I’m more anxious today than yesterday… Still no period and while my directions said to call Thursday (tomorrow) morning, I couldn’t resist asking the nurse a few questions this afternoon. She explained that it’s not necessarily a true period they are waiting for, but rather they need my estrogen level to be very low before we can move to the next step, and usually estrogen is lowest at the very start of a cycle. So, she told me to call back in the morning and they would schedule my first estrogen level (blood-draw) and ultrasound. No idea why they couldn’t just schedule it when I was on the phone today…
And so I wait. This waiting is really getting to me… While I wait I find myself researching things I don’t understand in any effort to make sense of this process, which seems so unnatural to me so far. I found the following information at http://www.ivfconnections.com/forums/content.php/421-Estrogen-(E2-Estradiol)-Values-Facts-and-Stats
Your body’s estrogen levels reveal a lot about your current fertility, and are used to measure your response to fertility treatments. Practitioners and patients often use three terms interchangeably when talking about the same thing: estrogen, estradiol, and E2.
Estrogen is the primary sex hormone that is present in women. Estrogen influences reproduction and sexual health, and affects a woman’s bones. Estrogen stimulates the lining of the uterus, so that it grows and can sustain a pregnancy. And estrogen is a measure of ovarian activity – as follicles produce estrogen. So the more follicles there are, the more estrogen will be present. Estrogen is measured in pg/mL.
In a regular cycle, estrogen rises as follicles develop, then drops at ovulation, rises again during luteal phase, and then drops unless there is pregnancy.
What should my estrogen levels be during an IVF cycle? This is pretty much a question that only your RE can answer. During a cycle, your estrogen will be checked along with an ultrasound follicle count – these two data points together will tell your RE how you’re progressing, and whether and how much to tweak your stims. Many doctors follow a broad range rule – if the level is between 150 – 500pg/nl on day eight, this is a satisfactory measure. And if it doubles about every 48 hours, follicle growth remains on track and is promising.
What estrogen level is too high? There are no real absolute highs or lows with estrogen, because no two women will have the same measurements. Estrogen varies from woman to woman, and it varies over time. Typically, women with PCOS have high estrogen levels, and lower egg quality. In an IVF cycle, since estrogen levels reflect the number of follicles that are growing, a quick rise in levels can mean too many follicles, or poor egg quality. Reproductive endocrinologists each have their own guidelines on what levels they will tolerate in their patients; many will cancel cycles when estrogen levels approach (or overtake) 4,000 pg/ml.
What estrogen level is too low? A low estrogen level means that there are not very many maturing follicles. Often times, your RE will simply increase your dose of stims to encourage more follicles to grow. Some doctors use a long lupron protocol, which can over-suppress the ovaries. If this is the case, your RE will already have a plan in mind for your continued treatment. (In some cases, cycles get canceled if estrogen is too low for too long; in other cases, more stims can get a cycle back on track.)
What if my estrogen level is rising steadily and then shoots up? A too-fast rise in estrogen may mean that you have too many follicles developing, and that you are at risk for OHSS (ovarian hyperstimulation syndrome). When an estrogen level rapidly increases too rapidly, your plan of care may need to change. Sometimes a doctor will cancel a cycle completely; others will retrieve the eggs but will not allow a fresh embryo transfer to take place. (In both of these cases, it is because pregnancy exacerbates the symptoms of OHSS.)
What if my estrogen level is rising steadily and then begins to fall? If the level of estrogen falls (or levels off and fails to rise) during a cycle, this is pretty indicative of a poor response, and/or that the eggs are not of good quality.
So this all sounds simple enough, but I have a strange feeling it’s not as easy as I think… And what happens if my level isn’t low enough? The nurse told me it would certainly change things, whatever the heck that meant! I just really don’t want to have to start all over!
In my continued quest for information I stumbled across a book I thought sounded helpful, “Woman Code” by Alisa Vitti. I’m actually listening to the audio book version, although I’m only about a third into it. So far though, I call BS. Now granted, I’ll admit, I had some preconceived negative opinions of holistic healing, of ‘finding my flo’ as the author repeatedly states. Blah blah blah, I thought. But more information is better, right?
The main premise of the book is to heal female hormone related issues naturally through changes in diet and lifestyle, infertility being one of the main claims. Now yes, I do believe a large part of our health is what we eat, but I’m having a really difficult time buying into the fact that I’m not getting pregnant because I enjoy sweets. I look at the literally hundreds of young mothers carrying their infants around at the hospital each week; you can’t tell me all of them eat perfectly. And if my diet is to blame, than these issues I’m experiencing really are my own fault? I’m not sure how I could ever come to terms with knowing I caused my own infertility issues… Food for thought I guess. There is a PDF which accompanies the audio book. I’ll upload it to my blog if any of you are interested in learning more.
As for tonight, I’m going to enjoy a few more Marshmallow Crispy Oreos and hope my doctor can give me some encouraging information tomorrow!