High E2 level during IVF cycle


#1

Hello! I’m 29 and my husband is 30. I was diagnosed with block tubes from contracting chlamydia 10 years back. I’ve had 5 failed IUIs with the last leading to a tubo-ovarian abscess on each side on my ovaries. That was painful. This is my first IVF cycle and it doesn’t seem to be going so well. Here’s my status:

08/02-08/04/13 Stim day 1-3: Lupron 5 units, Follistim 150 units, Menopur 1ml liquid mix with powder

08/05/13 Stim day 4: E2 levels at 800. Lupron 5 units, Follistim 75 units, Menopur 1ml liquid mix with powder

08/06/13 Stim day 5: E2 levels at 1539. Lupron 5 units, Follistim 75 units, Menopur 2ml liquid mix with powder, but draw only 1ml of mix

08/07/13 Stim day 6: E2 levels at 2458. Lupron 5 units, Follistim 50 units, and no menopur

08/08/13 Stim day 7: E2 levels at 3561. Lupron 5 units, Follistim 25 units, and no menopur

08/09/13 Stim day 8: E2 levels at 5124. Lupron 5 units. No follistim and menopur. Coasting time.

I thought my follicles would be a good size by now, but the doctor said they didn’t grow much from yesterday, 08/08. I don’t know if the growth is slowing down due to the medication being reduced, but I’m scared that by coasting, my follicles won’t grow. I’ll be coasting today 08/09 until tomorrow when I have to go back into the office for a blood draw and ultrasound. I’m very worried about my cycle being cancelled due to the high estrogen levels that can lead to OHSS. My doctor’s said if my E2 levels get to around 6,000 then he’ll cancel my cycle. I’ve read forums and watched YouTube videos of people going through an IVF cycle with OHSS. It sounds bad. Please provide comments on your experience. Thank you!


#2

[quote=lindat915]Hello! I’m 29 and my husband is 30. I was diagnosed with block tubes from contracting chlamydia 10 years back. I’ve had 5 failed IUIs with the last leading to a tubo-ovarian abscess on each side on my ovaries. That was painful. This is my first IVF cycle and it doesn’t seem to be going so well. Here’s my status:

08/02-08/04/13 Stim day 1-3: Lupron 5 units, Follistim 150 units, Menopur 1ml liquid mix with powder

08/05/13 Stim day 4: E2 levels at 800. Lupron 5 units, Follistim 75 units, Menopur 1ml liquid mix with powder

08/06/13 Stim day 5: E2 levels at 1539. Lupron 5 units, Follistim 75 units, Menopur 2ml liquid mix with powder, but draw only 1ml of mix

08/07/13 Stim day 6: E2 levels at 2458. Lupron 5 units, Follistim 50 units, and no menopur

08/08/13 Stim day 7: E2 levels at 3561. Lupron 5 units, Follistim 25 units, and no menopur

08/09/13 Stim day 8: E2 levels at 5124. Lupron 5 units. No follistim and menopur. Coasting time.

I thought my follicles would be a good size by now, but the doctor said they didn’t grow much from yesterday, 08/08. I don’t know if the growth is slowing down due to the medication being reduced, but I’m scared that by coasting, my follicles won’t grow. I’ll be coasting today 08/09 until tomorrow when I have to go back into the office for a blood draw and ultrasound. I’m very worried about my cycle being cancelled due to the high estrogen levels that can lead to OHSS. My doctor’s said if my E2 levels get to around 6,000 then he’ll cancel my cycle. I’ve read forums and watched YouTube videos of people going through an IVF cycle with OHSS. It sounds bad. Please provide comments on your experience. Thank you![/quote]

that is really high E2 - how big/how many follies do you have? My E3 was 3000 at trigger and I got 14 or 15 eggs.


#3

High E2 level during IVF cycle

I have about 20 follicles. Most of them are around 11-15mm in size and I think a few are 16-20mm. I don’t know if coasting will help reduce my estrogen levels and still keep my follicles growing.


