Decline in fertility?

Dear Prof. Winston,

I would like to ask if you have ever come across anyone that has experienced a radical decrease in fertility in a short period of time. I had tests done within a month of my 38th birthday and had an AMH of 29.4 and an AFC of 20 which I was delighted about. I had the tests as I was considering egg freezing amongst other options. With these results I thought I had some time to research things properly in order to come to an important decision. After much research I decided to proceed with egg freezing and had repeat tests just prior to the procedure to find that only 14 months after the first tests my AMH had dropped to 4.4 and my AFC was 8. I was devastated. My doctor can give me no answers as to what could have caused this radical decrease in such a short space of time. He said he would only expect to see this if Id had a drastic illness or chemotherapy, and Ive had neither. The worst illness I had had in the intervening period was shingles which Im told couldnt have caused this. I went ahead with the egg freezing but the results were very disappointing, I had 11 follicles at the last scan, 8 of which were of a decent size, 6 eggs were retrieved but only 4 were mature enough for freezing. Im very worried whether I may be in an ongoing radical decline. Im going to get retested next month but Im very worried and looking for answers. I really want to have a child but Im currently single and dont know whether to give up on meeting someone and go straight to donor IUI (which Im reluctant about) or hold out and try egg freezing again. I did egg freezing in the hope of gaining just a little more time but I now feel like a ticking time bomb and I know four eggs is nothing to be relied upon in any way. I have had a battery of blood tests done to rule out other factors such as thyroid but nothing of any significance has come up, other than my being somewhat Vitamin D deficient. My only other medical issue is a Vitamin B12 deficiency, but at the time of the latest tests my Vitamin B12 was greatly elevated due to b12 shots I was receiving. It might be worth mentioning that my initial tests and the later tests and procedure were carried out at different facilities. My doctor reviewed the original tests and concluded that there were no errors in the original tests. Im trying to come to a decision as to how to proceed and Im finding it very difficult. I have seen a fertility counsellor a couple of times which is helpful but Im finding the lack of answers on my condition is exacerbating an already difficult decision making process. Any advice or insight would be greatly appreciated. Thank you very much for making this service available, I think its an enormously generous thing to do. All the best, S

Dear S,

It does not sound to me that you are in decline at all. These tests are notoriously unreliable and the fact is you are still producing follicles is encouraging – and it is normal for women of your age to only produce a few eggs on stimulation. To have around 11 follicles of which 8 are of ‘a decent size’, with 6 eggs were retrieved and 4 mature enough for freezing is a completely normal response. Actually, as we age, it seems this lowered response to gonadotrophins given by injection is quite usual – which is why I have tried to advise so many women to have frequent natural intercourse rather than IVF when possible. I certainly do not want to sound at all unfeeling – but sex works, often better than IVF.

Added to which, I have to tell you that you are writing to somebody who basically mistrusts the whole egg freezing vogue. If I am brutally frank, it seems that this is a good way for clinics to make a cracking profit out of the understandable anxieties of women who feel worried because they have not found a partner. Incidentally, I also find it disturbing that it is common for clinics to charge £200 – £350 year to store frozen eggs, when liquid nitrogen in which they are kept only costs a few pence per litre. Of course, egg freezing and storage is justified where a women who has been diagnosed with some form of cancer may shortly be sterilised by radiation or chemotherapy by the impending treatment, but I am very dubious (excepting obvious outside medical conditions) it is justified for social reasons in most cases.

You may care to know of the current figures which we managed to obtain from the HFEA, the regulators: Between 1991 to 2012, 2,262 women in the UK have had a total of 20,465 eggs frozen and stored. Of these 243 have been treated by thawing and fertilising the eggs. There have been a total of 253 cycles and 21 pregnancies achieved. We don’t know how many of these pregnancies actually ended in a live birth. No figures are available since 2012, but I understand the number of women seeking this treatment has doubled. But, however you look at this treatment, the best that can be reasonably expected is around a ten per cent pregnancy rate and it probably will be quite a bit lower in women in their late 30s. And added to all this is the concern that we don’t fully know what the long effects for a child after it grows up might be – when it has been subjected to freezing in the egg stage.

Incidentally – you mention the Vitamin B12 issue in your email and deficient Vitamin D. These are important vitamins in human reproduction – at least during pregnancy – but I doubt that they have much relevance to your key predicament.

I am really sorry to be so negative. I don’t envy this predicament and genuinely sympathise. But I am really very uncertain that you are thinking of a wise course of action.

Warmest wishes
Robert Winston