Premature Ovarian Failure

May 8, 2007 - Tuesday
12:43 PM to (EST)
Guest Speakers: Dr. Deborah Minjarez
Colorado Center for Reproductive Medicine

Categories
Acupuncture • Donor Egg • Endometriosis • IVF • Pregnancy • Pregnancy Loss

	Hollie joined.
	Corey_Whelan joined.
	suzie33009 joined.
	dminjarez joined.
Corey_Whelan	Hi everyone!
Corey_Whelan	I'm Corey Whelan, your chat moderator tonight and The AFA's Director of Development. Welcome early birds and Dr. Minjarez!
dminjarez	Hi Corery. Thanks for having me participate in such an important topic.
	hoping4grace joined.
Corey_Whelan	Deborah Minjarez is a board certified reproductive endocrinologist, with the Colorado Center for Reproductive Medicine. She is well known as an expert in premature ovarian failure, as well as other reproductive health issues. We are very, very lucky to have her here tonight.
Corey_Whelan	We are a few minutes early, but please feel free to post your questions for Dr. Minjarez. WElcome, Hollie, hoping and suzie!
Corey_Whelan	Have any of you been diagnosed with pof?
Hollie	I haven't been officially diagnosed yet, but I've had two labs drawn in the last 2 wks and my FSH was over 50 both times. I also have not had my period for over 4 months. I'm 29.
Corey_Whelan	Hollie, have you been ttc?
Hollie	yes, for over 2yrs
Corey_Whelan	Do you have a question for Dr. Minjarez, Hollie?
	kconnaghan joined.
suzie33009	my doctor thought I had it..but I just did a clomid challenge test ..my day 3 FSH was 7.6 and day 10 was 8.3....I am 42....so we will try again
Corey_Whelan	good luck Suzie.
Corey_Whelan	welcome, kc
dminjarez	Hollie, in patients with POF it is very important for two levels to be drawn to confirm the diagnosis. Have you had any additional testing?
Hollie	A year ago I had a level that was 23, but the lab thought it was a mistake
Hollie	my next two levels were normal - but I had a functional cyst that had to be surgically removed.
dminjarez	Have there been any other recommendations such as chromosomes, thyroid testing, autoimmune, etc?
Hollie	until a couple of weeks ago, I hadn't had my FSH drawn again... I've had 2 draws recently, a week apart... both of those were over 50
	nlaurente joined.
Corey_Whelan	Welcome nlaurente!
Hollie	so far no other recommendations - I have not been ttc for several months and I got the order for the recent labwork from my pcp. I'm seeing my regular gyno for my yearly on the 25th
dminjarez	Hollie-Important to disucss with your physician or a reproductive endocrinologist additional testing. 15% of POF cases are assoiciated with other medical conditions.
nlaurente	Thanks Corey! Glad to be able to join today.
kconnaghan	Thanks from me too Corey.
Corey_Whelan	no prob y'all
	moesbaby joined.
Hollie	do you think that my high FSH and amennorhea could be caused by something other than POF? LH was also very high (45 one time and 50 the next) E2 was 49 and 103 respectively
nlaurente	Dr. Minjares, what is considered premature ovarian failure?
	kfenton joined.
Corey_Whelan	Hi Moesbaby! We are chatting with Dr. Minjarez about premature ovarian failure - please don't hesitate to jump in
dminjarez	POF occurs in 0.1% of women who are 30 or younger. With two elevated FSH values and no regular cycles this confirms your diagnosis. In Suzies case, she was initially given the wrong diagnosis.
	hoping4grace left.
	RJ0152 joined.
Corey_Whelan	Hey RJ, welcome
dminjarez	If an FSH is drawn randomly in the mid cycle it is not unusual to detect an elevated FSH. Thus important in women with cycles, to check the FSH on day 2 or 3 and also obtain an US to assess the volume of the ovaries.
dminjarez	30% of women with POF will also have hypothyroidism and about 3% will have diabetes, so important to disucss with your MD that a more thorough evaluation is required.
	liz246 joined.
Hollie	How important is HRT (hormone replacement therapy)? What is your opinion on HRT for a woman with a dx of POF and endometriosis (stage III)?
dminjarez	A very important question. The controversy regarding HRT applies to the older menopausal female and not women with POF. The current consensus is the data cannot be applied to young women. There is more risk for you long term if you do not receive some form of hormone supplementation ie...bone density, fractures. Is there any family history of breast cancer?
	teacher422 joined.
