I am 41 years old and have seen an infertility specialist for an evaluation. I have had two FSH levels taken. The first one was 21, but the second FSH level was 10.2. I was then instructed to contact someone for a consult for IVF. My husband was also checked and all is good except that he has a low sperm count. The doctor's are not as concerned with his low sperm count because they say there is something that they can give to him to help. Am I a candidate for IUI or is IVF my best opportunity to conceive? Everything else seems to be ok except for my age and FSH levels. Please advise on the next step.
At age 41, fertility will have decreased significantly in most women. This is true even if their FSH levels are normal. FSH levels fluctuate during the 28 days of the cycle and on the same day from cycle to cycle. FSH levels should be drawn on the second or third day after a full flow menstrual bleed. It should always be drawn along with an estradiol level.
Laboratory assessment of FSH levels will vary from lab to lab. It is necessary that a lab defines their normal ranges based on women with demonstrated normal fertility and infertility.
As a woman's ovarian reserve declines, the FSH levels will start to rise. At first the FSH will fluctuate with sporadic elevations and then later will become persistently high. By the time the FSH level has started to fluctuate with occasional high levels being detected, there has already been a significant decline in ovarian reserve. Thus, women with even a single high FSH have a much poorer chance for having a baby compared to women with women with normal levels. There is also evidence that when women with high FSH levels do conceive, they are at greater risk for miscarriage and babies with Down syndrome compared to other women of a similar age.
Given your history, the chance for pregnancy and live birth using IUI or IVF with your own eggs will be very low. Egg donation would afford a much higher chance for a healthy baby.