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Lisa F - August 26th, 2005 3:14 PM

Dear Dr.

Can you tell me if there is a link in poor egg quality and high E2 levels while stimming ?

I am currently on my 5th fresh Ivf cycle. My eggs seem to be ok ,and I have about 80-90 fertilization. The problem seems to be that my embryos are slow to divide. On day 3 they are mostly 4/5 cells. I usually get a 6 and a 7 cell as well. My E2 levels have been very high on my first 4 cycles and I was wondering if the E2 levels might contribute to the slow division? I only stimmed for 7/8 days each time.

This last cycle my new res goal was to keep my E2 levels low so I could stimm a few more days. He managed to keep my levels much lower and I stimmed for 9 days. The results were, 1-8 grade 2, 2-6 cell grade 2, and some 4 cells. So, it seems that the results are still pretty much the same. I am waiting now to see if any of these embryos make it to blasts. I have never done a blast transfer before and I am worried the embryos won't make it. I have only ever had one early blast that the clinic said stopped compacting .
Do you think that I have an egg quality problem? I have never been pregnant. First and second Ivf when I was 27, and third and forth after I was 35.
Thank you,
Lisa

Dr Smith - August 29th, 2005 9:53 AM

I am not aware of any direct cause-and-effect relationship between high estradiol and egg quality. However, they are related, usually because the stimulation is cut too short (i.e. <9 days) due a fear of bringing on hyperstimulation syndrome. It looks like the RE addressed this issue, to some degree, in your most recent cycle. I say "to some degree" because 9 days is really the minimum time needed for the eggs in the larger follicles to mature. Some people's eggs may need longer than 9 days to mature or need more than 9 days of stimulation to allow the eggs in the medium-sized follicles to mature. You may be one of these people.

Inadequate cytoplasmic maturation of the egg (from cutting the stimulation too short) can lead to slow division cycles and arrested development of the embryo prior to the 8-cell stage. Since you've never had a stimulation of more than 9 days, I'm reluctant to say that you have an "egg problem". However, if you have been diagnosed with Polycystic Ovarian Syndrome (PCOS), you may have an inherent egg problem. We have observed slow division and decreased blastocyst development is PCOS patients, even when the stimulation is stretched out to 10-11 days.

Lisa F - August 29th, 2005 7:09 PM

Hello Again
Thank you for responding. I thought I should mention that I had 18 follicles and only 8 eggs. Could this have been because the smaller follicles did not have time to develope? My re told me that 2 of my eggs were overmature and pulled apart when taking them out of the follicle. So it appears that my stimms were cut off to prevent my E2 from rising and to save the other follicles that appeard to be ready. I have never been diagnosed with PCOS. Could you please explain what it is? I have blocked tubes. Could PCOS be a result of that?
Thank you

Dr Smith - August 30th, 2005 8:08 AM

It sounds like there was a lack of synchrony in folliclular development - a few large follicles and several small ones. For some individuals, the synchronization of folliclular growth is difficult to control during ovarian stimulation. Lack of synchronized growth usually results in a "mixed bag" of maturity and developmental potential of the eggs. Also, I forgot to mention in the previous post that only estradiol levels above 6000 pg/ml are associated with decreased egg quality.

PCOS is caused by an hormone imbalance. Don't worry, blocked tubes cannot cause PCOS. For more information on PCOS, see http://www.wdxcyber.com/dxinf001.htm

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