Hollie	No... I do have fibrocystic breasts, though.
dminjarez	The options for women with POF are traditional HRT (lower dose is now available) and oral contraceptives. The benefit of HRT is the hormonal dose is not high enough to suppress potential ovulation and there have been reported cases of remission. The pill is more convenient and data from the last 2 years have supported no increase in breast cancer or cervical cancers. This also will help in managment of the endometriosis.
	slgraves joined.
nlaurente	I'm curios about HRT, is it performed in older women mainly due to risks of osteoporosis, or is it being used for fertility also?
teacher422	Good evening everyone, my name is Deneen. I have a high FSH and am looking into possible accupuncture to bring it down!! I am 43 years old!!
Corey_Whelan	Hi Deneen
dminjarez	The main indication is for bone density and symptoms (hot flushes). It may be that adding HRT may have some "priming effect" thus why a potential pregnancy.
teacher422	Hello, I came in a little late!!
Corey_Whelan	Hi teacher!
	kay joined.
	hoping joined.
dminjarez	I agree that acupuncture is also important as an alternative. There is data that it can have an effect on the FSH level but no data on improving ovarian function. It may be that multiple approaches are necessary to better care for patients with POF>
nlaurente	Does that mean that HRT could be a viable treatment option for infertility for women over 40 yrs old that still have menstrual cycles?
RJ0152	Dr. Jerome Check actually did a study on POF (3 case studies in research article...link attached. oldest woman was 45. He used E2 priming and result was a successful pregnancy carried to term: http://humrep.oxfordjournals.org/cgi/reprint/15/8/1709
teacher422	At 43 and a high FSH is POF a possible diagnosis?
dminjarez	The problem with adding HRT is that it can cause abnormal bleeding if not taken to coordinate with someone's cycle. In patients with elevated FSH (please keep in mind that this is very different from someone with true POF) who still cycles attempting estrogen priming can be beneficial in increasing ovarian response.
dminjarez	The true definition of POF is not only an elevated FSH but also menstrual cycle irregularity or complete cessation of menses.
teacher422	Is estrogen priming something that is widely practiced?
	clw joined.
dminjarez	I know of many practices that do not use priming and less that use it to assist patients. What have other people seen?
teacher422	What does estrogen priming entail?
Hollie	Are there any fertility options other than donor egg IVF for a woman with POF? Are you aware of any clinical trials for new techniques that are using POF patients in their studies?
RJ0152	I know Cooper Center uses it for women with FSH over 12-15 to bring down FSH and help increase ovarian response
	slgraves left.
teacher422	Where is cooper center? I attend the"Center" at Uconn Medical!
	jjfox joined.
dminjarez	Patients will take estrogen for 25days and add progesterone for 10days. Another protocol for those who have cycles and can detect an LH surge is starting 10 days later. The thought process is adding estrogen enhances FSH receptors on follicles and thus stimulation or growth.
	beadgirl68 joined.
liz246	Hi everyone, I have been having accupucture treatment for a year now, I'm 33 years old and FSH of 13,7. - Clomyd challenge test was FSH of 20. Although accupuncture did not bring my FSH down. I have never felt so calm, relaxed and more in control while going through the whole fertility rollercoaster. We'll see next week if it helped making our IVF successful. I have a regular cycle etc. But my dr. did diagnose me with possible POF. Do I really have POF? What options do I have if this IVF doesn't work?
	kfenton left.
	kfenton joined.
	kaykay joined.
dminjarez	Liz your true diagnosis is diminished ovarian reserve and not true POF. However, women with an elevated FSH have been shown to enter menopause earlier than expected.
