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Discussion Starter · #1 ·
Hi all.

Second post on FF and really apreciate the response form my first post.

Todays help is regarding my wifes Oestrogen level that we have just heard back from the hospital..

My wife is big on low doseage cycles ( we did a low dose at Create last year.. ) and at present we have just started a cycle In Manchester on a short Cycle... Their protocol is to start on a high does ( 450 purogen ) then have a blood test...

Well my lovley wife has just emailed this over..

"I am confused. This morning I asked the nurse what they expect my oestrogen level to be and they said 250 - 500. So when I get my result and its 1407 which is 3 x what they expected it to be she said leave the dose as it is and we will take blood again on Thursday. What is the point of doing it in the first place it seems to me that I am over responding??? What do you think? Shall I dose myself ? She said sometimes it flares up in the beginning."

What does everbody reckon.. I can't find out online what oestrogen should be after two days of the Purogen injections..


Any help would be great as my wife is at work and can't use the internet.


Many thanks

Simon

 

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after 2 days of stimming this is alittle high BUT they will keep an eye on her at every app.if they say stay on the same dose then this seems to be ok.whens you next app???they will check her bloods again at next app.has she had a scan done???
 

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Discussion Starter · #3 ·
Thanks W4M,

Jo has another blood test on thursday so I guess we'll have to see what happens then..  She hates having to take high amounts of the drugs...

many thanks


Simon
 

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im guessing she will be having a scan thursday aswell?? ^idiot^ i had a blood test and a scan at every app to have a look at follie activity.is this your first go??
 
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do you know how many follies she has? Oest levels correspond to these so we are all different etc. Thursday she will only be day 4 right? so there is plenty of time to drop the dose - if they still say they are high then, please ask them why they are not doing this!!

xxx
 

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Hello Simon  :)

I can see why that feels incredibly frustrating actually.

Agree with the other though - it sounds as though Thursday is the day to find out again what the levels are and then definitely ask for a clearer explanation if necessary.

Or is contacting the clinic again tomorrow an option?

Emma x
 

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Discussion Starter · #7 ·
Hello nice FF people
It's wife now(thank you for chatting to my husband), I'm not sure if you have read the posts by my husband but basically I am having huge dilemmas because I do not like taking large doses of drugs and my clinic seems to disagree with me. Not very good at doing what I'm told.

What's happened so far is I have previously had an antagonist cycle at 150 gonal f in October last year. We got 6 eggs and 6 fertilized good grades etc, and I was quite happy with that apart from the fact it didn't work! E2 at trigger time approximately 6000.

Now I am on my freebie on the NHS who have put me on the Co Flare (day 2 bloods fsh 10.8 and antral follicle count 7 E2 180) which starts at 450 Puregon(tried arguing the toss before hand for a lower dose but they weren't having it), after bloods taken on day 3 (2 doses taken) my E2 was 1400 and they advised me to stay on 450 until day 5 (4 doses taken).


Basically I reduced the dose to 300 for the last 2 days against their advice but felt much happier, todays E2 has come back at 3667. I admitted to them what I had done but they still want me to take 300 for the next 3 doses even though 3667 seems very high for 4 days of stimming. I am not due for another blood test + scan until Sunday and not sure where to go with all this. My instinct is to reduce it further to 225, but I wondered if anyone has had any experience like this or if the E2 plateaus.

In my mind a few good quality eggs has to be preferable than aggressively treating me with drugs to produce more which may not be good quality. I'm just not sure I need such high doses of drugs when I seem to be responding ok.

Thank you ladies for all your info in the past it's been incredibly helpful to read about your experiences especially when i don't know anyone who has had ivf treatment.

wife

 

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Hi

I believe many clinics would look for a minimum of around 200 pg/ml per mature follicle (which is approx 734 pmol/l)

If your E2 level is at 3667 (I'm assuming pmol/l) then this, according to the above, would indicate around 4/5 mature follies....do you know how many follicles you have at this stage ?

It does sound like your clinic are keeping a close eye on you and personally I would go along with their professional and qualified advise, rather than trying to go it alone and make your own judgements regards doses etc. You need to remember it's a fine science between drugs dose, hormone levels and maturing eggs......if you drop your drugs dose against their advise then you could be hindering the follicles/eggs you have as they still need to mature (they look for follie to be minimum of around 18mm to ensure mature egg).

At this stage, your E2 levels, whilst possibly a little higher, are not drastically so and you are being closely monitored which can only be a good thing. Obviously I'm not medically qualified but I've been at risk of OHSS twice through 4 treatment cycles. The first time I was at risk was on our 2nd IVF (private)...I had 28 mature follies although I didn't have E2 levels checked they were concernedm, dropped my drugs dose right down to almost nothing (75 IU Gonal F) and brought EC forward.

