I'm too young to feel this dang old

My RE surprised me today when I answered the phone and it was him.  I was taken back that the RE would take the time to call me personally.  Well, as you have probably figured out, it was not with good news that he made such a personal connection.  I had my blood drawn last week for my pre-IVF labs and expected they would come back as normal as the last set I did 5 years ago.  I don't remember getting old in the last 5 years, and I'm still under the "AMA", so I didn't give it another thought.  So honestly when my RE called I was surprised.  Well, apparently there is a fairly new marker for ovarian reserve (how normal your ovaries are functioning), AMH (anti Mullerian hormone) which decreases with age, until you reach menopause and it becomes zero.  Mine, according to the RE, is lower than it should be for my age.  I asked if I was pre-menopausal and he said it wasn't that low.  He explained that it would simply mean that I would most likely not have a chance of hyper-stimming (OHSS), which is good, they will have to probably use twice the dosage of FSH (stim meds), I wouldn't have to worry about unwanted ovulation during stims, and that I would most likely not get a large (meaning normal) number of oocytes retrieved (we had 13 retrieved with our son's IVF, we are probably going to be lucky to get 4-5 now).  Those that aren't familiar with IVF may think the 4-5 is 3-4 more than you need to make a baby, but just because they are mature, doesn't mean they'll fertilize, and doesn't mean they'll make it to transfer.  So starting with 5 may put us, if we're lucky, with 1 blast to transfer.  That, of course, being worst case besides no blasts to transfer.

I asked my RE about my time on Lupron (which is an artificial menopause) effecting the results.  He said that it shouldn't, but also said he's pretty sure its not been studied, so he did not know.  I immediately want to blame it on the Lupron and the fact that I'm now on CD 49 with no sign of AF.  RE said the Lupron should be out of my system by now, but was curious about why I haven't started yet.  He is sending me for more labs to see where I am with normal cycle hormones and repeat the AMH for good measure.  I asked about forcing AF to get started with IVF and he said it wouldn't be necessary and that if all is quiet in there, I can just jump in anytime.  Quite honestly I'm a little afraid of that.  We did that with the FET and it didn't work, so naturally I don't want to make the same mistake.  I'm sure the RE knows what he's talking about and wants to optimize our chances, but I just wish my cycles were normal from the start of the next IVF.

I was hoping that all was still okay with me and with my DH (which, by the way, his SA came back normal, phew!) so I could just worry about the normal stuff, not worry about my chances being decreased because I've waited too long or something is different about me now as opposed to 5 years ago.  I have to try to let my positive thoughts prevail and focus on the things that are working for us (like my DH's swimmers and all that I DO have working right). 

On an encouraging note, my RE emailed me and wants me to email him when I go for my lab work so he can personally call to explain the results.  I have no doubt that we made a good choice in switching to this practice. This RE is really making a positive impression on me and easing my mind that he knows what he's doing and he cares about what he does and who his patient is.  That kind of service in this context is absolutely priceless!