time someone comes to an RE, they are already fed up with trying naturally. However, some patients find value in coming to me for evaluation and advice, without necessarily wanting to take the step towards actual medical treatment.

I usually start by explaining to them that many couples in the world will end up getting pregnant naturally. Typically, these couples don’t need any help and it just happens. So by virtue of the fact that they have made the effort to see me, it is likely that they have already tried on their own and something about this strategy was unsatisfactory enough for them to make them want to come see an RE. I then acknowledge the fact that some patients who give up on trying to conceive on their own, still have the possibility of doing so. Making the right fertility decision requires a balance between giving an adequate try on your own, when appropriate, vs. knowing when to get help when you’ve already wasted too much time in futility. It might not always be an issue of YES or NO, whether you can get pregnant naturally. It might also be an issue of WHEN. For example, if you are 30 years old and were told that without treatment, you had a 10% chance of getting pregnant in the next five years. But WITH treatment, you had a 80% chance of getting pregnant within the next four months. Even though you still have a chance of getting pregnant naturally, there is ample justification for you wanting to take the treatment route.

So the big question is when is it possible for an infertile couple to still get pregnant naturally? Well, as long as you are developing eggs, as long as there is a reasonable amount of sperm and as long as the tubes and uterus are clear, then there’s the possibility of getting pregnant naturally. In general for average couples, this chance is around 20% per month, but in some super-fertile couples it can be higher, like maybe 25-30% and in sub-fertile couples it would be lower, maybe 5-10% month. For couples who have the label of unexplained infertility, their odds are closer to 2-3% per month. You might wonder why a couple would just settle for a 2-3% per month, when they can boost their chances through IUI and IVF. Well, although IUI (low-tech treatment) and IVF (high-tech treatment) dramatically increase your chance of getting pregnant, you have to take into account the costs of infertility treatment and balance just how badly you want a baby RIGHT NOW vs. how patiently you are willing to wait and/or take the risk of still not being pregnant in three years.

So many times, my new patients and I spend a significant portion of our one-hour initial consultation discussing their situation without ever venturing into the topic of actual medical treatment. Rather, we focus on playing detective to discover their specific fertility problem or problems. Then, for the appropriate candidates, we talk about ways to boost their chances of conceiving naturally.

For these couples, the focus is on these three questions:
1. What can I do to improve my natural fertility?
2. When and how should I have sex?
3. When should I give up and move on to medical treatment?

Some of these issues have been discussed already in other posts, but I will review the rest here shortly.

It took 400 cases for the courts to recognize this abuse.

We already work with a very good Christian embryo-adoption agency locally, but it’s encouraging to hear that others are being established.