Estradiol question
12 Replies
Tanya1231 - April 27

What is the correlation between E2 levels and mature eggs? For instance...I am on day 10 of stimulation and I have 5 mature size follicles but my E2 is only 537. What are your thoughts on this?

 

B. Jacobs, M. D. - April 27

Estradiol is mase by the cells which line all the follicles. Measuring estradiol levels gives us an indirect measure of all the active follicles. It really dose not relate to maturity of eggs. Typically estradiol, during stimulation, will be about 300 pg/ml to 350 pg/ml per each ovulatory size follicle (about 17 mm mean diameter).
Good luck.

 

hoping41 - April 29

So can we take the question a step further? What are causes of having a low estradiol level repeatedly through treatment per number of follicles? And what can be done to increase estradiol?
I've been on follistim/femara for one cycle 4 follicles, but estradiol only 597, and then straight follistim150, again 4 follicles, but estradiol was at 407.
Thank you so much for your advice!

 

B. Jacobs, M. D. - April 29

Actually, a very high estradiol level is not desirable for several reasons. To provide a reliable answer to your question,. I would have to have your entire medical record. Please discuss your issues with your RE. He/she is in a much better position to give you an answer.
Good luck.

 

mo - April 30

Dr Jacobs,
Hi. I have 2 questions:

1) Can assited hatching be done on frozen embryos? My RE office is very hesitatant to do this, they're saying the embryos are too fragile. Thoughts?

2) I was given a standard dose of 0.2ml of estradiol during my FET. My breasts were EXTREMELY sore...I would wake up in the middle of the night w. them throbbing! Is this normal? i know tenderness is part of estrogen and progesterone therapy but I think my dose was too high...what do you think? The RE office said this was a standard dose and should not be decreased for the FET cycle. Thoughts?

 

lenlance - April 30

I was to have a saline ultrasound today but the doctor had a hard time with my cervix. and the balloon would not stay in place. kept popping out. after several tries he thinks i have cervical stenosis. Now he suggests hysteroscopy with cervical dilation. Do you think i should go ahead and have cervical dilation with hysteroscopy? what are the complications related to dilation of the cervix?

 

B. Jacobs, M. D. - April 30

There are 2 possibilities as to the reason the ballon kept popping out. One is that you do have cervicle stenosis, and the balloon did not enter the uterine cavity. The othe is that you have an incompetant cervix, and it will not hold anything in your uterus - including a pregnancy. I do not have enough information to tell you which it is. If you do have an incompetant cervix, you do not want cervical dilitation.
Good luck.

 

lenlance - May 1

than for the response. well what am concerned about is i had a saline ultrasound before with no problem. i then had iui followed by a miscarriage. i was given cytotec instead of D&C. could this be the cause for stenosis?

 

B. Jacobs, M. D. - May 1

Again, I do not know that you have cervical stenosis. I think there is a real possibility you have an incompetant cervix.
Good luck.

 

mo - May 2

Hi Dr Jacobs, you did not answer my questions ;o) Any reponse will be great...I now have 3 questions actually

1) Can assited hatching be done on frozen embryos? My RE office is very hesitatant to do this, they're saying the embryos are too fragile. Thoughts?

2) I was given a standard dose of 0.2ml of estradiol during my FET. My breasts were EXTREMELY sore...I would wake up in the middle of the night w. them throbbing! Is this normal? i know tenderness is part of estrogen and progesterone therapy but I think my dose was too high...what do you think? The RE office said this was a standard dose and should not be decreased for the FET cycle. Thoughts?

I now have a 3rd:
3) what are your thoughts on the viability of embryos frozen in the pronucleocitic phase (day 1)? Ever heard of this practice? Know anyone who used this practice successfully?

 

B. Jacobs, M. D. - May 2

1) WE commonly do assisted hatching of frozen thawed embryos.

2)I use a different protocol for preparing the endometrium for frozen embryo transfer. I cannot speak to the protocol your RE is using. Yes, estrogen can cause breast tenderness, especially if you have fibrocystic changes.

3) A number of years ago, we used to freeze the fertilized egg (2 pronucleii). Today we almost exclusively freeze blastocysts on day 5. Occassionally we will freeze a day 3 cleavage stage embryo.

Good luck.

 

mo - May 3

Thanks for your responses. Some follow-up

1) regarding 1 and 2; what are your thoughts on doing assisted hatching on thawed blasts?

2)2nd question: have you ever frozen assisted hatched day 3 embryos? What has been your experience in terms of these embryos making it to healthy, full term pregnancies (and healthy babies)?

 

B. Jacobs, M. D. - May 3

We routinely freeze blastocysts, and frequently do assisted hatching on them. As far as day 3 embryos, a smaller percentage of them are good embryos, vompared to blastocysts. Not all day 3 embryos make it to blastocyst. If a day 3 embryo is good, it can be frozen and assisted hatchong performed.
Good luck.

 

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