The short answer is NO. A woman with diminished ovarian reserve, as indicated by an elevated day-3 blood FSH level, does not have the time to waste on relatively low-efficacy treatments. Regardless of age, she should be looking preferentially at IVF rather than alternatives such as Controlled Ovarian Hyperstimulation (COH) with or without intrauterine insemination.

The basal blood FSH value is a reflection of ovarian reserve (how many eggs are still left in the ovaries) and is not the CAUSE of a poor follicle/egg production. It is also NOT the cause of poor egg quality.

What is true is that women with diminished ovarian reserve are “poor responders” to COH (produce fewer eggs). Their stimulation protocols should preferably be individualized so as to down-regulate their own pituitary production of LH, in advance of initiating COH. This means that agonist “flare” protocols and the administration of LH antagonists (e.g. Ganirelix, Cetrotide) starting 5-7 days after COH with gonadotropins has commenced, should be avoided. Also, they should preferably not receive much LH/hCG-containing fertility drugs such as Repronex or Menopur. Failure to recognize this could compromise egg/embryo quality and decrease the likelihood of a pregnancy (see my previous post on IVF Stimulation Protocols)

Day-3 FSH levels will often fluctuate from month to month. A higher or lower FSH level on day 3 of a particular cycle does NOT mean that the woman will respond better if stimulated with fertility drugs in that cycle.

Simply stated, there is no point in postponing ovarian stimulation for a subsequent cycle to wait for the Day-3 FSH level to come down. It only puts an extra burden on an already taxed biological clock and the bottom line is that it probably won’t help. A woman cannot suddenly grow more eggs for recruitment by waiting for the FSH to fall to a lower level. Likewise, it is pointless to go on to a birth control pill or take estrogen/progesterone preparations in an effort to lower the blood FSH level in the hope of improving subsequent ovarian response to gonadotropin stimulation.