High E2 Levels, What's considered too high?

[DaniGirl]

Hi,

I'm in the middle of my first IVF cycle and responding really well to the meds. Too well, I'm afraid. On day 6 of stimulation, my E2 level was 425 with 20 follicles under 10mm. On day 8 though, my E2 level was 1263, with 12 follicles between 11 and 13mm, and another 14 follicles under 10mm.

Now, on day 10, my E2 is 3260, with 15 follicles between 15 and 17mm, and another 11 between 13 and under 10mm.

I had read somewhere that at 7000 you are at risk of hyperstiming, and that the clinic will likely cancel your cycle. Am I misinformed or is this true?

Any information would be greatly appreciated.

-Dani

[Ghost]

Hi,

I'm in the middle of my first IVF cycle and responding really well to the meds. Too well, I'm afraid. On day 6 of stimulation, my E2 level was 425 with 20 follicles under 10mm. On day 8 though, my E2 level was 1263, with 12 follicles between 11 and 13mm, and another 14 follicles under 10mm.

Now, on day 10, my E2 is 3260, with 15 follicles between 15 and 17mm, and another 11 between 13 and under 10mm.

I had read somewhere that at 7000 you are at risk of hyperstiming, and that the clinic will likely cancel your cycle. Am I misinformed or is this true?

Any information would be greatly appreciated.

-Dani

What protocol? Are you on Lupron? Or will you be starting Ganirelix (or Cetrotide)?

[DaniGirl]

I'm on Lupron, I've been taking it for several weeks, once I started stims, they dropped my Lupron down to maintainence level (5 units).

-Dani

[Ghost]

I'm on Lupron, I've been taking it for several weeks, once I started stims, they dropped my Lupron down to maintainence level (5 units).

-Dani

If you were on an antagonist protocol, like Ganirelix or Cetrotide, they could trigger you with the Lupron. With the Lupron trigger, OHSS does not occur. Lupron would induce an LH surge that would then mature your eggs just like hCG (in fact, in natural cycles, it's LH, not hCG, that does this). But once you are on Lupron, you cannot use Lurpon for the trigger. It won't do anything at all.

So you are pretty much limited to using hCG.

Clinics use various means for reducing OHSS incidence in high risk patients. One common practice is to coast the patient. This involves stopping the FSH meds for a few days and letting the follicles fade a bit. Unfortunately it's bad for the oocytes if they go more than 3 days.

They can also try giving you protein (and perhaps Gatorade). These help a little.

[DaniGirl]

Thanks Ghost.

As they told me that we're probably going to stop the follistim tomorrow, and increase my concentration of hcg, it looks like they're planning to coast me. But the ER is still scheduled for Saturday, which is 3 and half days away, so it looks like things are going to be cut close.

-Dani

[Ghost]

Thanks Ghost.

As they told me that we're probably going to stop the follistim tomorrow, and increase my concentration of hcg, it looks like they're planning to coast me. But the ER is still scheduled for Saturday, which is 3 and half days away, so it looks like things are going to be cut close.

-Dani

Sounds like Filicori's method.

Best of luck to you.

[lynniecat]

I have read and been told that over 5000 is where you have problems or even 4000. I think you are safe at your levels. My friend has PCOS and wound up with only 4 follicles and and E2 of 1800 on day 11. Her follicles count was low because they were trying to avoid over stimulating here. She had over 50 antral follicles.

So I think you are ok for now.

[lynniecat]

And one other thing...I only has 5 follicles growing and the 2 14s were both mature. So you could even trigger today and have a bunch of mature follicles though they will probably have you go another day?


Do drink TONS of fluids. Lots of gatorade! My friend did that and it really helped her. If you do develop OHSS, they can drain the follicles during you pg. I know others have had to do that.

I hope you are fine though, keep us posted!

[kerpupples]

In the cycle where I got my BFP my estrogen was ~6600 the day before I triggered. They were concerned about OHSS but it didn't occur but obviously the ER and ET went well. Best of luck to you Dani!

[DaniGirl]

Oh thank you! I was pretty much ready to give up hope until you said that. The only thing that's got me worried is my E2 levels. I don't feel bloated, and I'm not gaining weight, so I'm fine in that regards.

Now I have hope that it's gonna be okay.

[Ghost]

Oh thank you! I was pretty much ready to give up hope until you said that. The only thing that's got me worried is my E2 levels. I don't feel bloated, and I'm not gaining weight, so I'm fine in that regards.

Now I have hope that it's gonna be okay.

It's a probability model. With 20 follicles, you have a few percent chance of severe OHSS. With more follicles, the probability rises.

We don't get much OHSS anymore, but way back when, we had a patient with E2 less than 3500 get a severe case. Other patients with E2 greater than 10,000 sometimes did not.

By the way, OHSS does not occur until after the trigger shot of hCG. You probably will not get it, but if you get early onset OHSS, it will start a few days after the trigger. If you get late onset OHSS, it will start about a week after embryo transfer (because of rising hCG produced by the implanted embryos).