Abstract
Providing reasonable expectations to patients with diminished ovarian reserve prior to attempting pregnancy through in vitro fertilization (IVF) is one of the most challenging aspects of fertility care. In some instances, advice from the clinician to pursue more effective treatment, such as donor oocytes, may not be acceptable to the patient. In this case report, a patient is presented who represents a poor prognosis candidate for IVF treatment. She was 43 years old with six prior failed IVF cycles and repetitive basal FSH values above 30 mIU/mL. Presented are the challenges in patient counseling and decision making. In her seventh IVF cycle, which she was strongly counseled against pursuing, the patient experienced the desired outcome of live birth. Increasing reports are emerging of live birth using autologous oocytes among women of advanced reproductive age. These instances, as well as the case of our patient, raise issues commonly encountered in patient counseling in poor prognosis patients. This discussion should include an emphasis on patient goals as well as an acknowledgement that no test for ovarian reserve has a 100% positive predictive value.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Committee on Gynecologic Practice. Committee opinion no. 618: ovarian reserve testing. Obstet Gynecol. 2015;125(1):268–73.
Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12(6):685–718.
The Ethics Committee of the American Society for Reproductive Medicine. Fertility treatment when the prognosis is very poor or futile: a committee opinion. Fertil Steril. 2012;98:e6–9.
Paulson RJ, Sauer MV. Counseling the infertile couple: when enough is enough. Obstet Gynecol. 1991;78:462–4.
Clapp D. Helping patients know when “enough is enough”. Sex Reprod Menopause. 2004;2:159–62.
Schlaff W. Autonomy, futility, and good business in reproductive medicine: is the slope getting more slippery? Fertil Steril. 2015;103:626–7.
Klock SC. When treatment appears futile: the role of the mental health professional and end-of-treatment counseling. Fertil Steril. 2015;104:267–70.
Dal Prato L, Borini A, Cattoli M, Preti MS, Serrao L, Flamigni C. Live birth after IVF in a 46-year-old woman. RBMO. 2005;11:452–4.
Trolice MP. Live birth from a 46-year-old using fresh autologous oocytes through in vitro fertilization. Fertil Steril. 2014;102:96–8.
Rani G, Goswami S, Chattopadhyay R, Ghosh S, Chakravarty B, Ganesh A. Live birth in a 50-year-old woman following in vitro fertilization–embryo transfer with autologous oocytes: a rare case report. Fertil Steril. 2015;103:414–6.
Gürgan T, Urman B, Yarali H, Duran HE. Follicle-stimulating hormone levels on cycle day 3 to predict ovarian response in women undergoing controlled ovarian hyperstimulation for in vitro fertilization using a flare-up protocol. Fertil Steril. 1997;68(3):483–7.
Martin JS, Nisker JA, Tummon IS, Daniel SA, Auckland JL, Feyles V. Future in vitro fertilization pregnancy potential of women with variably elevated day 3 follicle-stimulating hormone levels. Fertil Steril. 1996;65(6):1238–40.
Bassil S, Godin PA, Gillerot S, Verougstraete JC, Donnez J. In vitro fertilization outcome according to age and follicle-stimulating hormone levels on cycle day 3. J Assist Reprod Genet. 1999;16(5):236–41.
Gingold JA, Lee JA, Whitehouse MC, Rodriguez-Purata J, Sandler B, Grunfeld L, et al. Maximum basal FSH predicts reproductive outcome better than cycle-specific basal FSH levels: waiting for a “better” month conveys limited retrieval benefits. Reprod Biol Endocrinol. 2015;13:91.
Society of Assisted Reproductive Technology. https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?reportingYear=2014. Accessed 14 May 2017.
De Brucker M, Camus M, Haentjens P, Verheyen G, Collins J, Tournaye H. Assisted reproduction using donor spermatozoa in women aged 40 and above: the high road or the low road? Reprod BioMed Online. 2013;26(6):577–85.
Filicori M, Cognigni GE, Gamberini E, Parmegiani L, Troilo E, Roset B. Efficacy of low-dose human chorionic gonadotropin alone to complete controlled ovarian stimulation. Fertil Steril. 2005;84:394–401.
Blockeel C, De Vos M, Verpoest W, Stoop D, Haentjens P, Devroey P. Can 200 IU of hCG replace recombinant FSH in the late follicular phase in a GnRH-antagonist cycle? A pilot study. Hum Reprod. 2009;24:2910–6.
Paulson RJ, Chung K, Quaas AM, Mucowski SJ, Jabara SI, Bendikson KA. Low-dose human chorionic gonadotropin alone can complete follicle maturity: successful application to modified natural cycle in vitro fertilization. Fertil Steril 2016.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Informed consent
Informed consent was obtained from the individual discussed in this case report.
Rights and permissions
About this article
Cite this article
Burks, H.R., Baker, M., Quaas, A.M. et al. The dilemma of counseling patients about poor prognosis: live birth after IVF with autologous oocytes in a 43-year-old woman with FSH levels above 30 mIU/mL. J Assist Reprod Genet 34, 1185–1188 (2017). https://doi.org/10.1007/s10815-017-0986-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10815-017-0986-3