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Carroll 3509 - August 29th, 2006 9:24 AM

I have several questions,

1. During IVF stimulation, what is the ideal range for estrogen and progesterone levels you like to see when you advise that the patient is ready for her HCG trigger shot?

2. What do the estrogen and progesterone levels indicate is physically happening?

3. My estrogen level for today is 4708 (stimulation day 11) and I'm taking HCG trigger shot tonight, but only 3/4 of the normal 1 cc dose. Is this estrogen level too high? I read that anythign over 4000 should be monitored closely and may be too much stimulation such that the cycle should be canceled. By the way, I have never had problems with PCOD.

4. ALso, why did they tell me not to take the full HCG dose--have I started to ovulate on my own?

5. What are the potential consequences for my egg quality with this high of an estrogen level?

6. How does this high estrogen level affect my uterine environment and chances for implantation?

7. Will the eggs continue to grow after the HCG is administered?

Thanks in advance for the answers--this resource makes the process less stressful.

B. Jacobs, M. D. - August 29th, 2006 5:37 PM

1. I do not use estrogen level as a determinant as to when to give hCG. I use follicle size. I use estrogen level to help determine modification of dose of FSH, and rarely to cancel a cycle. I do not follow progesterone levels during stimulation.

2. Estrogen levels are a reflection of the number of follicles which are active.

3. I become anxious if estradiol is over 3500 pg/ml, and would probably cancel a cycle with an estradiol of over 4000. I am a coward!

4. Some people feel there is a lesser risk of hyperstimulation if you administer a lesser dose of hCG. I have seen no data to support that hypothesis.

5. We do not have adequate data to answer your question. Commonly women with polycystic ovaries have very high estrogen levels and lesser egg quality. We observe that very rapid rise in estrogen seems to be associated with poor egg quality.

6. I have seen no data to answer your question.

7. Eggs go through a series of processes which may allow them to be fertilized after administration of hCG. What you are seeing on ultrasound is not the eggs, it is the follicles, which contain eggs.

Good luck.


Carroll 3509 - August 30th, 2006 8:46 AM

Dr. Jacobs,

Would you cancel this cycle with this high level? I forgot to mention that the 4708 estrogen level was almost double from what it was the day before. I don't think my RE expected that.

They explained the high number to me by saying that they saw three additional above 10 mm. follicles on my ultrasound which were not measurable the day before.


B. Jacobs, M. D. - August 30th, 2006 5:40 PM

With an estradiol of over 4700 pg/ml, I would be concerned about a hyperstimulation syndrome. The safest thing to do would be to cancel the cycle. A reasonable alternative would be to freeze and store all the embryos. That would eliminate the potential for hCG of a pregnancy prolonging and worsening a hyperstimulation.
Good luck.

B. Jacobs, M. D. - October 22nd, 2008 4:53 PM

It seems that this web site has been highjacked. I am glad to answer legitimate questions, if you choose to use the link on our web page, <www.texasfertility.com>, or you can e-mail me at jacobsmd@texasfertility.com.

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