If a 38 year old female patient had 4 donor egg cycles where there were no pregnancies during the first two and one pregnancy each in each subsequent cycle ending in miscarriage at the third week?
There is no male factor and no pelvic distortion in the reproductive organs. The patient has elevated fsh and diminishes AMH – hence – donor egg.
She is symptomatic for endometriosis, has hypothyroidism as too does her mother and maternal grandmother. There is h/o infertility or miscarriage in the family.
Patient is normomorphic.
Her reproductive endocrinologist recommends another donor-egg cycle. I advised her against this.
What would you advise this patient to do from a Western medical perspective?