Low E2 after 7 days stims
1 Replies
Staci - March 5

Dear Dr. Jacobs,

The month before last I was writing to you regarding getting cancelled before ER due to my Dr.'s perceived OHSS risk.

I started another IVF with the same clinic as soon as I was able to in the hopes things would go better. I was started out on only 1 75 i.u. vial of Bravelle and 1 of 75 i.u. Menopur (the prior cycle I had been on 3 vials of Bravelle and 1 of Menopur with no adjustments made throughout the whole cycle). I protested since I had an issue with not responding well to 150 i.u. Gonal F and 75 i.u. repronex on my first ever cycle (and that was even a greater dose) but the Dr. insisted that, based on my last cycle, the 1/1 combination should be enough.
I should mention that I am 36 and I do not have PCOS.
We are doing IVF/ICSI for male factor infertility.

After 4 nights of stims he counted off around 5 4mm to 6mm follicles on each side. He said that was all he would expect to see at that time and just to increase my dose by 1 vial for 2 nights then drop back down to the 1/1 combination the night before going back in for an ultrasound. I called the 3rd day and requested to stay on the higher dose (I could feel my E2 level was just not rising) and they said okay.

At any rate, last Fri., after 7 days of stims, I went back in and he was still counting off only 4 on the right and 6 on the left and the largest were only 9mm. He didn't indicate this was an issue, said I'd probably have 10 eggs and that my retrieval would likely be Thurs. He scheduled my next appt. for Tues. He kept me on the same slightly increased dose of meds (150 Bravelle and 75 menopur).

At this point, things really didn't seem right to me so I called one of the nurses and got my E2 readings from all my visits. They were:

Baseline scan: Under 20

Day 5 (after 4 nights of 75 i.u. Brav/75 i.u. Menopur): 36
Lining = 3.1 mm

Day 8 (after 3 nights 150 i.u. Brav/75 i.u. Menopur): 159
Lining = 5.1 mm

My question is, in your opinion, should this cycle have been canceled by now? That's basically what most women on message boards are telling me.

Is there any possibility of a good outcome from this? I am not sure what questions I should ask on Tues. when I go in. Needless to say, I don't want to waste our money going through an egg retrieval if it is unlikely I'll even have enough eggs (or eggs of a decent quality) to do anything with. I fear he is hesitant to cancel due to the fact that my last cycle was canceled for the complete opposite reason and, prior to undergoing this cycle, I requested many times that he not do anything which would land me at the opposite extreme.

I'm sorry for the length of this e-mail but felt I needed to give you all the details so that you could give me your opinion. If I was one of your patients and I had an E2 level of only 159 that far into things, would you cancel?

Many thanks,
Staci

 

Barry Jacobs, M. D. - March 5

I cannot second guess the RE you are seeing. The stimulation protocol he is using is different from mine. I do not use any LH in ny stimulation protocols. Also, he has experiece working with your ovaries, and I do not.
Good luck.

 

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