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Hopkins Health
New Hope for Women with Premature Pre-Menopause
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| His new approach for prematurely menopausal women, notes gynecologist Jairo Garcia, M.D., determines when best to begin ovary stimulation, increasing the chances of fertility. |
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Some women refer to menopause–the period when hormonal changes, hot flashes and mood swings signal the end of one’s reproductive years–as that “nasty little detour along the highway of life.” It usually occurs around age 51.
But some women, because of reasons like autoimmune problems or cancer treatments, go through this life change before age 40–when they’re still very much thinking about having children. Then it’s much more than a nasty detour. It’s like they’ve run into a wall.
“For career or other reasons they’ve put off having a child, expecting that they could conceive in their late 30s or early 40s,” says gynecologist Jairo Garcia, director of Hopkins’ in vitro fertilization (IVF) program. “Then they begin to have premenopausal symptoms and realize their delayed dream may not happen.”
Garcia, however, has developed a fertility protocol to keep the dream of childbirth alive for these premature pre-menopausal women, who are often difficult to identify. First, using blood tests and ultrasound, Garcia checks the levels of estrogen and follicle stimulating hormones, or FSH, on day 2 of the woman’s menstrual cycle. Garcia explains that after age 35, eggs left in the ovaries each month in these pre-menopausal women tend to be damaged, which means the pool of eggs available vary tremendously month to month. When there are few eggs available, the body secretes more of the FSH hormone. And instead of taking two weeks to ovulate, the patient might ovulate in six days.
“By applying these tests,” Garcia says, “we’re able to identify these particular patients and determine when best to begin medical stimulation of ovaries and follicles.”
If the estrogen and FSH levels are in line, Garcia will begin ovary stimulation on day 3 of the patient’s menstrual cycle. On day 7, he’ll check estrogen levels again, and continue stimulation depending on those levels. The patient will continue to be closely followed until the follicles are larger than 18 mm, typically on day 9. The eggs are retrieved 36 hours later.
“This approach is important because typically these women don’t participate in fertility programs,” Garcia says. “They don’t believe they can get any help.”
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