instruction: hello doctor my husband and I recently underwent an if cycle and it failed originally my husband has a problem with morphology but now I a have poor ovarian reserve I am 39 years old and my am was 24 however my fish was last time am was not repeated I was stimulated with the maximum dosages and only produced three eggs which all produced embryo I do not know the quality only that one had progressed normally by day we did a day transfer on the second day after the transfer I had what I can only describe as scab like discharge about the size of a tear one the sixth day I finally left the house and started to resume so level of normal activity no heavy lifting and that afternoon I had a very bright red urine flow like a small amount of blood pass when I used the bathroom I thought that it might have been implantation bleeding but clearly not I want to try if again but I am afraid of the same results in doing research I found a book that suggests many environmental factors such as bra and phthalates can play a part in egg quality quantity and affect the sperm as well the book suggests waiting three to four months prior to beginning if to get the full effect of supplements recommended as well as let the harmful chemicals leave your body my questions are given my numbers in your opinion will my number of eggs change drastically while waiting or should I be normal should I retest my am before making this decision also is there any way for me to preserve my eggs not menstruate until the month before the if procedure my thought was to take birth control pills for three months and not take the sugar pills is this safe can it be done what are the repercussion finally based on our numbers would you recommend that we use donor eggs instead of trying another cycle this time around will have to be the last as we do not have any money after this one it is critical that we make the right decision
output: hi looking at your case history it would better to go for donor eggs ovarian reserve decreases with age and retesting for am anti mullerian is not going to affect the outcome increase ovarian reserve so no point in retesting am by taking of oral contraceptive pills continuously you cannot halt a decrease in ovarian reserve loss of eggs menses is just an indicator of loss actually a woman loses 400 600 eggs per month irrespective of whether she gets menses or not what you see on ultrasound is just loss of dominant follicle the loss of those 600 follicles cannot be seen it can be perceived indirectly by decrease in am increased requirements of hormone injections during if in vitro fertilization reduced number of eggs retrieved and low pregnancy rate one more effect of advanced age would be increased risk of down syndrome in the baby if you try with your own eggs so considering your advanced age low am poor response to stimulation low number of embryos formed in the last cycle and increased risk of down syndrome with own eggs I would suggest to go for donor eggs