Why We Do Not Turn Patients Away Based on Their Odds

Two poor recommendations based on age and AMH

There are two poor recommendations that fertility practitioners can make based on AGE and AMH level.

Both these measurements are used to prognosticate. It's pretty obvious that the older one is the harder it is to get pregnant and that AMH naturally decreases with age, so why would a fertility provider counsel against getting pregnant with one's own eggs rather than donor eggs? It might be judgmental philosophy, or a program's rule of thumb, or a business model. This all doesn't make a lot of sense to the patient who desperately wants to conceive using their own eggs.

Patients should be given a choice in how they want to develop their family

Having a family is a personal individual major life decision that should be guided by the patient's choice. At Chelsea Fertility NYC our motto is "with a little help from my friends". This captures the essence of this issue. Let's simplify this: you want to get pregnant with your own eggs — is it possible or not? That is the question, not whether the clinic will have better stats if you enroll or not and whether it will necessarily be easy or hard to be treated with IVF cycles. Look at it differently — should IVF be done for only good prognostic patients? Medicine certainly would be practiced differently if doctors only treated "easy" patients.

What AMH predicts, and what it does not

The broad choices are own eggs (self eggs, autologous eggs) or using donor eggs. As long as a woman is under 40 even with a low AMH her egg quality allows her to conceive with her own eggs. AMH does predict low egg yield at egg retrieval for IVF but not quality. So frankly a woman who is 28 years old with low AMH for her age is better off prognostically than a 38 year old with an above average AMH. This is an important nuance that can be overshadowed by the mythology associated with a low AMH.

Is there an age cut-off for using your own eggs?

Furthermore if a patient is not peri-menopausal (but is menstruating with normal day 3 FSH/estrogen levels) she is a candidate for ovarian stimulation and will respond to a tailored protocol allowing treatments. So the age range here can be expanded over age 40. Some larger programs where individual customized care can be challenging due to large staff rotations have to use algorithms to function, which means all patients at age 43 are told they need to have donor egg to procreate, for example. At Chelsea Fertility NYC and for four decades of my practice in REI, I do not have strict age cut offs. Clearly after 45-46, the chances zero out with your own eggs regardless of whether eggs can be harvested due to egg quality. Remember your eggs are as old as you are and therefore susceptible to entropic degradation leading to dysfunction. Having said that we allow our patients a choice between their eggs or donor eggs — looking at each case individually and clarifying the success percentages for both pregnancy and delivery. Remember miscarriages also increase with age, so the older woman faces multiple challenges.

The bottom line

One size does not fit all and every one of our patients deserves at a minimum the real transparent biological facts and options to make THEIR decision.

If you have been told elsewhere that you are not a candidate for treatment with your own eggs, schedule a second opinion with Chelsea Fertility NYC — we will review your case individually.