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New Diagnosis of Low Reserve


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#1 silverdollar

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Posted 19 June 2010 - 10:02 AM

During my first IUI last week I was landed with the news that I have low ovarian reserve based on this cycle's Day 3 blood work:

FSH 10.2, Estradiol over 300

I am 32, so based on my age the RE feels we are dealing with a quantity rather than a quality problem. The plan is to ramp up the IUI's with injectables next cycle and see if I respond better than I did to oral stimulation (produced one mature follicle). I'm working hard at taking this process one step at a time, and staying positive. I know there is no way to create more eggs. I've started acupuncture again thinking it might help to bring my FSH levels down for the next cycle and maybe I'll need less high of a dose of injectable drugs.

I can't help but wonder what this means for the future. Will I get pregnant at all? If the IUI's don't work, will I be a candidate for IVF? If I do get pregnant will this be my only baby? Will I have an early menopause?

If anyone has any experience with this, or advice for a younger woman running low on eggs, please respond. Thanks in advance.

Unexplained IF/ DOR. Began TTC in 2008.
After a wild and crazy ride on the treatment train, our baby GIRL arrived on Jan 6, 2012
Hold on.... Surprise spontaneous just 7 months postpartum while still breastfeeding!!! Baby boy born May 2, 2013
My heart couldn't be more full :)
 
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#2 feydruss

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Posted 19 June 2010 - 10:53 AM

I can't help but wonder what this means for the future. Will I get pregnant at all? If the IUI's don't work, will I be a candidate for IVF? If I do get pregnant will this be my only baby? Will I have an early menopause?


Maybe. Probably. Maybe. Maybe. I know that's a lot of non-answers, sorry.

My doctor basically forced us into TTCing before DH was ready because he saw that my levels were whacked out when I was 34. My paternal grandmother, with whom I share a TON of physical characteristics, went through POF around the same age, so my doc was worried. We went from six months of Clomid straight to IVF, no IUIs at all. We had approximately six months in between fresh cycles, and my RE was shocked at how much my system had deteriorated in that time. Same protocol (at first, until we had to ramp it up), but very different results. He actually said that this could be my last cycle. Yeah, no pressure at all, thanks!

It's hard to say what will happen. You might want to talk to your RE about moving to IVF sooner, because the odds are better than with IUIs for someone with a low reserve. There's less room for error in some ways. But if you have no male factor problems, then maybe it's worth doing another IUI w/injectables. You could give it one more shot, but then plan to move to IVF if you're able to (emotionally, physically, financially).

IVF doesn't always work on the first cycle, as many people here can attest to. So you need to be prepared to roll with the punches and make decisions based on your levels and family desires.

We were sure that this cycle wouldn't work, and were prepping for another FET. And I was honestly starting to research surrogates, because after 7 embryos implanted (in theory), it was clear to me that I had implantation issues. But it worked, which shocked the hell out of us. We expect this will be our only pregnancy. If we lose one of our twins, we may consider trying again in 18-24 months for a second, but the chances of success for me at that time are very very minimal--I may be in full menopause by that point.

I don't know if any of that helps, but many of us have been where you are (or close to it), so know that we understand. :grouphug2:

3rd cycle was the charm (despite everything going wrong)!
History and details in my profile
Twin boys Milan and Duncan born at 32w4d on 15 November 2010


#3 silverdollar

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Posted 19 June 2010 - 11:28 AM

Fey,
Thank you for taking the time to respond, while you are meanwhile dealing with such a stress with your own pregnancy right now.

The plan, if I'm not pregnant with this IUI, is to try one IUI with injectables, see how I respond to the stims, and then if that is not successful consider another IUI or straight to IVF. I've remortgaged the house to cover the financial part, so one less stress.

I am trying not to think of the past, but I am a bit angry that if I had signs of this a year ago, why did my doctors brush this concern aside because of my age. I waited a year on waitlists for help, while older patients got bumped in front of me.

