Hi,

I’m looking for some explanations. I’m 38 and have unexplained fertility. My husband is 36 and has no issues. We have been TTC for about a year now and are on our second IUI. Here is what happened:

IUI 1
CD3
FSH 6.2
LH 2.6
DHEAS 135
E2 45.4
Plan – Daily Follistim 150 injections

Day 4 of Follistim 150 injections
E2 94.6

No more E2 tests
Completed 8 days of Follistim 150
6 follicles total - 2 over 18
Triggered after 8 days of meds, followed by 2 IUIs the following days
IUI failed
IUI 2
CD3 (after 8 days of bcp for corpus luteum cyst)
E2 <20 (this has been a problem with other tests…all levels seem ‘normal’ but E2 is undetectable – except during first IUI attempt)

Day 3 of Follistim 150
E2 133

Day 7 of Follistim 150
E2 76.4!
6 follicles total - 3 at 16 and 3 between 10-12

Based on falling E2, the doctor postponed hcg shot. He upped Follistim to 225 for 2 days (total injections days will be 9) and will do hcg on Thursday and IUIs on Friday and Saturday.

I cannot understand why the estradiol would drop with growing follicles. The nurse couldn’t explain anything to me and I can’t find anything on line that would explain this. Why is this happening? Why would upping the Follistim increase the E2 if the follicles are already growing and should be producing estradiol? How serious is this problem?

Can someone help explain why this is happening and if there is anything I should be doing differently. I’m worried because my OB/GYN told me I have hypothalamic amenorrhea (my RE disagrees) and I’m worried that excessive exercise (triathlon training 10-15+ hours a week) could be hurting my chances for a successful pregnancy.

Thanks,
Kristin

Kristin,

A drop in estradiol during an ovarian stimulation cycle with Follistim may happen as a result of at least 2 causes.  One would be a premature LH surge.  After an LH surge the estradiol drops and ultimately ovulation occurs and progesterone rises.  If LH is measured at the time of the estrogen drop, then it would be high if there was a surge.  Also if progesterone levels increased prior to the hCG injection, it would point to a premature LH surge.
The other possibility is that for some reason the follicles had inadequate FSH stimulation and the estrogen dropped off due to a lack of stimulation although the follicles will still grow. Increasing the dose or adding a medication that has LH activity (like Repronex or Metrodin) would likely correct that.

If you really have hypothalamic amenorrhea (which means that you don’t get any periods on your own and your estrogen levels are always low) then LH activity is probably necessary and you should be on one of the medications listed above or take additional LH injections.  But it would seem likely that your RE would be in a better position to make that diagnosis than your Ob/Gyn.  It is associated with heavy physical training.

Best of luck!

Dr. Barry WiItt

Hi,

I’m looking for some explanations. I’m 38 and have unexplained fertility. My husband is 36 and has no issues. We have been TTC for about a year now and are on our second IUI. Here is what happened:

IUI 1
CD3
FSH 6.2
LH 2.6
DHEAS 135
E2 45.4
Plan – Daily Follistim 150 injections

Day 4 of Follistim 150 injections
E2 94.6

No more E2 tests
Completed 8 days of Follistim 150
6 follicles total - 2 over 18
Triggered after 8 days of meds, followed by 2 IUIs the following days
IUI failed

IUI 2
CD3 (after 8 days of bcp for corpus luteum cyst)
E2 <20 (this has been a problem with other tests…all levels seem ‘normal’ but E2 is undetectable – except during first IUI attempt)

Day 3 of Follistim 150
E2 133

Day 7 of Follistim 150
E2 76.4!
6 follicles total - 3 at 16 and 3 between 10-12

Based on falling E2, the doctor postponed hcg shot. He upped Follistim to 225 for 2 days (total injections days will be 9) and will do hcg on Thursday and IUIs on Friday and Saturday.

I cannot understand why the estradiol would drop with growing follicles. The nurse couldn’t explain anything to me and I can’t find anything on line that would explain this. Why is this happening? Why would upping the Follistim increase the E2 if the follicles are already growing and should be producing estradiol? How serious is this problem?

Can someone help explain why this is happening and if there is anything I should be doing differently. I’m worried because my OB/GYN told me I have hypothalamic amenorrhea (my RE disagrees) and I’m worried that excessive exercise (triathlon training 10-15+ hours a week) could be hurting my chances for a successful pregnancy.

Thanks,
Kristin