“Doctor, what can I do about my poor ovarian reserve?” For years, I have been asked that question on a near daily basis because diminished ovarian reserve is so common in our fertility patients. Usually I have tried to use the analogy that using fertility medications in such cases is like “throwing bricks in the Grand Canyon.”

Well, during my vacation in June we actually went to the Grand Canyon and I can definitively state that throwing bricks into the canyon is absolutely not permitted by law. In addition, given that the Grand Canyon is 277 miles long, 10 miles wide and 1 mile deep it seems clear that filling it in by hand is not going to happen!

So if using fertility drugs in these cases is unhelpful then what can be done? Recently I received a welcome birth announcement from a happy patient. She first came to see me after turning 40 and had been to several other fertility clinics. They had been trying for over 5 years and were getting burned out from all the testing and failed treatments. After failing to conceive with several IUI cycles, she had undergone a stimulated IVF with a pretty poor response and no baby. Their previous REI had suggested that IVF was no longer a good choice and that there really was nothing left to do except donor egg IVF or adoption.

At our initial consultation we discussed all the options (including donor egg IVF and adoption). Although they understood that these alternative paths were very successful, they were really not interested unless no other options could be considered. Ultimately, they elected to pursue NC IVF because of the previous poor response in stimulated IVF and an AMH level of 0.6 ng/mL plus a day 3 FSH of 11 IU/L and an estradiol of 97 pg/mL. On her first attempt we got a very nice 8 cell day 3 embryo and she successfully conceived and delivered a full-term healthy baby. Needless to say they were over the moon and could not imagine having success so quickly after trying for so long. Woo-hoo!

So take it from us, we now know from first-hand experience that throwing bricks in the Grand Canyon does no good! Plus it can get you arrested…