Ghost: E2 levels for transfer

[LYD10]

Ghost, my E2 level at retrieval is likely to be 4000. I am not worried about OHSS because I've had higher E2 level on my first fresh cycle and my body seems to be able to handle it. But I am worried about the uteral environment being suboptimal for the embryo transfer. So I am considering a freeze all and transfer later. Do you know what E2 levels are optimal for putting embies back in and what level is too high? Is there a cutoff that your clinic uses to determine when to freeze all embies - but not so much to avoid OHSS as to avoid BFN.

[Neffi211]

Ghost--

On this subject-- I had FET yesterday and RE never checked my E2 levels.....is that normal? Once my lining was good, thats all they seemed to care about.

LYD- during my fresh cycles I was never told my E2 levels, so sorry I can't chime in....

[Ghost]

My clinic does not use E2 levels as a criterion for freezing embryos.

There are publications that say high E2 affects receptivity, and others say it does not, but in our experience the E2 level has not been very relevant.

[Ghost]

Ghost--

On this subject-- I had FET yesterday and RE never checked my E2 levels.....is that normal? Once my lining was good, thats all they seemed to care about.

LYD- during my fresh cycles I was never told my E2 levels, so sorry I can't chime in....

The relevance of E2 for FET is to develop the lining. If the lining becomes thick enough, then the E2 was clearly adequate.

[Neffi211]

Ghost--can the E2 be too high though?

[Reem]

LYD10 - i have no scientific answer, but i can say that with all my fresh cycles where my E2 was 4000 (plus or minus) i got BFN, in the fresh cycle where my E2 was 2000 i got BFP (miscarried later but the endo was receptive)
i dont know if it was a coincidence or not but i thought i could share my experience with u.
Good Luck!!!

[Ghost]

Ghost--can the E2 be too high though?

Not that I know of.

[leorira11]

Lydia - my e2 has always been much higher with fresh than frozen, and I have always gotten pregnant with a fresh... no idea if higher levels affect receptivity...

[LYD10]

I found this paper that found significanlty lower implantation rates if your cumulative E2 for the duration of the stims is above 16300. Thats total estrogen from day 1 of stims to day after trigger. http://www.springerlink.com/content/t40 ... lltext.pdf

I am going to estimate my cumulative estrogen exposure.

[margi26]

Lydia: Congratulations that your cycle is going so well!! I am not trying to discourage you in any way from freezing as it seems to work very well for lots of people. Just to let you know with my IVF#4 (that resulted in my twins) my E2 was 6450 at trigger. The day before was almost 5000. Not sure how to add cumulative, but if you add up my levels over the days of stimulation, I was easily over 16000 as I was at 600 at just stim day #5 and stimmed for 10 days. Not sure what to make of it. My RE coasted me the last couple of days to keep my rise from going too high for fear of OHSS--since I had a bad case of it with my first IVF cycle.

Whatever you decide will be best I am sure!!!

I will be stalking you!

[Ghost]

I found this paper that found significanlty lower implantation rates if your cumulative E2 for the duration of the stims is above 16300. Thats total estrogen from day 1 of stims to day after trigger. http://www.springerlink.com/content/t40 ... lltext.pdf

I am going to estimate my cumulative estrogen exposure.

Be aware that there have been various findings. There is uniform agreement that endometrial development is altered by stimulation. Recent reports indicate that this may result in reduced receptivity. Whether that results from estradiol levels, progesterone levels, their ratio, or perhaps something else is an open debate. Some have found high estradiol levels to be a problem, others have not. Many have found progesterone to be a problem, but some have not. We will not be able to sort it out here, I assure you.

[LYD10]

Thanks, Ghost. How is projesterone affected during stims? what is it supposed to do during normal cycle and what does it end up doing during stims?

well, as you said - doesnt matter what it is but something seems to decrease the receptivity after stims. I think the rational thing for me would be to freeze all, wait 2 months and transfer then. my eggs have a lot of lipid content and my embryos freeze/thaw very well. i've never lost an embryo in the thaw - and i've done 3 fets - with 10 embryos total. i've lost one cell of one embryo in all 3 fets. so the rational thing for me would be to do a frozen transfer right after. there is just no downside to that scenario - except for waiting 2 more months. which is an emotional downside i suppose.

anyway i'll discuss all with my doc and embryologyst and see where we end up.

what do you think?

[LYD10]

Lydia: Congratulations that your cycle is going so well!! I am not trying to discourage you in any way from freezing as it seems to work very well for lots of people. Just to let you know with my IVF#4 (that resulted in my twins) my E2 was 6450 at trigger. The day before was almost 5000. Not sure how to add cumulative, but if you add up my levels over the days of stimulation, I was easily over 16000 as I was at 600 at just stim day #5 and stimmed for 10 days. Not sure what to make of it. My RE coasted me the last couple of days to keep my rise from going too high for fear of OHSS--since I had a bad case of it with my first IVF cycle.

Whatever you decide will be best I am sure!!!

I will be stalking you!

Thanks, Margie - it is good to know about your E2 levels! how are you holding up with twins? good for you!!!
Urghh - it is so hard to decide what to do. the thing is - my embryos freeze well. so there is no downside to freezing all except waiting for another 2 months. and frozen cycle is what worked for me before - and they say just do what worked before. so - i am suffering over this decision. i want to optimize my chances - which rationally speaking means - freeze all and do frozen in 8 weeks.
i guess i'll be consulting with my docs at the retrieval and decide then.

[Ghost]

Thanks, Ghost. How is projesterone affected during stims? what is it supposed to do during normal cycle and what does it end up doing during stims?

well, as you said - doesnt matter what it is but something seems to decrease the receptivity after stims. I think the rational thing for me would be to freeze all, wait 2 months and transfer then. my eggs have a lot of lipid content and my embryos freeze/thaw very well. i've never lost an embryo in the thaw - and i've done 3 fets - with 10 embryos total. i've lost one cell of one embryo in all 3 fets. so the rational thing for me would be to do a frozen transfer right after. there is just no downside to that scenario - except for waiting 2 more months. which is an emotional downside i suppose.

anyway i'll discuss all with my doc and embryologyst and see where we end up.

what do you think?

Makes sense to me.

The progesterone can sometimes rise too early, before the trigger. In a natural cycle, the rise of progesterone is the signal of an ovulating follicle's response to an LH surge, and times the receptive phase of the endometrium. So it's easy to imagine that altering that timing could be problematic.

[margi26]

If freezing has always worked best for you, then I would stick with what works despite the wait. If you don't, and go ahead with fresh transfer, and then they don't stick you will always be second guessing yourself. 2 months seems long in the short run, but in the big picture, it isn't really to get your LO.

Good luck with all!!