Endometrioma/Low AMH/Low FSH

Abbygirl

1 Posts
Reply Posted on: Jun 19, 2012 at 8:29am
Dr. Braverman,
I have a history of 6 miscarriages with 1 sucessful pregnancy in the middle. I am currently 36 years old. My diagnosis is as follows:
Compound heterozygous MTHFR
One mutation PAI-1
One mutation Factor XIII
Extremely high NK cells (don't have it in front of me right now, but CD56+ was in the mid-twenties, I think)
Weakly positive on ttg test for celiac disease (7, with 4-9 being weakly positive)
Without synthroid, my TSH runs from 3.5-5.5.

My miscarraiges typically occur at 8-10 weeks after seeing a healthy heartbeat. I did have one 14 week loss. Four of the six losses have had chromosomal testing and all have been normal.

For my successful pregnancy, I was on lovenox, baby aspirin, folbee, prenatal vitamins.

For my three subsequent pregnancies, I have been on the same regimine, with the addition of synthroid in my last pregnancy to keep my TSH under 3.

My last loss was in October 2010. We have seen Dr. Coulam and Dr. Kwak and plan on doing prednisone and intralipids in my next pregnancy (in addition to the regimine described above). I have also gone gluten free for the last two months.

We have been trying to get pregnant since June of last year with no luck. I have done 6 cycles of clomid and two of femara. I seem to ovulate every cycle, although my lutual phase is short (9-10 days even on clomid or femara).

I am now seeing a RE who has identified a 4cm endometrioma on my left ovary. I have laparoscopy scheduled for this Friday. At my preop appointment yesterday, the RE threw me for a complete loop--he said that my AMH is .38, which is indicative of poor ovarian reserve (my FSH, however, is 3). He is concerned about the lap since studies have shown that lap for endometrioma removal causes AMH to decline. He is leaving it up to me to decide if I should do the lap or skip it and go straight to IVF.

I really don't want to do IVF because of (1) the cost, (2) the fact that I have gotten pregnant 7 times on my own (usually the first cycle trying) and (3) the high risk that I will miscarry anyway due to all of my other issues.

Is AMH really reflective of ovarian reserve when there is an endometrioma present? How can the low AMH be reconciled with the low FSH?

Given these numbers, is there much likelihood that I will be able to get pregnant naturally after the lap or is IVF really our only option?

I just seems incredibly bizarre to me that I would be able to get pregnant so easily and then all of a sudden my age makes me absolutely infertile. I would think that removal of the endometrioma, which is the only thing that has changed or developed since my last pregnancy (at age 34) other than my age, would help my case, although I am learning that what makes logical sense isn't necessarily the way things work out :)

Thanks!

Dr. Braverman

2027 Posts
RE: Endometrioma/Low AMH/Low FSH Posted on: Jun 19, 2012 at 9:04am
Hi , I am very sorry for all your losses. I dont think you need IVF when you are getting pregnant so easily (although with your history that surprises me). But I do think you should focus solely on implantation issues that go along with endometrioisis. If you are concieving again I dont see the need to remove the endometrioma, but at some point we have to prove that the embryos are genetically normal , as someitmes severe endo can affect the maturation process and cleaning it out (along with the endometrioma) could help.
If you need assistance with the implantation issues feel free to call my office and schedule a consultation I would be happy to help you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.