RJ0152	Teacher422, Cooper Center is in Marlton, NJ....http://www.ccivf.com/. They use estinyl for E2 priming
teacher422	I am a little baffled as to why my doctor says that because of my high FSH my only option is getting donor eggs...is it becasue of my age (43) that IVF is not an option?
dminjarez	For young women, it is important for centers to allow patients to attempt an IVF cycle. The pregnancy rates are lower (20-30%) but not as low as what was quoted in the 1990's (<10%).
teacher422	Thanks for the information-dminjarez!!!
dminjarez	Teacher- the concern is not only an elevated FSH, but as we normally age (or mature) we produce more genetically abnormal eggs and miscarriage rates are 30-40%.
teacher422	So, it is normal for this not to give me that chance as a 43 year old!! What if I am persistent!!
teacher422	I see re: miscarriages!!
suzie33009	is the high FSH an indication of genetically abnormal eggs?
kaykay	i once had an eleveated FSH of 14 and has fluctuated between 1-9 since. does that mean i am going thru POF?
teacher422	Is it worth the risk?...I mean miscarriages happen to younger women as well!!
dminjarez	At CCRM, we have not had success (remember a + test is not what is important, but delivery) if an FSH is greater than 18 in a young patients (under 35). In older patients, I can only think of 1 who had an FSH of 15 who was successful. We may have a positive test but many have blighted ovums and miscarry.
clw	I recently read an article connecting POF with Fragile X. Is it possible to have a normal karyotype and still be a carrier for Fragile X, resulting in POF by age 30?
nlaurente	Dr. Minjares, I'm in my mid-40s, no history of pregnancy, tubes are good, regular cycle, FSH is bet. 7-14 (few months ago, FSH was ~8), etc. Started trying to conceive in early 40s, tried stimulation with IUIs, but my system doesn't seem to respond well to the drugs, max of 3 follicles. Under natural cycle (no drugs), system is observed to ovulate normally, i.e., LH surge at Day 12 consistently. Is this the ovarian factor causing low response to stim drugs or it's something else?
dminjarez	The miscarriage in younger patients is 10%. For patients who are older, I counsel them regarding their guarded prognosis, and allow them to make the decision about moving forward.
	pcoleman joined.
dminjarez	It is important to address the fragile X. This is the most common cause of mental retardation in children. Boys are severely affected compared to girls.
kfenton	Dr., what do you consider a younger patient?
dminjarez	There is data than any woman with a history of POF, family history of POF, elevated FSH and age under 40 should be screened in the event she spontaneously concieves.
teacher422	Is CCRM Cooper Center?
dminjarez	younger patients-under 35.
dminjarez	Colorado Center for Reproductive Medicine
pcoleman	Can fragile X be tested with an amniocentisis?
RJ0152	I have heard of many women in their 40s that have FSH levels higher than 15 who have conceived, even some naturally. Here is a list of women from a board I am on that have had success with high FSH and even over 40....
teacher422	Thanks!!
RJ0152	http://www.network54.com/Forum/53068/
Hollie	my mother went through "early menopause" - she had her last period at the age of 41. Is it possible that my (unofficial) POF is related?
dminjarez	Correct...there are many who do conceive naturally, keep in mind that IVF is very different.
	iminnyc joined.
teacher422	What is their secret...is there one..I need some hope!!LOL!!
dminjarez	Hollie, 8-10 years before full blown menopause we begin to have "egg quality issues". There is a higher probability of developing early menopause if there is a family history.
RJ0152	How is IVF different? I know some of these women conceived via IVF, so just curious
dminjarez	I have been fortunate, that I had a patient with an elevated FSH fo 25 at the age of 42 who had a successful pregnacy....acupuncture, lifestyle changes, but not through IVF.
suzie33009	what do you think about DHEA
teacher422	What type of lifestyle changes did she take on or that you recommended?
dminjarez	In women who are older, with an elevated FSH, she may or may not respond, there is a higher probability of genetically abnormal eggs, and embryos are more fragile in an artificial environment.
nlaurente	With your success, is this a long shot that fertility treatment has hope for women in mid-40s?
dminjarez	Yes...I have several on DHEA. I especially use it in conjunction with estrogen priming-75mg daily.
teacher422	Sorry!!! What is DHEA? I'm sort of new to this way of living!!
suzie33009	I also take 500 mg of L-Arginine 4x a day
dminjarez	lifestyle changes-Eliminating some of the best things in life....caffeine, simple sugars/simple carbs, overall mind body programs.
nlaurente	Dr, my FSH 3 mos ago was 8, but as we speak, i;m not responding very well to stimulation. What do you think are other causes...mid-40 age..
dminjarez	Yes...I have also seen benefits with the L-arginine.
teacher422	L-arginine ? what is that used for? and DHEA?
dminjarez	There can be several reasons in addition to age. Over suppression with oral contraceptives, commonly used before IVF cycles, Lupron can also over suppress.
teacher422	Yes!! They are gret things...but then again so are children!!
teacher422	great things!!
nlaurente	we
Hollie	What is the success rate for IVF with donor eggs for someone with POF?
