Oopause: Poor  ovarian response

 
Most frustrated thing in IVF is Oopause: Poor  ovarian response. Natural fertility is very poor in women in their 40s, because of poor ovarian function. Well before the menopause, egg quality starts declining, so that even if you do have regular periods, the quality of the eggs is not good enough to achieve a pregnancy. This is called the oopause. Miscarriage rates are also very high in older women (can be as high as 50% in women more than 43) because their eggs are genetically abnormal, causing the fetus to be genetically abnormal too. Your best option would be donor egg IVF.

The reason for early miscarriages is a genetic abnormality in the embryo.  One of the possible reasons for this could be poor egg quality, as suggested by your high FSH levels.  This is a little known condition called oopause - the time period before the menopause - during which fertility progressively declines because of deterioration in the quality of the eggs.  This can manifest itself in many ways, some of which are extremely subtle, which is why the oopause is so hard to identify.  Initially, these women may present as having recurrent miscarriages, and then as having "unexplained infertility."  While the number of eggs they grow seems fine initially, they do poorly in the IVF lab.  Initially they may have unexplained implantation failure of apparently satisfactory embryos, later, poor quality embryos, and then failure of fertilization.

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