E2 question

[needtheanswers]

Hi Doctor I really need some answers to see what to do. Anything provided is very helpful. I am 40 going on 41.

I was first given Lupron (10 units) for 12 days prior to be putting on Follistim. After I stopped Lupron, and 5 days before starting Follistim, I began taking Cetrotide 50 units (until trigger).

Dosage-Follistim (600 units for 2 days, folowed by alternating between 300 and 375 until trigger, along with cetrotide each day, and 1 vial of Menopur every other day).

I stimmed for 11 days. I was triggered because I was told my "E2 level had dropped". (My first ultrasound E2 level was 902, then 2 days later it rose to 1900, and the next day it dropped to 1800, so I Had to be triggered. They also told me my lining went from 15 and the next day (trigger day) dropped to 12.

They retrieved 18 eggs-9 mature and 6 imature, and 3 misc?

I was told medication was not strong enough so next time i would do better with estrogen priming to keep E2 level up, and increase dosage of Follistim to 750. vs 600 and alternating 300/375.

What do you think happened?

If I were your patient would you try increasing the dosage to 750 along with daily estogen shots. They never told me what range they wanted to see the estogen level at at trigger time. Thanks.

[Scott Roseff MD]

There are lots of reasons for estradiol dropping. These include, and aren't limited to, the use of Lupron and/or Cetrotide in situations that aren't optimal for their use; poor choice of dosage of Follistim and/or Menopur, premature luteinization of follicles, and diminished ovarian reserve.

So, of 9 mature eggs - you didn't tell us how many fertilized, how many embryos formed, what the embies looked like, how many were transferred, etc. etc.

Estrogen priming is often helpful in "older women" - Why wasn't this done the first time?

We don't use estrogen injections in any of our patients who are stimulating for IVF - Never heard of this....

Good luck,
Dr. Roseff in FL
Our philosophy is, "Do it ONCE, do it RIGHT, and just make it WORK"!

[needtheanswers]

estrogen drop-more info

Hi I will try to answer your questions. Out of the 18, only 3 fertilized normally. They were: 2 A quality and 1 C quality. They went through PGD probe and out of the 3 sent, 1 was normal-A quality hatcing balst. I froze it, and want to bank more embryos rather then taking one to transfer. I also have tested positve for some immune issues after wodnering why good quality ones did not stick. They want me to undergo more immune due to my own and very strong maternal family history of autoimmune issues. (I developed preclampsia, etc, etc. with first child) Not sure if we are getting off track. Just telling you there is a strong suspcion that in the past IVF failed diue it immune issues.

By the way, fsh levels have ranged from 5.0 to 6. clomid challenge test was normal 6.6. Precycle E2 levels in normal range I have been told.

Now when I reviewed previous IVF cycles the very first IVF cycle I did horrible. Used Lupron, follistim, and menopur and got 10 eggs, only 2 mature. rest had holes-smoked appearance. When the doctor looked back he saw that LH was too high. Recorded LH readings during stims were 6.7, 7, 8, and 13.1. At trigger Estrogen level was at 2733.

He then changed my protocol totally. He told me no more lupron, no birth control pills, just bravelle at 450 each day and menopur followed by ganirelix towards the end of stims. my estrogen levels ranged from 3900 to 5770. Eggs retrieved were roughly between 14 to 21 eggs.

And while on the same bravelle protocol for 3 consecutive cycles, my LH stayed low, and I had as much as 10 ferilize normally. I am convinced when I am not on lupron anf follistim, I do better wih bravelle, menopur kept to a minium, and ganirelx. Could this be that i repsond better on bravelle then follsimt? or not well on lupron or cetrotide?

Does any of this sheds some light?
Could Lupron or cetrotide effected estrogen levels?
If so, how.

if not, what are the possible reasons for the drop in estrogen. (1900 to 1800 in a course of a day)

What is premature lutenization? Is that possible here? (is this when LH goes up) Please remember I have had issues with LH in the past. Can lupron or cetrotide raise LH and drop estrogen???.

would you increase dosageto 750 vs 600 then 300/375 til trigger. Or since I had success with bravelle, go back to bravell protocol with ganirelix-dosae 450 or a little higher and see if I could get a better response on dffenrt meds.

I only went back to the follistim instead of bravelle 3 months later because the new doctor addressed my immune issues, and old doctor refused to get me tested or treated despite my history.

Thanks

[Scott Roseff MD]

Sorry, tough to say without reviewing your records. If you're interested in a record review second opinion, please let me know.

Regards,
Dr. Roseff in FL