Well, that's very interesting! Even though your FSH was high, were you still making eggs that fertilized? I've heard of that being the case. It's quite possible that this RE is concerned with his success rates, although an RE at another clinic also told me that in women over 40 they prefer the FSH to be single digits to be for the cycle to have a reasonable chance of success. But perhaps this RE was also concerned about his stats.

I was also told that since my periods are still regular and by all signs apparently still ovulate that I probably did not have an elevated FSH, so maybe I just assumed that double digits meant the decline of ovarian function.

I'm still interested to hear what others' experience has been with their clinic's preferred day 3 FSH levels. Is it more that your chances of getting pregnant in a given cycle are just a little less likely if the FSH is more than 10, or that it's a complete waste of time?

BB wrote:
There's an interesting article called "Prognostic assessment of ovarian reserve" in the January 1995 issue of the Journal "Fertility and Sterility" (available at medical libraries, among other places). The study talks about basal FSH on day 3 as well as something called the "Clomid challenge test".

The article says that "elevated basal day 3 FSH concentrations are highly predictive of diminished ovarian reserve as defined by poor gonadotropins responsiveness and pregnancy rates in patients undergoing complex ovulation induction or one of the assisted reproductive technologies."

A study using the clomiphene challenge test is described in the article The clomiphene challenge test was used to evaluate 51 infertile women > 35 years old. All 51 patients had normal basal FSH concentrations but 18 had elevated values after clomiphene was adminstered (100 mg on days 5 through 9). Those 18 were categorized as having diminished ovarian reserve. Of those 18 only 1 (6%) conceived although 14 of 33 (42%) of the adequate reserve group became pregnant.

The article talks about the importance of having valid ways to assess the measured values: "the threshold values for a normal and abnormal test should be based on clinically defined endpoints." "For those centers that do not have a large clinical volume or who would like to apply these screening tests without waiting the required time to accumulate all the follow-up data, comparison of their assay system with those from one of the centers where the original research was done is indicated."

In the summary it says that "all women > 30 should be screened because the the rise in incidence of diminished ovarian reserve begins at approximately that time."

As I interpret the article, the idea is that if you have poor ovarian reserve (i.e. no good eggs left) then you are wasting your time doing anything but donor eggs.

I would like to add that the editor of the journal had an article which directly followed this article questioning some of what was written in the article. "However, neither baseline values of FSH nor the clomid stimulation test provies 100% prognostic reliability." "The use of the Clomid challenge test to study ovarian reserve is not precise enough to merit total reliance on the results".

Another question pertains to the significance of alternating values. Some women will have an elevated value one month and the succeeding month's value will be normal. I suspect that the clomiphene challenge test would be helpful for these women.

While my personal experience has been that with our FSH assay those with elevated FSH values over 10 or those with elevated Day 3 Estradiol have not been successful with IVF or ovulation induction. Dr. Check has written that treatment with high dose oral estrogen prior to initiating superovulation and IUI may temporarily restore fertility. However, the take-home-baby rate is very low and donor oocytes should be considered.