Question about E2 levels/egg quality/lining

[fantesia28]

Hello,

I have a couple of questions. I have experience 2 miscarriages, plus one recent chemical pregnancy in the past 8 months - I do have two living children as well.

I have undergone a series of tests for recurrent loss, but it appears that it boils down to me having a high fsh level, low E2 and low antral follicle count. So... I CAN easily get pregnant, yet I am not able to stay pregnant (have conceived the first try each month we tried).

The past two months my FSH was in the 30's with lower E2 levels on day 3 of 23 one month and 11 last month. I did ovulate last month and had the chemical pregnancy. I have also recently had a hyseroscopy before my cycle in May. Since then my periods have been usually light from my normal periods. I have been told by my RE that it's due to the low E2 levels, egg quality, but I don't understand why this is suddenly an issue since the hysteroscopy since it was never an issue before.

This month I had my cd2 labs done and my FSH was 3.61, but my E2 was elevated at 136. I did not have an antral follicle count done this month.

So here are my questions:

• If my cycles are lighter than normal, would this suggest that my lining might be too thin to have successful implantation? If yes, would supplementing estrogen in the follicular phase be beneficial to help with this in your opinion?
• If one has an elevated E2 on Cd2, does this affect the egg quality in a negative way? Someone told me that it can cause the eggs to start maturing too soon and thus affects the quality. If this is the case, I may not want to TTC this cycle for fear of another loss.
• Do you feel that a hysteroscopy could cause the lining to be thinner than normal?

Thanks in advance!

[Scott Roseff MD]

Hi,

To answer your questions:

• If my cycles are lighter than normal, would this suggest that my lining might be too thin to have successful implantation? If yes, would supplementing estrogen in the follicular phase be beneficial to help with this in your opinion?

==> It's a possibility. As for supplementing estrogen, if the reason you have light periods is due to poor egg quality/quantity, then merely supplementing estrogen in the follicular phase may be fruitless.

• If one has an elevated E2 on Cd2, does this affect the egg quality in a negative way? Someone told me that it can cause the eggs to start maturing too soon and thus affects the quality. If this is the case, I may not want to TTC this cycle for fear of another loss.

==> A high cycle day 2 E2 level may be due to diminished ovarian reserve (DOR). DOR can be defined as poor egg quality, or poor egg quantity, or both. In women with DOR, the FSH may "rev up" very early, resulting in an accelerated development of a dominant follicle, and that can cause the E2 to rise high early in the folliclular phase.

• Do you feel that a hysteroscopy could cause the lining to be thinner than normal?

==> A diagnostic hysteroscopy (just looking in without doing intrauterine procedures or surgery) should not change the uterine lining. IF it does, it may be for that particular menstrual cycle but NOT for the following menstrual cycle.

I hope this helps!
Dr. Roseff in Florida

[ajourney]

continuation to lining question

Hello doctor
I was reading this thread and wanted to understand better one point. In answer to question1 you indicated that a lining could be thin because of poor egg quality or quantity.....? Is this correct that 'lining quality' also depends on egg quality/quantity?

Please advise.
thanks

[Scott Roseff MD]

Diminished ovarian reserve is a low likelihood but possible cause of a thin lining.

Hope this helps,
Dr. Roseff in FL