Jenna’s Story with Diminished Ovarian Reserve
When I was a little girl playing with Barbies, I would imagine growing up one day to marry a handsome, kind guy like Ken. We’d live in a pink house and have a dog and two adorable children. Like most women, when I thought about my future babies, labs, drugs, and needles were not part of the picture.
I did meet my own “Ken”- my husband Kirk- when I was 34. We got married when I was 36 and started trying to have a family right away. After spending my 20’s and 30’s trying not to get pregnant (so ironic, right?) now, it was constantly on my mind. I heard sweet stories from friends who’d conceived on their honeymoon and thought maybe- just maybe- that would happen for us. At the same time, there was a nagging feeling in the pit of my stomach- I was worried about my age, being in the high-risk pregnancy category of “over 35.”
With every month that passed, I became increasingly disappointed to see a straight line instead of a plus sign on the pregnancy test.
For women under 35, the guideline for seeking help is one year, but for women over 35, it’s just six months. At eight months of trying and now 37, I made an appointment with my primary care doctor, who referred my husband and I to a Minneapolis fertility clinic.
The first step involved blood tests and ultrasounds to understand what my “ovarian reserve”- the quality and quantity of eggs- was like. I think I missed in fifth-grade health class that women are born with a set number of eggs- and you can’t make or get any more. It’s well known that ovarian reserve declines with age. But we don’t always know why else it declines- or declines much sooner than expected. In about 10% of women, their ovarian reserve is much lower than what would be expected for their age. That’s called diminished ovarian reserve, or DOR. In most cases, there are no symptoms or signs, and doctors often can’t pinpoint the cause.
While there are many hormones and factors that go into analyzing a woman’s ovarian reserve, the two big ones are called AMH and FSH.
AMH, which stands for anti-mullerian hormone, is a protein produced by cells that surround follicles in the ovaries. Generally, AMH levels under 1 meet the diagnosis for a diminished ovarian reserve. FSH, or follicle stimulating hormone, creates egg-containing follicles for ovulation. Again, generally speaking, FSH levels above 10 are also considered evidence of a diminished ovarian reserve.
When I got my AMH and FSH test results back, I googled my way to a diagnosis that was later confirmed by my doctor: DOR.
My AMH tested at 0.4 (quite a bit under 1) and my FSH came in at 17 (significantly over 10.) This was a very hard thing to hear- even for a 37-year-old, these levels are not average- they’re closer to the levels of a woman in her early-to-mid 40’s. When people would casually tell me that I was still relatively young and still had time, I was frustrated that my outsides didn’t match my insides. I felt broken, defective, and damaged- and super-confused by this new world I didn’t understand.
Our OBGYN explained that it would be challenging- about a 1-3% chance- for us to conceive without help. Our options were to start an IUI (intrauterine insemination) cycle or go straight to IVF (in vitro fertilization.) She also told us women diagnosed with DOR have a lower response to stimulating medications used in both IUI and IVF compared to women their age whose ovarian reserve testing is normal- as well as a higher risk of miscarriage, one of my greatest fears.
My husband and I decided to try IUI first, simply because IVF is not covered by my insurance and basically equals the cost of a new car.
One cycle of IUI totals about $1,000 compared to a round of IVF ringing in at $15,000-$20,000.) We both hoped IUI would work, but our first and second procedures failed. Today, we’re on our third cycle with IVF up next.
Going through a DOR diagnosis and fertility treatments has taught me many things, but chief among them would be patience, the power of vulnerability, and the power of support. Waiting? Waiting sucks. I don’t know many people in our instant-gratification society who enjoy waiting. But I have no option other than taking things one day at a time and working on my patience.
On the power of vulnerability and support, by opening up about my struggles I’ve been able to be a resource for other women in my life who are just entering this odd process that is not always publicly discussed.
And the power of support- I’ve met so many strangers on infertility Instagram’s like this one and in-person support groups I can talk to who “get it”- and that’s such a comfort. I read something that said, “one stranger who understands your experience exactly will do for you what hundreds of close friends and family who don’t understand cannot.” While my friends and family are absolutely amazing, there’s something to be said about seeking support from those who have also walked this difficult path and uniquely know how to light the way.
There is so much that we still don’t know- what lies ahead, how long it will take, how it will change us. In the end, we may get our pink house (not really, but it’s a metaphor,) dog, and two adorable children- or the picture might look a little- or a lot- differently. I am coming to learn and accept that.
Medical Disclaimer:
The information provided in this blog is intended for general informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider or qualified medical professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this blog.