Interestingly my mom and maternal grandmother both had babies in their early 40's and went through menopause shortly after in their mid 40's.

Thanks again and my thoughts are with you during this tough time.

Unexplained IF/ DOR. Began TTC in 2008.
After a wild and crazy ride on the treatment train, our baby GIRL arrived on Jan 6, 2012
Hold on.... Surprise spontaneous just 7 months postpartum while still breastfeeding!!! Baby boy born May 2, 2013
My heart couldn't be more full :)
 
Full details are now in my profile "About Me" page

#4 LisainSK

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Posted 19 June 2010 - 11:56 AM

Silverdollar,

Ask your doctor to check your AMH levels (anti-mullarian hormone). The AMH and resting follical count via ultrasound are apparently more accurate than FSH. AMH can be tested at any time in your cycle. This is according to Dr. Hudson via ivf.ca and my new RE in Denver. Also according to an oxford health online journal, the AMH is more accurate at predicting POF and egg quality. So it seems to be the new and better way to predict POF. My AMH came to 1.0 and they'd like to see it minimum 1.2. Combined with sub-par follicle count (estimated 6 eggs) we're doing donor eggs. If we were able to just do conventional IVF without genetic screening we would have went ahead with IVF using my own eggs but I need minimum double the number of eggs collected so that we could screen fo'r my chromosomal inversion. It was a heartbreaking decision but we felt that we had all the answers and could confidently move onto donor eggs.

I wonder too if I'll go into early menopause...my maternal grandmother did not start having kids until 42 and my mom didn't start menopause until her late forties...so hard to know.
Me (33) and DH (35)....married 10 years (small town sweethearts)

December 2006: TTC # 1
May 2007: DH S/A...normal.
September 2007: BFP au naturelle...holy smokes!
November 2007: M/C # 1 @ 12 wk. DNC reveals a Partial Molar Pregnancy.
January 2009: Referral to local OB/GYN
April 2009: Dx Unexplained. Referral to Calgary RFP.
May 2009: Clomid Cycle # 1...BFN
June 2009: IUI # 1 w/ Clomid # 2 and HCG...BFN
July 2009: Clomid Cycle # 3...BFP! Happy but terrified of another m/c.
September 2009: Worst fears confirmed...M/C # 2 @ 8 weeks
October 2009: IVF Orientation at Calgary RFP and on wait list.
January 2010: Dx (Me) Abnormal Karyotype (Pericentric Inversion Chromosome 16)
March 2010: RFP Referral/Consultation with Reprogenetics in New Jersey
March/April 2010: PGD/IVF success odds very low...20% estimated "normal embryos" per cycle and a 41% pg rate
May 2010: Consult with Dr. Schoolcraft of Colorado Center for Reproductive Medicine
June 2010: One Day Work Up @ CCRM (Denver, CO)
June 2010: Predicted Low Responder (Low AFC and AMH). Inversion in difficult spot...We're doing Donor Eggs!!
July 2010: Discovery that I am also a carrier of Fragile X...my eggs didn't have a chance.
July 2010: Annonymous Egg Donor chosen through CCRM
August 2010: Mock FET Cycle completed.
DE IVF # 1
September 2010: Donor Eggs retrieved. Blastocysts to undergo PCR genetic screeing.
October 21, 2010: U/S showing 9.9 mm lining with triple stripe; E2 = 1600 and 1397 US units
November 1st, 2010: FET # 1 (Elective Single Embryo Transfer - eSET)
November 10th, 2010: Beta HCG # 1 = 82, P4 = 23.1 US units
November 12th, 2010: Beta HCG # 2 = 186! BFP!!
November 17th, 2010: Beta HCG # 3 = 1461
November 19th, 2010: Beta HCG # 4 = 3740
November 26th, 2010 U/S: hb = 120 bpm, measuring 6w1d, actual gestation is 6w2d since transfer, CRL = 3.8 mm
Dec. 10th, 2010 U/S: hb = 180 bpm, measuring 8w2d - exactly 8w2d since FET, CRL = 1.8 cm
February 18, 2011: Anatomy scan
EDD = July 20th, 2011

June 28th, 2011 @ 3:19 AM MTN: Levi Darrell John born at 36w6d at 6lbs 14oz and 18" long. He is precious beyond measure.

