Making a Leap of Faith... at Dominion Fertility
As regular readers of this blog may remember, last summer we adopted a second four-legged friend from a high kill shelter in South Carolina. Lucky had heartworm and his life had taken a turn for the worse since he had been abandoned by his former owners. Fortunately, he responded very well to medical treatment and was declared healthy prior to making the journey up to join our family. Although we think that he may be a Goldendoodle, we really have no idea about his doggie DNA. He has shown absolutely no interest in swimming and after getting a bath in our upstairs bathroom during the winter he refused to go anywhere near the stairs for nearly 2 months! But one thing that he absolutely loves is riding in the car. He sometimes sits in the minivan while it is in the garage in hopes that one of us will decide to take him for a spin. Since a boat is kind of like a car with no roof he quickly decided that tooling around on our boat was pretty awesome. This past weekend we were out on the lake and pulled up to the dock at the market to grab a snack. Lucky was happy to get back on land for a few moments to use the doggie facilities (nearest tree). Suddenly he realized that just 20 yards away there were a bunch of Canadian Geese. However, they were not on land.
They were happily gliding around the end of the docks seemingly oblivious to Lucky. As we walked back to the boat Lucky decided to check out the geese from a different vantage point.
I walked with him to the end of the dock and we stood for a few moments watching the geese mill around about 10-15 yards away from us. Then Lucky launched himself into the air and off the end of the dock. I have no idea what he was thinking… He hit the cold water and immediately turned back toward the dock…all hope of catching a goose quickly forgotten. As I helped him clamber up on the dock he seemed a bit embarrassed by the whole affair. However, his happy personality soon returned and he dried out quickly in the heat of the day. It remains to be seen how he will now regard swimming.. recreational activity or near-death experience. So what does this shaggy dog tale have to do with infertility? Well, on some level pursuing fertility treatment is a leap of faith. Our patients are making the assumption that there is a good egg, a good sperm and a uterus capable of carrying a pregnancy. We really wish that we had definitive tests to figure out if these assumptions are correct, but we do not. AMH, FSH/estradiol and antral follicle count will predict responsiveness to fertility medications for stimulated IUI or stimulated IVF cycles.
As such, we can advise patients with poor ovarian reserve that they may want to consider Natural Cycle IVF or pursue dramatically different paths to parenting such as donor egg or adoption. Recently I had this discussion with a patient who was < 40 years old but with poor ovarian reserve as evidenced by her AMH, antral follicle count and FSH levels. I explained that the use of medications was unlikely to improve her odds of success and that NC IVF probably made the most sense in her situation. In our program we have seen very reasonable pregnancy rates in patients like her as NC IVF pregnancy rates per embryo transfer clearly relate to maternal age only and are NOT dependent upon ovarian reserve assessment. Making that leap of faith is difficult. Sometimes you come up short…just like Lucky in his attempt to secure a tasty lunch of Canadian Goose….BUT sometimes the leap is successful.