#4

I had high estrogen levels for my last 2 cycles 7400 and 6400, and both were not cancelled. Your follicles will grow even while coasting - mine did. If you were on an antagonist cycle, your RE could have used a Lupron trigger, which doesn’t exacerbate the OHSS. You cant use a Lupron trigger if you used Lupron in your protocol. HCG trigger will make the OHSS worse. If your AFC and AMH are high, why didn’t your RE use antagonist? You might be able to do the retrieval but have to freeze and transfer later. Ganirelix or Cetrotide after the egg retrieval can help with OHSS, as does cabergoline.

[QUOTE=lindat915]I have about 20 follicles. Most of them are around 11-15mm in size and I think a few are 16-20mm. I don’t know if coasting will help reduce my estrogen levels and still keep my follicles growing.[/QUOTE]


#5

In your last two cycles with high e2 levels, was that the levels before you injected the trigger shot? Did you ended up having mild OHSS. My RE never discussed an antagonist cycle. I’ll definitely have questions for him tomorrow. I hope your transfer goes well.


#6

Yes, those were my estrogen levels before trigger. I know women at my clinic who’ve had higher estrogen than me. Our clinic is aggressive but manages OHSS well. It is serious and can be dangerous. I was very bloated and in pain, but I didn’t need to have any fluid aspirated. You should start drinking lots of Gatorade or other electrolyte type drink - not water, and eat lots of protein. It will help with your recovery.

[QUOTE=lindat915]In your last two cycles with high e2 levels, was that the levels before you injected the trigger shot? Did you ended up having mild OHSS. My RE never discussed an antagonist cycle. I’ll definitely have questions for him tomorrow. I hope your transfer goes well.[/QUOTE]


#7

[QUOTE=YellowAster]Yes, those were my estrogen levels before trigger. I know women at my clinic who’ve had higher estrogen than me. Our clinic is aggressive but manages OHSS well. It is serious and can be dangerous. I was very bloated and in pain, but I didn’t need to have any fluid aspirated. You should start drinking lots of Gatorade or other electrolyte type drink - not water, and eat lots of protein. It will help with your recovery.[/QUOTE]

My E2 level was 7500 at trigger. I only did 5000 iu of trigger (half dose) to help reduce the chance of OHSS. Dr prescribed Cabergoline and I drank lots of Gatorade, fluids, and ate salty food. It seemed to keep the OHSS at bay. We retrieved 19 follicles!

I’m now 5 weeks pregnant!

Good luck!


#8

[QUOTE=lindat915]I’m very worried about my cycle being cancelled due to the high estrogen levels that can lead to OHSS.[/QUOTE]

Estrogen does not cause OHSS, but it does reflect OHSS risk. The cause is the numerous follicles and other hormones they will release after they are exposed to hCG.

[QUOTE=YellowAster]I had high estrogen levels for my last 2 cycles 7400 and 6400, and both were not cancelled. Your follicles will grow even while coasting - mine did. If you were on an antagonist cycle, your RE could have used a Lupron trigger, which doesn’t exacerbate the OHSS. You cant use a Lupron trigger if you used Lupron in your protocol. HCG trigger will make the OHSS worse. If your AFC and AMH are high, why didn’t your RE use antagonist? You might be able to do the retrieval but have to freeze and transfer later. Ganirelix or Cetrotide after the egg retrieval can help with OHSS, as does cabergoline.[/QUOTE]

Pardon me for saying this, but you have done your homework very well and posted an excellent, informed response.

It baffles me that any centers still put high responders on Lupron protocols. Coasting and cabergoline are not as effective as the Lupron trigger in preventing OHSS.


#9

Yesterday, 08/10, my e2 levels went from 5124 to 4242. I got the okay to take the hcg trigger shot of 5,000 units due to the e2 being high. I’ll be having my egg retrieval on Monday, 8/12. I was wondering if anyone knew if hydrosalpinx are visible during an egg retrieval. The RE hasn’t seen any in all my ultrasounds. My hsg x-rays that I did a few years back weren’t accurate, but I know with a history of chlamydia and not being able to conceive for a few years even with iuis makes me believe I have hydrosalpinx that are not visible with regular ultrasounds. If this ivf fails, then a laparoscopy will be the next route.