Visit my blog at:

http://wantedonegood...o.blogspot.com/

February 2012: Bye Bye IVF.ca community...you are the reason I got to where I am today. I am forever reached via pm as my email alerts me. Take care all...wishing you all peace in your hearts soon.

#5 silverdollar

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Posted 19 June 2010 - 12:43 PM

I will for sure be asking my RE (who happens to be Dr. Hudson incidentally) about having the AMH test. A proper follicle count will be on the list too -never actually got one of these at the right time of my cycle yet. :(

When this news was delivered my brain went immediately to donor eggs. I know that's jumping too far ahead. I wish you all the best with your journey. Thanks for the reply -You guys are quick!

*Edited -didn't mean to put the angry icon in

Unexplained IF/ DOR. Began TTC in 2008.
After a wild and crazy ride on the treatment train, our baby GIRL arrived on Jan 6, 2012
Hold on.... Surprise spontaneous just 7 months postpartum while still breastfeeding!!! Baby boy born May 2, 2013
My heart couldn't be more full :)
 
Full details are now in my profile "About Me" page

#6 wannakid

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Posted 19 June 2010 - 01:05 PM

Hi Silverdollar,

If your recent "diagnosis" is based on only one month's FSH count, then I would be reassured. It is quite possible that your FSH just happened to be high that one month that it was tested, and that it will go down (with correspondingly higher antral follicle count numbers on another Day 3). Once last year, I had FSH of 16 (my IUI cycle was cancelled). It went down to between 7 and 8.8 every single month since then. From having sought out information on this topic, I can tell you that many people are able to have successful IUIs and IVFs with low antral follicle counts. When I first started with IUIs on Clomid, I only had 1 follicle, but subsequently have had IUIs with up to 5 follicles (which is the max. for IUIs anyways).

Having said that, given that you know that you may have a high or increasing FSH with potentially low ovarian reserve, I agree with the other person who said that you should consider moving quickly to IVF. I have had multiple failed IUIs and only determined that there may be a low ovarian count issue in last year.... in hindsight, I wish I had moved on to try IVF sooner. I have had 2 cancelled IVF cycles due to poor response to meds (too few follies). I am hopeful that there are different protocols of meds to try, at higher dosages, that will get me to an IVF retrieval (even if I only get 6 follies at the retrieval).

Anyways, don't lose hope in using your own eggs. You are still young!

Just my 2 cents....

WK

#7 DeeJay

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Posted 19 June 2010 - 01:21 PM

That's the news I was given as well and we are doing an IVF antagonsit protocol with Estrogen patch priming first.

I can't do IUI as I have blocked tubes, but low reserve does not immediately mean IVF /donor eggs/ no success.

Good luck!
Deb & Chris
DH and I: 36-37
Married 2 years, together 8, trying the whole time!

DX: Tubal scarring from car accident @ 15yrs. One 100% blocked, 1 80% blocked. And due to age, low ovarian reserve.

DH's spermies are still swimmin away, no problems yay.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

First Cycle
Chemical pregnancy.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Second Cycle
Sucess! 2 Girls!! Avery & Sydney born June 12/11 at 30w1d.

See in the 'About Me' section on my profile for more details on protocols and timing.

src="http://lpmf.lilypie.com/p2YAm4.png" width="400" height="80" border="0" alt="Lilypie Premature Baby tickers" />

#8 aprilbaby

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Posted 19 June 2010 - 02:08 PM

HIgh Fsh does not mean much at your age. It only means you MIGHT not respond very well to meds. Your egg quality should still be great. DO not worry about it and if your RE is worried about it then change clinics!