Corey_Whelan	folks, I need to let you know that we only have ten minutes left.
kaykay	i had a high FSH level of 14 when I was nursing my daughter 2 years ago. My FSH level has ranged betw 1-9 since but i haven't been able to conceive with 4 IUI's and 4IVFs (2 chem miscarriages). could the high FSH have been due to my nursing or might i be going thru POF. i am also 38 years old
dminjarez	DHEA-androgen made by the adrenals. We make estrogen from male hormones and thus by providing the building block from the start stimulation may be enhanced. This is was published by Baylor some time ago.
teacher422	Oh noooo!! Dr. are you planning on moving anywhere closer to Connecticut?!!
nlaurente	we're currently on our 1st IVF cycle using antagonist procedure at ~500IU gonal/repronex, and only showing 1 growing follicle and 1 nor growing..is this overstimulation?
dminjarez	No...I like Denver too much!
dminjarez	Kaykay unlikely the breast feeding had any effect. When we breastfed, it suppress our FSH.
teacher422	I though you might say that!!!
kay	Is there any hope for someone with POF and thyroid anti-bodies?
dminjarez	The success rate with donor in the US averages 50-55%. There are centers that have rates over 60% such as CCRM and others.
moesbaby	Dr. Minjares~I'm doing my 1st IVF in Aug with Cornell/Dr. Davis do you think at the age of 43, one active ovary, DH has fine sperm. Would ICSI help our chances? Was told by previous Dr. should use egg donor due to high FSH clomid chalenge was 17.
teacher422	Thank you Doctor!! You have given me a lot of new information!!
dminjarez	Kay....your POF seems to be autoimmune in origin. Keep in mind that there have been reported cases of regular cycles and ovarian function returning. But important that your doctors track you closely to ensure that you do not develop other autoimmune issues.
beadgirl68	I was told that because of POF that the only way to have children is through a donor's eggs. So we decided to wait, in the meantime I've been on hormone therapy. Could that therapy have any affect on the little eggs I have left? Or should we go straight to donor eggs?
nlaurente	what are the symptoms of overstimulation?
dminjarez	Women with only one ovary normally have lower pregnancy rates than patients with two functional ovaries. The benfit of ICSI is to prevent polyspermy...too many sperms getting in the egg.
Corey_Whelan	folks, I want to thank you all for your participation tonight. Thanks especailly to Dr. Minjarez for all of her time and effort, and invaluable information. What a great chat!!
	woodigit joined.
dminjarez	It depends on your desire for your family, how long you had had the diagnosis. Currently with waits to find donors taking longer you may want to initiate the process 6-9 months before you would like to be pregnant.
Corey_Whelan	I wish you all so much luck on your journeys!!!!!!
teacher422	Thank you again Doctor!!
dminjarez	Thanks to all of you!
nlaurente	Thanks Dr. Minjares!
beadgirl68	Thank you Dr.
Corey_Whelan	I'm so sorry that we've run out of time. The transcript of this chat will be up in a few days. I also invite all of you to participate on the AFA's message boards.
RJ0152	thank you Dr.
kay	Would you happen to know where I can look up these cases for POF autoimmune?
Corey_Whelan	Thanks again Dr. Minjarez. Our chat is officially over.
Corey_Whelan	Kay, I don't know, I'm sorry.
Corey_Whelan	good night all
	kfenton left.
	woodigit left.
dminjarez	Corey..Thanks again for having me.
	dminjarez left.
	kay left.
	teacher422 left.
	Corey_Whelan left.
Hollie	Does anybody else in here have extremely high FSH levels?
Hollie	I've seen people talking about 14 and 15... mine are over 50.
	nlaurente left.
	kconnaghan left.
	moesbaby left.
	kaykay left.
	beadgirl68 left.
	jjfox left.
	hoping left.
	suzie33009 left.
	pcoleman left.
	Hollie left.
	iminnyc left.
	liz246 left.
	RJ0152 left.
	clw left.

Premature Ovarian Failure

Categories

Chat Archives