low e2, big follicles

[sophie6]

Hi Dr. Roseff,

I'm 42, usually avg - good responder for IUI. I'm doing IVF this cycle with Luteal estrogen priming, no other suppression (patch removed on first day of stims). I've been using 600 follistim for last 3 days. Three days ago, I had 9 antral follicles (all less than 10mm). Today I have the following follicles:

15.6, 14.4, 13.6, 11.4, 11.2, 10.0

My lining went from 2.9 three days ago to 5.8 today, but my estrogen is only 78! LH is .7 and P4 is 04.

Any idea why e2 is so low with several bigger follicles and a lining that is growing? Is my LH too low??

Thanks,
Sophie

[Scott Roseff MD]

Hi Sophie,

It's LH that stimulates androgen (male hormone) production by the ovary, and that androgen gets converted (via aromatase enzyme) to estrogen. If there's insufficient LH, then estradiol levels tend to be lower.

Why are you doing a cycle restricted to just FSH???

Dr. Roseff in FL

[sophie6]

Thanks so much for your reply. My LH levels tend to be all over the map (from above normal, to below normal-- very unpredictable). One of the Drs consulted with felt that high LH can compromise egg quality. I am not using any suppression (lupron, cetrotide, etc..) this cycle, so I asked my current RE if we could omit the menapur and she agreed. I didn't anticipate my LH levels going quite this low with no suppression.

She has asked me to add in the menapur again. I'm wondering if several days of low LH levels has already compromised the quality of this batch of eggs. What do you think?

Of course, at 42, I know DOR is my biggest issue. My original diagnosis though was ovulatory dysfunction because I tend to have periods of time when I am hypogondatrophic (like now). If you have any thoughts on why this happens to me, I'd love to hear them. None of my REs have been interested in the "why" of it.

BTW-- I have one child conceived via low stim IUI at 38. Just looked at records from her cycle-- normal LH levels-- not too high and not too low. Wish I could just will that to happen all the time!

Thanks again,
Sophie

[Scott Roseff MD]

Hi Sophie,

As a Board Certified RE, I would be able to determine your underlying reason(s) for hypogonadotropism but can't do so without seeing you here. If you're ever interested in that happening, let me know....

I personally would not be comfortable with follicles of your size and an estradiol level under 100 pg/ml.

All my best,
Dr. Roseff in FL

[sophie6]

Thanks, Dr. Roseff. Just saw my RE and she thinks we should cancel. It's good to know that a second doctor thinks this situation is not optimal for continuing. At least I can feel certain that we are making the right decision.