ghost or anyone... levels before retreival

[brit1612]

This is my fourth ivf and I was on the boards a lot during my ivf in june. I have been trying to stay away lately so I did not drive myself nuts, but I have a situation that I have never had before.

Today is day 8 of stimulation, and my estrogen level was 2613 and progesterone was 3. They want me to take an antogon (spelling??) shot tonight so that I can go one more day of stims without my levels going to high. I have a few follicles that are ready now, but they think that 4 or 5 more will catch up if we wait one more day before trigger. They seemed to be the most concerned about my progesterone level. I don't know if this is something that can effect the outcome of my cycle. Any input would help.

[brit1612]

I just got off the phone with the nurse and they can not find this shot anywhere. So, I will not be taking the shot tonight, and I will be going in to the doc in the morning. I am concerned that they thought I should do the shot and now I will not be doing it. Please let me know what ya'll think. Is a prog. level of three too high for the day before trigger?
Thanks for any input.

[Ghost]

This is my fourth ivf and I was on the boards a lot during my ivf in june. I have been trying to stay away lately so I did not drive myself nuts, but I have a situation that I have never had before.

Today is day 8 of stimulation, and my estrogen level was 2613 and progesterone was 3. They want me to take an antogon (spelling??) shot tonight so that I can go one more day of stims without my levels going to high. I have a few follicles that are ready now, but they think that 4 or 5 more will catch up if we wait one more day before trigger. They seemed to be the most concerned about my progesterone level. I don't know if this is something that can effect the outcome of my cycle. Any input would help.

I can answer some of your question. I'll need more info for the rest.

Antagon (now called ganirelix, or genirelix acetate) is used to prevent ovulation. It's name is derived from the fact that it is a GnRH antagonist. It's GnRH that your hypothalmus releases to signal the pituitary to release an LH surge for ovulation. Antagon blocks that by binding the pituitary receptors.

They are concerned about your levels of progesterone because progesterone starts the endometrium developing, and you have not had your eggs retrieved yet. Progesterone is released in greater amounts after ovulation, and in lesser amounts late in cycles of ovarian stimulation, and they might also be concerned that you may be about to ovulate. It's difficult to read their minds on that one.

Is your progesterone high? Two answers.

1. If you are in the US, and your progesterone is measured in ng/ml, then 3 ng/ml is indeed high, especially considering you are not triggering until tomorrow at least.
2. If you are outside the US, where they probably measure progesterone in nMol/l, then 3 nMol/l is just a little high, but not too bad.

If (1) above is the case, then my clinic would almost certainly freeze all of your embryos for later use with a better endometrium and carefully timed progesterone exposure. If (2) is the case, then have to wait and see what it is tomorrow.

[brit1612]

Thank you very much. I am in the US, and I will be going in to the office in the morning. What should I be looking for tomorrow? If the level has not gone up, is it ok to continue as planned? If the clinic wants to go on as scheduled will this hurt my chances of conceiving? I appreciate all of the help. This cycle has gone very smoothly until today, what would cause this jump in my progesterone level?

Thanks again.

[Ghost]

Thank you very much. I am in the US, and I will be going in to the office in the morning. What should I be looking for tomorrow? If the level has not gone up, is it ok to continue as planned? If the clinic wants to go on as scheduled will this hurt my chances of conceiving? I appreciate all of the help. This cycle has gone very smoothly until today, what would cause this jump in my progesterone level?

Thanks again.

It's called premature luteinization. The follicles being to luteinize before the intended time. That means they start to secrete progesterone. You might have one or two follicles way ahead of the others, perhaps over 20mm? If so, those would be likely suspects.

Your progesterone will very likely be higher tomorrow. The trend at this point is almost always upwards.

The consequence of proceeding is a lower chance of success than if your progesterone was in control. How much lower? Varies from clinic to clinic. Some clinics have seen this effect and others have not. Of course, they are looking for an effect at 0.9 to 1.2. Up at your level (3.0), I think they would all see some effect. The effect is believed to be the endometrium begins development ahead of the embryos, and is then receptive at the wrong time (too early) for the embryos.

At my clinic you'd get your embryos frozen, and your chance in an FET would be just as good as in a fresh cycle with ideal progesterone.

[NY4thtry]

brit

i am confused.. how could they not find the shot.. i have used ganarelix many times and it is readily available...

[Ghost]

brit

i am confused.. how could they not find the shot.. i have used ganarelix many times and it is readily available...

I know. We must have 50 or more around the clinic.

[brit1612]

Thanks ghost. I don't know why they could not find it. The nurse faxed the request late in the day and did not follow up on wether or not the pharmacy had the shot. Once I called their emergency line they called their pharmacy that usually always has it in stock but they were out. I don't know if they had any around the clinic, but this was all done after hours.

