1. Having high FSH predicts you are less likely to respond to the stims used to hyperstimulate the ovaries for conventional IVF (these are injectable hormones, FSH and sometimes LH, examples include Gonal-F, Follistim, Repronex, and Bravelle).

(1.a. Many women with high FSH, including probably many who never even know they have have FSH, get PG naturally. In fact, at least one study suggests that high FSHers without other IF problems get PG about as easily as everyone else. But if you need IF treatment for diagnosed or other reasons, having high FSH can complicate matters).

2. However (this is important), some women with high FSH do respond just fine to stims. That is, FSH is a predictor but it is not a perfect predictor. If you have high FSH you are at increased risk for a cancelled cycle, which is when you start taking the stims to prepare for IVF but your ovaries don't respond well and that therefore, you don't go forward with treatment that month. A number of studies find that high FSHers who don't get cancelled do about as well as non-high FSHers do at IVF. This is important because while, obviously, a cancelled cycle is a very, very frustrating result, it actually represents a much less costly/invasive procedure than going through a whole IVF cycle and still getting a BFN. In other words, in some ways cancellation isn't necessarily bad (again see below).

3. Besides varying the amount of stims you use, REs can prescribe protocols that differ in other ways. This is very important because Lupron, a drug used in some (not all) cycles appears to over-suppress some high FSHers (prevent them from responding adequately to stims). These women may do just fine, though, if allowed to try an "Antagonist" protocol, one involving NO Lupron and using a drug called Cetrotide or Antagon to prevent ovulation from occurring prematurely (which is what the Lupron is also for -- but it works in a different way from the antagonists). So getting cancelled on one protocol does NOT mean you shouldn't try another.

4. If you want another "estimate" of how likely/unlikely you are to respond to stims, you can get an antral follicle count done via vaginal ultrasound. This counts the number of follicles that are visible in your ovary ready to ripen -- more is better, and about 3 per ovary would

generally be good in a high FSHer. I'm not sure if there are any different rules-of-thumb for women who have just one ovary, but hopefully your RE can advise you about this.

5. Another option for high FSHers is no- or low-dose cycles. These skip (or drastically reduce) hyperstimulating the ovaries and focus on harvesting the one or two eggs that (hopefully) develop naturally each month. The downside is, you are relying on just 1-2 eggs to make IVF (a costly, complicated procedure) work. The upside is, no need to respond to stims, cheaper than conventional IVF, and possibly better in that it doesn't mess up the natural process of ripening the eggs. A clinic particularly well known for this approach is the Cooper center in NJ (http://www.ccivf.com). It will work with you long-distance and allow you to travel in just for egg retrieval/embryo transfer if you want. For a cost of $300, you can do an initial consult with an RE there by phone.

6. Some REs will recommend that women with high FSH use donor eggs. This can be a good option, particularly for women who feel more strongly about getting PG/having a baby quickly than about having a genetic link with their child. However, it's not very time-sensitive -- it works as well for women in their mid 40s as for everyone else. The same is not true if you are ttc with your own eggs, so it makes sense to ttc with your own eggs first and not allow anyone to rush/push you to DE.

7. Some REs are high FSH friendly, and some aren't. If you'll post where you live, the women on this board may be able to recommend a high-FSH-friendly RE near you.