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One of the books, Dr. Greene has written: Perfect Hormone Balance for Fertility
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Enhancing Fertility 
Hi Dr. Greene,
I was reading through the SIRM forums the other day and came across one of your posts where you said you don’t use LH on older or perimenopausal women for IVF cycles. As an apparently perimenopausal woman of 38 who had 2 IVF cycles cancelled due to nonresponse, I find this very interesting since I was put on both Luveris and Menopur (having an even poorer response to the Menopur than I did to the Luveris) and am wondering if you could write something about it on your blog. I belong to forums ivf.ca and know a lot of women would find that article very helpful. I can’t find the exact post anymore and want to give the correct info to my fellow IVFers.
Thanks so much.
Denise
Dear Denise,
Thank you for the suggestion for a future blog post. Life has been a bit chaotic lately as we’ve had a rather busy February IVF cycle. I am now working on the next blog post about the impact of LH upon egg quality. Please check back for this upcoming entry and alert your forum members at ivf.ca.
Best thoughts,
~Robert
Thank you for your patience. I have posted a new blog entry today that addresses how and why specific medications/hormones used during fertility treatment can improve or compromise egg quality. I hope you find that this clarifies this for you. Please share it with the group your referenced in your previous post.
Best thougths,
~Robert
Good morning Dr Green,
I am 40 years old, living in Spain and I bought recently your book “Perfect Hormone Balance for Fertility”, which generated a very high interest in my quest to get pregnant. I have already had 3 IVF cycles since April 2010. The first IVF cycle gave a result of 7 ovocytes and then 4 embryons, which were declared abnormals by genetical analysis. The process stopped and there was no embryons transfered. The 2nd IVF cycle stopped with the vitrification of 4 mature ovocytes. During the third IVF cycle, which ended today, 5 mature ovocytes were added to the previous 4 vitrificated. We got then 9 embryons, 4 of which saw their development blocked and 5 were seen as elegible for biopsis and genetical analysis. Amongst the 5 remaining embryons, 4 were declared abnormal and 1 was declared normal. This last one was theoretically elegible for embryon transfer, but it blocked his development after the biopsis. As such, it was lost also and there was no transfer. At my age (40), this type of situation can occur, of course, but my deception is high and I would like to give myself the best chances in order to get pregnant in a near future, at least to have done all the possible in order to give me the best chances. What would be your advices to maximize my chances of success? What would be on one hand your specific advice in order to keep my FSH as low as possible (now, level of 12) or eventually lower it? On the other hand what would be your specific advice to improve my genetical diagnostic (increase my egg´s quality)? Would you have eventually some links with some practicians in Spain (Madrid) who are sharing your approach regarding the hormone balance and the fertility? I would like to talk with you directly, but I do not have your phone number to do so. Anyway, if you want to call me, my mobile phone number is +34 679 45 17 89. I thank you already very much for your answer! Maria Jesus Soriano Palomo, Madrid
Dear Ms. Palomo,
I am so sorry to learn of all that you’ve been through and yet not achieved a successful pregnancy. These are very complicated questions and they would be far more successfully discussed rather than having me try to write answers in this format. If you’d like to set up a consultation, that would allow me to review your medical history more fully and discuss possible treatment modifications more directly then I’d encourage you to call my office at 916.568.2125. I regret that I don’t know any physicians in Spain that I can refer you to but I can tell you that we’ve taken care of couples this year that have traveled to us from Spain, Germany, France and various parts of the USA. Whatever you decide, I do wish the very best outcome as soon as possible.
Best thoughts,
~Robert
Robert Greene, MD, FACOG
Medical Director
SIRM–Northern California
Hi Dr. Greene
I have read your blogs related to egg quality and factors which can improve it. Iam 32 years old with low AMH . I am planning to go for ivf cycle through you. where can i contact you?
Dear riki,
Thank you for your interest in my opinion and the opportunity to assist you in your quest to conceive. I am in the process of relocating to a center that is offering a very comprehensive approach to the diagnosis and management of fertility problems. Please check back with me in a couple of weeks so that I can provide you with details.
Best thoughts,
~Robert
Robert Greene, MD, FACOG
Hi Dr. greene,
Can you please provide me your current office details?
Thanks
Dear riki,
Thank you for your interest. I am in the process of joining Dr. Rob Kiltz at CNY Fertility in Syracuse, NY. Please check out our website to learn more about the holistic approach to fertility care that we offer: http://cnyfertility.com . Better still, you may be shocked at how reasonably priced the treatment options are. The goal is to make more options available and affordable to people seeking treatment. I welcome your feed back and hope that you like what you see.
Best thoughts,
~Robert
Robert Greene, MD, FACOG
I love your Blog, it’s nice when you can tell somebody actuallly puts effort into a blog, and gives the blogs value.
Dr. Greene,
My REI specialist at Yale recently diagnosed me with early premature ovarian failure. I have a low AMH, low progesterone, and spotting around day 20 of my 22 day cycles. Ultrasound showed normal ovarian size and normal number of follicles for my age – age 33. An adrenal hormone test also showed I have low 17 hydroxyprogesterone. Could my low AMH be due to the low adrenal hormone? Is there any chance I just need help with the adrenal fatigue, supplement with progesterone, and that I’m actually not experiencing decreased ovarian reserve?
Thank you!
Rachel
Dear Rachel,
There are many factors that can contribute to premature ovarian failure (POF). Fortunately, I can reassure you that having a low adrenal hormone is not one of them. In fact, there is no recognized diagnosis of “adrenal fatigue” by either the medical endocrionlogists nor the reproductive endocrinologists. Here is a link to an more detailed explanation that you may find helpful: http://www.hormone.org/Public/upload/Adrenal-Fatigue-Web.pdf . Please let me know if I may be of further assistance to you.
Best thoughts,
~Robert
Robert Greene, MD, FACOG
CNY Fertility Center
Hello Dr. Green:
In reading the above discussion, I am curious about the significance of Anti-mullerian hormone. How significant is an abnormal result in indicating true POF?
Thanks
Trisha,
I believe that one of the values of AMH is helping patients choose their treatment modality as well as optimizing their chance of completing their family. For instance, if a woman has a lower AMH then anticipated, she may choose to move more quickly to IVF or even consider moving on to an egg donor. Similarly, if someone’s goal is to have more than one pregnancy, AMH might sometimes suggest that someone consider “embryo banking” (creating embryos for freezing with the goal of having them for later use). Does this make sense?
Best thoughts,
~Robert
Robert Greene, MD, FACOG
Robert,
Thank you – that makes sense. So what about my low 17 hydroxyprogesterone and low morning cortisol? I understand that POF can be due to decreased ovarian reserve or hormonal insufficiencies. My AMH is 0.16 and 0.2 (tested twice). Could this low AMH be reversed? Is it definitive? Can it be that i just have hormonal insufficiencies that can be treated rather than decreased egg number?
Thank you,
Rachel
Hello Rachel,
Cortisol levels can vary day-to-day depending on a variety of factors; most notably how someone slept and whether or not they are feeling stressed. Thus far, there is no proven way to reverse a diminished AMH. Typically, they do not vary much and rarely will they increase but I have seen it occur. Unfortunately, that’s why we currently treat a low AMH as condition where a woman’s egg number is lower than anticipated. Hope that this helps clarify.
Best thoughts,
~Robert
Robert Greene, MD, FACOG
CNY Fertility Centers