Estradiol levels while on stims
6 Replies
Lila - September 2

I am sure this is a question you probably get all the time and I apologize to put you through the paces again but in scrolling back through your old posts I could not seem to find the information I was looking for so sorry in advance for asking again but here goes:

I am on day 6 of stims. U/S check today showed 9 follicles (4@ 12, 2@14, 2@15, and 1@16) but when they called with my estradiol level it was 449. That seemd low to me. Is there a rough rule of thumb about number of follies and amount of estradiol that is an ideal range?

Does the size of the follies need to be taken into consideration with regard to amount of Estradiol? IE if you are getting to mid to upper teens in size I assume you are getting closer to a trigger shot and thus is there a minimum amount one needs to see per folly that would indicate they are maturing properly?

I understand about the upper limits and the issue of OHSS but are there issues if you are on the low end? If there being too low is a problem what issues is it indicative of?

If it matters my personal are 38yrs old, unexplained fertility, protocol = Lupron at 10 units for 12 days and then AF followed by Lupron at 5units and Bravelle at 450IU per day.

Thank you for your help in this matter.


B. Jacobs, M. D. - September 3

As a general rule, we expect an estradiol of 250 pg/ml to 350 pg/ml for each "mature" follicle (17 mm mean diameter). I would also expect your estradiol to roughly double every 48 hours. In an IVF cycle, we find that if estrogen levels rise too rapidly, there is poor synchronization in the maturation of nucleus and cytoplasm in the egg. At this point, I do not find a need to worry.
Good luck.


Lila - September 3

Thanks so much for the reply


Lila - September 4

Sorry to bother you again but went in for B/W and US again today and 4 of the follies were at 21 so I have been told to trigger tonight. My estradiol level is only at 913, which still seems ridiculously low to me. So I have 3 questions:

First if I am trying to be realistic about if this cycle is working or not what would be your expectations from a patient with only 7 days of stims, 9 follies total (besides the 4 @21 the rest were 15-18 in size), and such low E2 levels? I am not trying to imagine problems just want to prepare myself and set reasonable expectations.

Second if in your opinion this cycle has problems is there any diagnostic information that can be gleaned from a patient with those stats? My DX is "unexplained" so I was wondering if these low levels might offer any hint of what is going wrong?

Third, if I were to try again it does not seem I am a classic "low responder" but is there any arguement for trying a micro-dose flare protocol next time? Would that protocol supress the baseline E2 as much as long Lupron? I was 14 to start, 72 hours later at 135, 48 hours later at 449 and another 48 hours at 913.

I know I should be happy I have no concerns of OHSS but would very much appreciate any light you could shed on my situation and any advice you may have to offer.

Thanks you for any help


B. Jacobs, M. D. - September 4

First, It has been a number of years since I have not found an explanation for a couple's impaired fertility. Since you seem to be a poor responder, I would use a microdose flare protocol. Finally, we do get mature eggs from small follicles, so I do not know that the current cycle is a waste. If you insurance is covering the expense of your treatment, you may wish to go to retrieval, and try.
Good luck.


Lila - September 4

Sorry to keep pestering you, but I am a little confused - does 9 follies qualify as a poor responder? I had 4 @21 and 5 ranging from 15-19 is size while not a tremendous response i thought for a 38 yr old on long Lupron with Bravelle that that was a decent response?

I also may have not explained my question well what I was wondering was if I have at least 9 follies of decent size but E2 level was only 913 is that too low? What does it mean if the follies are not producing adequate estradiol? Does that effect their quality?

Thanks you again for your time and help.


B. Jacobs, M. D. - September 5

Typically, I have 10 to 15 follicles from which i can get eggs. Your estradiol level is a bit low, but that may not be a reflectioin of the quality of the eggs. If your estradiol rose too high and too fast, it may adversly effect quality of eggs.
Good luck.



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