Ghost- I did have a follicle that was measuring at 25 today, and the rest of them were between 14 and 20. I had one large follicle last cycle also, but it did not seem to hurt anything.

Thanks for the help.

[Ghost]

Thanks ghost. I don't know why they could not find it. The nurse faxed the request late in the day and did not follow up on wether or not the pharmacy had the shot. Once I called their emergency line they called their pharmacy that usually always has it in stock but they were out. I don't know if they had any around the clinic, but this was all done after hours.

Ghost- I did have a follicle that was measuring at 25 today, and the rest of them were between 14 and 20. I had one large follicle last cycle also, but it did not seem to hurt anything.

Thanks for the help.

My guess is that the 25mm follicle is producing almost all of your progesterone.

[brit1612]

I went in yesterday and some of the follicles had caught up and the 25 had not enlarged any. My progesterone had fallen on its own to 2.5 and I triggered last night. I will be going in tomorrow for retreival. Is this a good sign that my prog. fell or should I still be worried about doing a fresh cycle? My clinic seemed pleased that the level had not increased. Thanks for all the input.

[Ghost]

I went in yesterday and some of the follicles had caught up and the 25 had not enlarged any. My progesterone had fallen on its own to 2.5 and I triggered last night. I will be going in tomorrow for retreival. Is this a good sign that my prog. fell or should I still be worried about doing a fresh cycle? My clinic seemed pleased that the level had not increased. Thanks for all the input.

Odd that it fell. Makes me suspect a measurement error in one of the measurements.

In any case, 2.5 is still high. At my clinic, you'd get your embryos frozen. No problem, the success rate is higher with the frozens.

[fruit]

Thank you very much. I am in the US, and I will be going in to the office in the morning. What should I be looking for tomorrow? If the level has not gone up, is it ok to continue as planned? If the clinic wants to go on as scheduled will this hurt my chances of conceiving? I appreciate all of the help. This cycle has gone very smoothly until today, what would cause this jump in my progesterone level?

Thanks again.

It's called premature luteinization. The follicles being to luteinize before the intended time. That means they start to secrete progesterone. You might have one or two follicles way ahead of the others, perhaps over 20mm? If so, those would be likely suspects.

Your progesterone will very likely be higher tomorrow. The trend at this point is almost always upwards.

The consequence of proceeding is a lower chance of success than if your progesterone was in control. How much lower? Varies from clinic to clinic. Some clinics have seen this effect and others have not. Of course, they are looking for an effect at 0.9 to 1.2. Up at your level (3.0), I think they would all see some effect. The effect is believed to be the endometrium begins development ahead of the embryos, and is then receptive at the wrong time (too early) for the embryos.

At my clinic you'd get your embryos frozen, and your chance in an FET would be just as good as in a fresh cycle with ideal progesterone.

so i was searching like crazy in all my previous tests trying to find something, a reason, an answer, anything ... and i found this post, i noticed that in my last ivf cycle my progesterone levels at the same day of trigger was 0.97 so Ghost - if u still read this - is it too high considering waiting another 5 days for the ET (5dt) i mean, does the endometrium began to develop and continued its developing in these 5 days before putting back the embryos ???
what is the ideal progesterone level on triggering day ???
what did u mean by "they are looking for an effect at 0.9 to 1.2." ???
thank u.

[Ghost]

The info out there has changed since 2008. Most new research is looking at thresholds of 1.2 or 1.5.

But some have seen the effect lower, near where yours was or even lower.

I'm not sure why some see it lower than others. Maybe it's just how they used their data? Or maybe one instrument reads 1.2 when another reads 1.0 or another reads 1.5? I don't know.

The ideal is anything lower.

Yes, the endometrium begins maturing when it gets a sufficient signal of progesterone. It continues from there.

so i was searching like crazy in all my previous tests trying to find something, a reason, an answer, anything ... and i found this post, i noticed that in my last ivf cycle my progesterone levels at the same day of trigger was 0.97 so Ghost - if u still read this - is it too high considering waiting another 5 days for the ET (5dt) i mean, does the endometrium began to develop and continued its developing in these 5 days before putting back the embryos ???
what is the ideal progesterone level on triggering day ???
what did u mean by "they are looking for an effect at 0.9 to 1.2." ???
thank u.

[fruit]

oh thanks a lot ghost for the reply.
im confused about something, do u think that if having progesterone levels at 0.97 on triggering day (and my lining were at 10mm), it is better to do a 3dt instead of 5dt ? (i mean before the endo develops a lot? ) or it doesnt matter ?
thanks

[Ghost]

oh thanks a lot ghost for the reply.
im confused about something, do u think that if having progesterone levels at 0.97 on triggering day (and my lining were at 10mm), it is better to do a 3dt instead of 5dt ? (i mean before the endo develops a lot? ) or it doesnt matter ?
thanks

I don't see why progesterone level should have anything to do with the ET day decision.

10mm is great.