Ghost--Estradiol question

[Stay Positive]

Hi there,

When I started my IVF workup a few months ago, results from Day 3 blood showed FSH: 6, AMH: 1.78, LH normal, and Estradiol: 79. Doc said all numbers looked great given my age (42), except Estradiol was a bit high (they like to see it below 50). They also thought that the high Estradiol number might be suppressing the FSH a bit.

Anyway, many tests later, with continued good results, I asked my doc how much that high Estradiol mattered in the big picture and he said it mattered very little, was of minimal concern, etc. I also found out that I did have a very small cyst that might have been responsible for the high Estradiol at the time of the Day 3 B/W.

Today I went for my baseline ultrasound and B/W as I just finished bcps and will start my REAL meds on Friday for my first IVF cycle. The U/S showed no cycts, but the Estradiol was still above 50 (69.3). Doc said to stay on course and start the meds and that he really wasn't concerned with the number.

My questions: 1) Given that I am cyst free, what might be responsible for the higher Estradiol number? and 2) Do these Estradiol numbers suggest that I should worry about anything not working well during this IVF cycle? I figure if my doc isn't concerned, I shouldn't be either, but just thought I'd seek your opinion.

Many thanks!

[Ghost]

Hi there,

When I started my IVF workup a few months ago, results from Day 3 blood showed FSH: 6, AMH: 1.78, LH normal, and Estradiol: 79. Doc said all numbers looked great given my age (42), except Estradiol was a bit high (they like to see it below 50). They also thought that the high Estradiol number might be suppressing the FSH a bit.

Anyway, many tests later, with continued good results, I asked my doc how much that high Estradiol mattered in the big picture and he said it mattered very little, was of minimal concern, etc. I also found out that I did have a very small cyst that might have been responsible for the high Estradiol at the time of the Day 3 B/W.

Today I went for my baseline ultrasound and B/W as I just finished bcps and will start my REAL meds on Friday for my first IVF cycle. The U/S showed no cycts, but the Estradiol was still above 50 (69.3). Doc said to stay on course and start the meds and that he really wasn't concerned with the number.

My questions: 1) Given that I am cyst free, what might be responsible for the higher Estradiol number? and 2) Do these Estradiol numbers suggest that I should worry about anything not working well during this IVF cycle? I figure if my doc isn't concerned, I shouldn't be either, but just thought I'd seek your opinion.

Many thanks!

All of that makes perfect sense.

Regarding your questions:

1. I cannot know. Some possibilities are a small cyst they did not see, or perhaps you are overweight (no offense intended) and adipose tissue is making estradiol.

2. It is possible that you will have a poor stimulation if the elevated estradiol indicates a follicle is already developing. That's why they scanned them to look for developing follicles (or cysts, we call them "follicles" when we want them, "cysts" when we don't).

[Stay Positive]

Thanks for the input. A few thoughts:

Fortunately my weight is fine and I am in very good shape, so I guess we will never really know the answer to question #1.

And I do not think that there was any evidence of follicles already developing via today's ultrasound (which I guess is a good thing but also doesn't help explain the higher estradiol # today). When you say that I might have poor stimulation, would it help to know that supposedly I passed my Clomid Challenge test with flying colors and everyone said I would likely be a great responder given the numbers at the end of the test (Estradiol: 880; FSH: 5.7; LH: 9.6)? At the time I thought the estradiol sounded really high, but of course I'm not qualified to know the difference!

Does this additional information give you any additional ideas, or should I just relax and think good thoughts? Would you have any pause for concern at this point if I was in your clinic?

Again, thank you.

[Ghost]

Thanks for the input. A few thoughts:

Fortunately my weight is fine and I am in very good shape, so I guess we will never really know the answer to question #1.

And I do not think that there was any evidence of follicles already developing via today's ultrasound (which I guess is a good thing but also doesn't help explain the higher estradiol # today). When you say that I might have poor stimulation, would it help to know that supposedly I passed my Clomid Challenge test with flying colors and everyone said I would likely be a great responder given the numbers at the end of the test (Estradiol: 880; FSH: 5.7; LH: 9.6)? At the time I thought the estradiol sounded really high, but of course I'm not qualified to know the difference!

Does this additional information give you any additional ideas, or should I just relax and think good thoughts? Would you have any pause for concern at this point if I was in your clinic?

Again, thank you.

The clomid challenge test is not relevant to the hypothesis of a small cyst. That test means you have adequate reserve, while a cyst can still screw up the stimulation.

I'm not saying you have a cyst, but that was among the hypotheses.

An E2 of 69 is not all that high. Sure, it exceeds the criterion I know of (I've seen protocols that call for E2 less than 50 or else less than 40 at cycle start), but not by all that much. I have seen cycles started with E2 as high as yours. I don't recall the outcomes. I know when we get values like 200 the docs won't start the cycle until they address it.

I vote for option B: Just relax and think good thoughts. Your doc knows a lot more than I do about you and your cycle.

[abogenpohl]

girl no worry this early in the game by the end of my stim meds my estradiol level was 2264 so u have a long way to go and no need to stress with it unless your dr tells you to stress. Most fertility dr. tell you when it's time to worry and it sounds like to me that he/she isn't concerned so enjoy the time you got and try not to stress just yet!!! baby dust to you and may god bless you very soon!!!