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A Final Graduation (A Case of Premature Ovarian Failure)

My last days at New Hope were a whirlwind of emotions and many sad goodbyes. Fortunately, one good-bye was a happy one: I was able to graduate AG!

AG had a beautiful ultrasound heartbeat on 3 separate occasions and the fetus was growing appropriately, so it was time to move her on to her obstetrician. AG is 36 y/o. If everything goes well this will be her second baby with New Hope. The most interesting thing is that she is menopausal and this pregnancy was from an embryo created from her OWN egg, not a donor egg. How can this be?

AG ‘s story starts 2 years earlier. She came to us after multiple centers in New Jersey and New York City told her that IVF was not possible because her baseline FSH was too high and her reserve was too poor. She was repetitively counseled to have an egg donor. She had never been pregnant before, but her work-up was all normal and her cycle was fairly regular. Unfortunately, timed intercourse and inseminations were not working, but no one was willing to try IVF.

On her initial visit, her FSH was indeed high, but it was because she was ovulating. Despite the suddenness of the whole situation, she desperately wanted to retrieve the follicle that was there, so we performed a natural cycle retrieval. We were able to retrieve an egg which fertilized and 2 days later I performed an embryo transfer. She did not become pregnant.

After the transfer failure, we had a long discussion. Because of her particular situation, I made one major suggestion: Embryo Banking. If her reserve was truly poor, then the next follicle she developed could be her last egg. Even if we were fortunate enough to help her conceive, there was a strong possibility that it would be her only genetic child. Surprisingly (maybe not so surprisingly), 80-90% of my patients return to see me for a second child, no matter how difficult it was the first time around, and many of them regret not having saved a few embryos for the future.

Through embryo banking, we could optimize AG’s chance of having 1 child and, if we were lucky, we could have a few extra embryos for the future. Is there any downside to banking? Of course! More treatments, more money, but the hope is that minimal stimulation IVF with less medication, less side effects and less cost would allow patient to undergo more treatments and optimize her chances. AG was all on board for this.

The next cycle did confirm what she had told us; her FSH was 18 IU/ml and she had only 2 antral follicles. Based on this information, we proceeded with Clomid only IVF which resulted in the retrieval of 1 egg (under local anesthesia, of course) which resulted in 1 embryo. Because our concern was our ability to retrieve eggs, as oppose to egg quality, we froze the embryo as a 6-8 cell embryo as not to risk damaging it.

This continued for next few months. Occasionally, AG’s FSH would increase dramatically (it peaked at 85 IU/ml) and we would perform Natural IVF so “Overstimulation” would not occur. Once AG was comfortable with the number embryos she had banked (or when she was just tired of the whole banking process), we performed a natural cycle frozen embryo transfer( no medications, no hormones, until ovulation occurred) and we were successful the very first time!

After a smooth pregnancy and delivery, AG returned to try for baby number two. Even though she was done with breastfeeding, she had not resumed her period. A test of her hormones revealed an FSH of 128 IU/ml; she was most likely in menopause which meant “No more eggs”. Fortunately, we had banked a few embryos so there would still be an opportunity for baby number two. Since AG was in menopause, we could not repeat the natural cycle frozen embryo transfer which worked before. This time we had to create an artificial hormone environment commonly known as a Hormone Replacement Cycle (HRT). Once again, we were successful on the first try!

So, good luck AG! I hope to receive a birth announcement this summer!