I had an fsh of 10-12 and I got pregnant on my first transfer with Natural IVF. Natural IVf means that we did not use any drugs. We just followed my natural cycle and then retrieved the one egg.

You have a great chance of pregnancy!


I also did acupucnture and herbs (they really helped elongate my cycle! )plus took..

CoQ10
E/Selenium/Zinc
Wheatgrass (dynamic greens)
Multi
Probiotics
Digestive Enzymes
me:35 dh:35
TTC 8 years
Unexplained/Mild Male Factor/High FSH

Multiple IUI's2004-2006-BFN

Adoption Process -2005
Our Beautiful Baby Boy#1!

Natural IVF/ICSI BFP (FSH 10-12) -2010
Acupucture,Herbs,CoQ10,Wheatgrass,Cod liveroil,Vit D, Organic Foods
02/21/10-One perfect embryo transferred
03/05/10-BFP-12dp3dt Beta 180!!
6w6d u/s-Baby measuring perfectly w/beautiful Hb 128
8w6d u/s-Baby measuring perfectly w/Hb 173
13w u/s-Baby moving around alot!
18w anatomy u/s perfect-Genetic tests excellent-Placenta Previa-BOY!
23w u/s-Placenta Previa resolved
32w u/s-All is Well! Still a boy!
Thank You God
Baby Boy Born #2 2010

Surprise Natural BFP2011
First spontaneous BFP in 10 years TTC
6w4d u/s-Hb 130
EDD 09/12
Baby boy #3 Born 2012

#9 capo

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Posted 19 June 2010 - 09:01 PM

I agree with the person who said your FSH levels vary. Mine spiked to 26 when I was about 30, but for the most part it was between 10 and 15 if I remember correctly. I had a very poor response to stimulation drugs for our IUIs and our first IVF which is why we opted for a 'natural' cycle the last time. The natural cycle with acupuncture and supplements produced 1 perfect embryo and because it was a much easier cycle for me and much less costly, we were willing to try it again at least 3 times. As it turns out, we adopted right after the IVF cycle and got a surprise natural shortly after that. Who knows what our bodies have in store for us!

My personal opinion would be try another IUI with stims asap so that you can gauge your response to the meds. That will give the RE information for planning your IVF cycle if needed. Another option is to go straight to IVF, but convert to IUI if they don't get the response they want the first time. That is just my 2 cents though. You have many options to explore and ultimately, you have to trust you RE and your gut!!
Me-35, DH - 41
TTC since 2005 - high FSH/low ovarian reserve and endo
Ectopic pregnancy Dec 2006
3 cycles clomid (Ob Gyn) - BFN
TCART
2 IUIs (Letrosol) - BFN
3 IUIS (Menopur & Letrosol) - 1 chemical pg
OFC
IVF#1/ICSI Feb./Mar. 2009 (Puregon & Repronex) 6 retrieved, 5 fertilized, 2 embies 3dt - BFN
July 20 - Laparoscopy & laser for stage 2 endometriosis, tubes clear
Sept. 2009 - Approved for CAS adoption!!
Create
IVF#2/ICSI Dec. 2009 - natural cycle - BFN
IVF#3 planned for Feb. 2010, but life had better plans:
Jan. 2010 Nicholas is our CAS miracle! Our son is home and we are ecstatic!
April 2010 surprise natural BFP - Allyson was born December 31st 2010!

What a year - we are truly happy and beyond grateful!

#10 silverdollar

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Posted 19 June 2010 - 09:22 PM

You ladies are awesome!

My FSH has been tested 3 times in the past year ranging from 6.8 -10.2. This cycle the Estradiol was also high, so it was masking the FSH level (meaning it's probably actually higher than 10.2). This is why the RE wants to get more aggressive. I'm happy with that anyway as we've been at this for 2 years on our own/ with beginner treatments.

I am very comfortable with the RE's recommendations. I think it makes sense to see how I respond to stims on an IUI cycle where the stakes are a lot lower. I always ovulate one egg, and they will still do the IUI with that. The plan is to move right into this injectable cycle in another week or so if I get my period (still holding out hope that I don't). I will have a lot more u/s monitoring next time and will make sure they do a follicle count early in the cycle.

