oversupression and egg quality
3 Replies
Lila - August 27

From your experience have you seen egg quality or quantity been comprmised if you have been on Lupron for too long? I have been on 12 days and am not supposed to start stims till after AF shows and I have just started spotting today.

From what I undersatnd Lupron can desesitize ovaries to FSH - is that correct and how long does it take for Lupron to have that effect?

The other question I have is if I start stims I am scheduled to take Bravelle (FSH only protocol) will the lengthy Lupron have shut off all LH? If so won't that be a problem in egg maturation if there is no LH in my stim protocol?

I know drugs and protocol questions usually go to Dr Jacobs but since you often see the results of those drugs more up close and personal under the microscope I would very much appreciate your opionion if my eggs from this cycle have any hope. I always value your opinion and ability to give a straight answer while also helping us learn what the heck is going on.

Thanks as always for your time and help.

As always thank you so much for your help.

 

Dr Smith - August 28

The effects of over supression with Lupron rarely make it to the dish. Over supression results in fewer follicles being availabe on the IVF cycle and a muted response to FSH. If this happens, the cycle is usually cancelled.

That being said, it is not uncommon to extend the Lupron a little bit to fit into a scheduled IVF series, but these days, most docs use the birth control pill to get the timing right.

Looks like you've been doing some homework about the LH issue. Although at one time controversial, a consensus has evolved that (at least a little) LH is required for normal follicluar and oocyte maturation. Over suppression with Lupron does result in extemely low levels of pituitary-derived LH. Accordingly, a pure FSH stimulation protocol should be supplemented with an FSH/LH containing medication (i.e. Menopur) to achieve appropriate follicular and oocyte maturation. An FSH only protocol would result in a very long stimulation and, in the end, crappy eggs.

Talk with your doc about a "mixed" protocol.

 

Lila - September 4

I have a follow up question if possible -

If you were oversupressed how would that play out - low response in numbers of follies, bad quality or E2 levels staying low through stims?

I have completed 7 days of stims (short I know) and am headed to trigger tonight. Appt today counted 9 follies total - 4 @21, [email protected], [email protected], and [email protected] That part all sounded good to me but my E2 is only at 913 (baseline E2 was 14). The 913 number seems below the accepted range since I have 6-8 "mature" follies. Is there an effect on the eggs if the follies are not producing adequate E2? I am just trying to be realistice with my expectations.

On this next question I know it is a bit off your specialty but do you have any idea what it means if you are not in the proper range for E2? Everything I find about E2 stresses the range and the problem if youare over that range but there seems to be no mention of under that range. Any light you could shed would be greatly appreciated.

Thanks as always for your time and help,
signed, another hormonally insane IVFer in DC

 

Dr Smith - September 5

Although the E2 is on the low side, there is only a moderate correlation between E2 and egg quality. The low E2 was probably caused by the prolonged suppression, but the follicles that did begin growing have grown in diameter faster than their capacity to produce E2. There appears to be some dysynchony here. It is a tough call - depend on the E2 and push the stim another day? or go with follicle size and trigger after 7 days of stim? I don't really have answer for you. It really about choosing the lesser of two evils. DAmned if you do, damned if you don't. And of course, hindsight will be 20/20.

Prolonged suppression can result in slightly fewer follicles developing on that cycle, but the main effect is seen in E2 production and the rate of follicular growth.

You are correct that the over production of E2 is associated with poor egg quality, but not as a direct cause and effect. I am not really sure about the effect of low E2, but when there is dysynchony between E2 production and follicular growth, its not a good sign. I wouldn't have high expectations for this cycle. I would recommend ICSI (even in the absence of a male factor) to facilitate fertilization in this case. I hope this advice gets to you in time. Best of luck.

 

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