With my most recent IVF (4th and NHS) I was at much higher risk of OHSS. I had 20 follies at 1st stimms scan (6 days of stimming)....by the time I had my 2nd stimms scan I had 35 follies and my E2 levels were around 10,000 pmol/l (9 days of stimms)....and drugs were dropped right down and they considered postponing EC and coasting me for a while......I went for another scan after 12 days of stimms (with these much lower levels of drugs) and I had 40+ follies and my E2 levels were 13,000 pmol/l

Whilst my levels were still much higher than they'd have liked, they were pleased that they'd actually plateaued (sp?) rather than increased drastically so consultant decided to go ahead with my EC and I had the trigger shot. As it turned out, I ended up getting 30 eggs collected and all were good & healthy and mature.....we ended up having 5 day blasto transfer and I didn't get even a sniff of OHSS (thankfully).

I do understand your concerns but I would honestly go along with your clinic's advise and not try and make your own call on drugs dose etc......I only say this as one of the concerns my consultant had was that if dropped drugs too much then could lose some of the follicles/eggs and whilst I could've coasted, which does actually have good success, there's also the risk of possibly losing the whole cycle.

Your clinic are the experts after all and I would speak with them again before dropping your drugs dose without their knowledge.

Here's a bit of info you may find helpful....

1 pg/ml = 3.67 pmol/l

100 pg/ml = 367 pmol/l (pg/ml to pmol/l = 3.67)
100 pmol/l = 27 pg/ml (pmol/l to pg/ml = 0.272)

http://www.fertilityplus.org/faq/hormonelevels.html

Not sure whether I've helped but I wish you luck
Natasha ^reiki^

/links
 

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this is about the most interesting query on here for a long time.

I have a lot of info on this dragged out of my various consultants. 

here goes:

1. At maturity you are looking for >800 per mature follicle. (BUT, you are not anywhere near maturity, after day 4 of stimms.) It also depends on whether they used clomid - clomid follicles are usually bigger and throw off more E2 as a result. SO! they tend to look for circa 1000 per MATURE follicle on clomid. if you don't have these levels, you don't have all mature follicles and you won't get good as fert rates, so the argument runs.

2. I can see why you want to reduce. I always want to, for health and for cost reasons too! However, you have only 7 follicles, I think you said, so their argument is that you are at low risk of OHSS. OTOH, even with the reduced self-dose (naughty girl) your nos are easily doubling every 2 days which is what is desired with E2 (and incidentally the same goes for HCG levels post a bfp! fingers crossed) 

3. your previous fert rates are interesting - they timed that well and you made the most of it. Often you will read on here of people getting large nos of follicles. Many of those don't fertilise so are wasted effectively. Much better to have a containable number - 5 to 10 for example, all of which fert. as yours did. THese are then more likely to be capable of reaching blastocyst (if you want to take that route).

Feel free to pm me 
 

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Discussion Starter · #10 ·
Thanks Minxy

I know you have a huge amount of experience with all this so I appreciate your input.

I'm pretty sure it pmol/l.
I haven't been scanned yet so I have no idea what's going on in there. If the cycle goes to plan I am not due egg collection until June 5th, 8 days away. I have only had 4 doses of Puregon so far, so very early on in the cycle, would I expect to have mature follicles at this stage?

Do you remember what your levels were around this time?
I am concerned because they started at
day 1     180 baseline
day 2/3  1407
day 4/5  3667 so they are certainly more than doubling, if I hadn't reduced the dose myself they would have been even higher!
I guess you are right and I should leave it up to the experts but I don't always have that much faith in them and the reason we went privately for our first cycle was so we could have the low dose.

It's such a headache

Thanks for your help

wife
 

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Hey, no problem....obviously, as I say, I'm not medically qualified so purely going on my experience, specifically my last treatment cycle.

I've no idea what my E2 levels were at baseline or early stages of stimms as I only had them towards end when I just kept producing more and more follies.

I do agree with you that if you'd not dropped your dose down yourself then your levels could well have been higher....it's so difficult to know though isn't it ?!

At this early stage the follies wouldn't/shouldn't be mature which is why it is indicative of slightly raised E2 levels.  When you had your baseline did they mention any follicles or cysts then or was it completely clear ?

When is your first scan ?  If you're concerned then can you not call your clinic and have a chat with them....maybe bring your first scan forward ?

Take care
Natasha x
 

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you don't say how old you are but 180 is a good baseline number. (the so called normal level for day 1/3 E2 is 280 (lister) or 300 (standard NHS) ) 180 allows quite a bit of stimulation that my starting point, around 250, wouldn't. I agree that a motivated and well read patient will have a very good view of what's best to do next.
 
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