Thanks for the info on the natural cycles wannakid. Capo I know you mentioned this in your PM too. Good to know there are options.

Deejay -Good Luck with your cycle!
Aprilbaby -congrats on your pregnancy

Unexplained IF/ DOR. Began TTC in 2008.
After a wild and crazy ride on the treatment train, our baby GIRL arrived on Jan 6, 2012
Hold on.... Surprise spontaneous just 7 months postpartum while still breastfeeding!!! Baby boy born May 2, 2013
My heart couldn't be more full :)
 
Full details are now in my profile "About Me" page

#11 kookacola

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Posted 19 June 2010 - 10:35 PM

Silver dollar , I wonder if you had the same re judging from what yo've told us;( ahh I did some iuis with clomid and letraxole and then I wasn't responding to clomid so re booked me for surgery and then we did iui with injections and even then with a 'conserative" dose I wasn't responding well. I ended up with ahh 4 follicles and bfn. Then I did the "flare' proticol and I got 6 follicles. What was ironic with my case was that local re diagnosed m eith pof and the clnic never even bothered to do any testing to investage that. So since I never responded on the highest dose ofr Gonal F, I moved onto d/e. I did have a pregnancy 7 years ago that we conceived naturally and I had a m/c. I did ask local re if he had any idea as to what happens ad most women want answers from such a loss. he felt that my egg quality "could" have been thr eeason why I m/c and he also said that I "may" have had a high fsh when I got pg too. Unfortunatly we'll n ever know, All we do know is how far along I was when I had the m/c:(

A question for all you ladies, do any of you have a lot of hair on your faces and other part of your body?

#12 silverdollar

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Posted 20 June 2010 - 07:56 AM

kookacola -No, I don't think it's the same RE. My GP and OBGyn were the ones that brushed this concern aside. I have only just started seeing the RE. Sorry to hear about your struggles. About your hair question -I have very little body hair. I think facial hair is one of the features of PCOS.

Unexplained IF/ DOR. Began TTC in 2008.
After a wild and crazy ride on the treatment train, our baby GIRL arrived on Jan 6, 2012
Hold on.... Surprise spontaneous just 7 months postpartum while still breastfeeding!!! Baby boy born May 2, 2013
My heart couldn't be more full :)
 
Full details are now in my profile "About Me" page

#13 LBBW

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Posted 20 June 2010 - 09:01 AM

Just a note of caution re: AMH... there are two scales. One is American/conventional units (ng/mL) and one is SI units used in Canada (pmol/L). They are VERY different.

http://www.drmalpani.com/amh.htm

I had an AMH of 10.6 pmol/L in Feb. I needed 225 IU Gonal F and 75 IU Luveris to get 4 good follicles (from an AFC of 6). Two fertilized and ET was 2 days ago. Quality is more important than quantity...and my RE said quality is often related to age...the younger you are the better.

A cheaper injectible cycle first to gauge your response to stims is a great idea...but if it is not successful strongly consider jumping right to IVF. Good luck!!
TTC since Oct 08
DH: found out July 09 azoospermia, then Aug 09 high FSH/low testosterone = NOA likely
Me: low ovarian reserve AMH 10 but normal FSH/estradiol

Testicular cancer diagnosis Oct 09 at our second opinion MFI urologist appt - radical inguinal orchiectomy with Stage 1A disease found - no chemo/rads just surveillance thank goodness!

