HELP - 43 years old and trying for a sibling for our 2 year old daughter

[teddybearkit]

At 40 we started fertility. Periods always very regular, sometimes 25 or 26th day and I suspected I was not ovulating some months at 40.  At that time FSH around the 6 mark.  Pregnant after 4 months -  missed miscarriage.  5 months later, pregnant at 41 using femera, dexamethazone and trigger shot.  Fertility doctor always impressed with number of follicles on day 3 and how thick lining of uterus was at ovulation.  My pregnancy was text book.  Decided not to do genetic testing because 12 week tests showed no markers. Odds were 1 in 15,000 for downs.  Nausea for 5 months but after I felt really fantastic physically.  Delivered vaginally on due date,  no complications.  7 pounds 6 ounces and healthy.  Now at 43, 44 in one month, we decided we would try once again.  Doc ran all tests 6 months ago, we went back on same protocol.  FSH now at lowest is 6 and at highest 11.  AMH 6 months ago was 16.6 (I live in Canada) which is considered medium ovarian reserve but heading towards low reserve.  Doing cycle monitoring - blood work and ultrasound.  Day 3 I start off with about 6 follicles on EACH side.  I did only femera for the first 3 months and was only getting 1 or 2 mature.  After 3 months decided to introduce GONAL F  with femera.  I responded well for my age I think.  At ovulation producing 6 mature follicles (I had one bad month where I only produced 3 or 4).  Nurse says when she looks at my monthly charts, she wouldn't know she is looking at the results of a 43 year old.   Questions:  1) What do you HONESTLY think my oddes are to get pregnant since AMH test was taken 6 months ago.  2). Should we consider IVF? odds?   3). Husband had mild heart attack since (EXTREMELY hereditary).   Do heart meds, blood thinners and blood pressure meds interfere with his sperm (mobility, sperm count...etc).  4). I take wheatgrass daily, 5mg of folic acid, very good antioxidant and mineral supplements, prenatal supplement, COQ10, Omega 3.  Would you suggest anything else? THANK YOU!

[Elaine Brown, MD]

Hi!
If you were my patient, I would FIRST remind you how lucky and blessed you are to have a baby of your very own!!!  Kiss that child every single day!
Secondly, your husband certainly could do a semen analysis to see if there has been any effect on his counts and/or motility.
To be completely honest, I think I would jump immediately to IVF from here.
It may be somewhat difficult to find a doctor who will accept you as a patient, as most like the FSH to be less than 9 and the AMH around 4 ish.
BUT 43 is the new 35 and the chances for pregnancy go down drastically from where you are.
Finally, since you had such a wonderful pregnancy and seem so young, you should think about the option of  donor eggs if you can't conceive your own child this time around.
One more thing--consider acupuncture when in cycle!
Improves blood flow in us "old ladies".
Good luck!
Dr B

[teddybearkit]

FYI, I posted this for the doctor forum.  Thanks