No sperm on MAPx3 and DH's FSH 28 so onto IVF with DS - OCP/Antagonist Protocol
IVF #1 June 2010 - 4 follicles - ER June 15th - 4 mature eggs, 2 fertilized - 3dt June 18th - BFN
IVF #2 Aug 2010 - 11 follicles WOW - ER Aug 18th - 9 mature eggs, 8 fertilized - 3dt Aug 21st of 3 embyros - BFP! Thank you.
Beta #1 13dp3dt = 254 then Beta #2 15dp3dt = 727 then Beta #3 17dp3dt = 1597
US 7wks1d & 9wks1d & 12wks2d showed one baby with good HR measuring right on.
EDD May 11, 2011

#14 silverdollar

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Posted 21 June 2010 - 07:19 AM

Thanks for the link LBBW. It's good to know there are 2 scales.

Yes, I think one, max 2, more IUI attempts and then IVF is where we're headed. Thank you for solidifying that.

Unexplained IF/ DOR. Began TTC in 2008.
After a wild and crazy ride on the treatment train, our baby GIRL arrived on Jan 6, 2012
Hold on.... Surprise spontaneous just 7 months postpartum while still breastfeeding!!! Baby boy born May 2, 2013
My heart couldn't be more full :)
 
Full details are now in my profile "About Me" page

#15 silverdollar

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Posted 01 July 2010 - 06:53 PM

An update from my RE appointment yesterday. In his opinion the low ovarian reserve is not a huge problem, but something that needs to be paid attention to in developing a treatment plan. He said even though there were signs of this for the past year he would not have done anything differently in terms of diagnostics or treatments because many people are successful on their own or with minimally invasive treatment.

His answers to my questions:

Will I get pregnant at all?
Probably, with a more aggressive approach.

If the IUI's don't work, will I be a candidate for IVF?
Yes, yesterday's ultrasound revealed that the antral follicle count is good, and this is a promising sign. IVF will be the next logical choice, but he'd still like to try 2 more IUI's to get a really good sense of how I'll respond. He did say that he probably wouldn't recommend IVF in an older patient with my FSH/E2 levels, but because of my age it's a whole different thing.

If I do get pregnant will this be my only baby?
As long as we start trying for #2 soon after weaning from breast feeding we'll have a good shot at having a second child. We may even get lucky and have a natural conception. If not, don't waste time before getting back to the clinic again.

Will I have an early menopause?
Probably. He figured early 40's like my mom, not next week or next year. He gave me a print out to read about AMH testing, but said it wouldn't influence the current treatment plan. It may be helpful to do before an IVF cycle. It costs about $250.

Thank you so much to everyone that responded to my original post. :)

Unexplained IF/ DOR. Began TTC in 2008.
After a wild and crazy ride on the treatment train, our baby GIRL arrived on Jan 6, 2012
Hold on.... Surprise spontaneous just 7 months postpartum while still breastfeeding!!! Baby boy born May 2, 2013
My heart couldn't be more full :)
 
Full details are now in my profile "About Me" page

#16 need2know

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Posted 21 July 2010 - 09:14 PM

Hi Silverdollar,

Just wanted to let you know that I too was diagnosed with low ovarian reserve at age 32 ( based on AMH blood test and confirmed by antral follicle count) but we were very fortunate to achieve a BFP with IUI and oral stims ( also one mature follicle. So there is hope for you. I also wonder what my chances of getting pregnant again and am hoping that we'll get lucky again. I also did acupuncture.

Good luck

During my first IUI last week I was landed with the news that I have low ovarian reserve based on this cycle's Day 3 blood work:

FSH 10.2, Estradiol over 300

I am 32, so based on my age the RE feels we are dealing with a quantity rather than a quality problem. The plan is to ramp up the IUI's with injectables next cycle and see if I respond better than I did to oral stimulation (produced one mature follicle). I'm working hard at taking this process one step at a time, and staying positive. I know there is no way to create more eggs. I've started acupuncture again thinking it might help to bring my FSH levels down for the next cycle and maybe I'll need less high of a dose of injectable drugs.

I can't help but wonder what this means for the future. Will I get pregnant at all? If the IUI's don't work, will I be a candidate for IVF? If I do get pregnant will this be my only baby? Will I have an early menopause?

If anyone has any experience with this, or advice for a younger woman running low on eggs, please respond. Thanks in advance.