I went in this morning for my E2 (Estrodial) and CBC (platelet count). In order to get the clearance to start FSH and hMG (Follistim & Menopur), your E2 level needs to be lower than 70. When I went in last week to get instructions for administering Lupron, the nurse reviewed our calendar and explained how things would proceed step by step from here on out.
On January 20th, I would take my last active BCP and wait for my period to show. My next appointment would be January 25th, today, for the E2 & CBC. She then explained that if my period hadn’t shown by today, my E2 levels would likely not be low enough to get cleared to start stims. I tried not to panic this weekend as my spotting noticeably cleared up (just in time right?), and then fortunately yesterday morning she made her appearance. And let me just say her presence is much more substantial than normal. So naturally I was pretty pumped. I knew that her presence by yesterday would mean that my levels would be dropping considerably. This morning Brian and I happily showed up at 8:30 for my blood draw and for the rest of the instructions on how to work the Follistim Pen and how to mix Menopur. The nurse was sweet and told me she’d call herself when she got the results back. And so she did. And as soon as the phone rang I had a funny feeling the news would not be good…
My E2 level? 346.
Fuck.
So. I was told as of now, not to start stims Thursday night. But I will need to go in Thursday morning for another E2 check, and an ultrasound to rule out any cysts. Fuck.
I have of course consulted Dr. Google only to find horrible information that makes me think IVF will never work for us. Basically one site indicated that elevated levels can point to a problem with ovarian reserve. Which can significantly lower IVF success rates. The only thing that kept me from hurtling myself on to the train tracks, was that I pulled up my records from my Full Blood panel on CD3 in October, and my E2 was 34. So the other possible scenarios, which I discussed with my nurse are:
A) It could be due to a Cyst. I have never had or been diagnosed with a cyst before, but I am technically poly cystic – so maybe now is just the time. Fanfuckingtastic.
B) My nurse said she has seen cases where Lupron actually causes stimulation instead of suppression, which in that case would cause a higher E2.
Now comes the part where I get to stew and over analyze things without having factual information to back it up. In the last few weeks I have, off and on, felt a strange pinching twinge on my right side near where my ovary would be. My right side is my dominant side, if that means anything at all. No pain, just a weird pinch while sitting up in bed, sporadically. It could have been gas, who knows.
Here are my concerns: I’m only on 10 units of Lupron per day. Which seems low compared to other bloggers – I know, I know, you’re not supposed to compare cycles since everyone is different. But really it seems low.
I could really use some more information about this, whether from experience or a reputable website.
HALP!
24 comments:
I don't have any advice to give, only support. How frustrated you must be. My E2 was high, too, but he'd given me estrace, so it was expected. I was also on 10 units of Lupron.
Try to stay sane until you get actual news of what's happening to you (vs. what's out there in cyberspace).
I was also on 10 units of Lupron. My last IVF cycle, (they do bloodwork and u/s before stims) and they found a few cysts. My E2 level was high because of that but I didn't ask the number.
I was benched, put on BCP for 2 weeks and then checked again. At that point the cysts were gone. It did delay the cycle by 2 weeks but it was not canceled.
Wishing you all the best, try not (I know it's impossible) to google worst case scenarios. **huge hugs**
Ugh, I'm sorry you have to deal with anything at all - I want this cycle to be smooth and easy for you!!!!
I think you can rule out ovarian reserve - the E2 is too high and doesn't match at all with your previous E2/ FSH's. I've had a higher E2 because of a cyst. I have no experience with Lupron, unfortunately, but it seems like you were either not suppressed enough or you have a cyst.
Hopefully this will just be a delay in your cycle. I know it's easier said than done, but try to wait until you have more info from your clinic before you worry. And, bottom line IMO, this will have no long term effects on the outcome of your cycle - you WILL get to cycle and you WILL have a lot of potential for success. It's just a matter of timing.
xoxo
makingmemom.blogspot.com
Hmmm.. interesting that they didn't do an u/s today too. I am always given an u/s and blood the day of baseline, so they can make sure there are no cysts. You may have a cyst and need to wait it out- I think that is extremely common (though frustrating) and more likely than the other scenarios pictured. So sorry! Hopefully things are not stalled too long.
I never had problems with my E2 dipping on an IVF cycle. But, I have had cysts on IVF cycles and IUI cycles. For IUI's, they did cancel. It happens. I am the same type of polycystic as you, (the kind where you still ovulate have regular cycles) and I do get the occasional cyst. Even non infertile women get them, so hopefully it doesn't speak to a higher problem. Just an annoying one!
Also, if they tested your FSH and your antral follicle count, you should know exactly about DOR.
Melissa, I am sorry to hear you are having complications when trying to get ready for the next step in the IVF process. I hope that you get some good feedback from those who are more familiar with the IVF process. Just know that I am keeping you in my thoughts! Try to hang in there as best as you can and take it one moment at a time if that is what you need to do. (HUGS)
Well F***. What the hell, universe? (Oh, and welcome to the cycling CA-RAY-ZAY Train! Toot Toot!)
My dear, you DO NOT DO NOT DO NOT have low ovarian reserve. Let's just scratch that off the list right away.
In all likelihood, you MAY have a cyst (shitty timing, I know), which may delay your cycle a bit, but Dr. 3 is The Man and can deal with this.
Also, perhaps you were never fully suppressed by the BCPs (could the break-through bleeding have something to do with this?). For both of my cycles, I had an E2 drawn the day after I stopped BCPs (remember though, I was on a totally different protocol), but since you never had your E2 tested, perhaps it was elevated (i.e. not enough suppression) BEFORE you started the lupron?
And it is true that teeny tiny doses of lupron can super charge the ovaries (i.e. micro dose lupron, like I was given), but I've never heard of standard lupron doses (i.e. 10 units) having the same effect.
Ah Hell. I'm just so sorry for the mindf*** you're going through, and SO wish your E2 would have played nice today. Just try to focus on staying calm (I know, easier said than done) and believing that Dr. 3 WILL get to the bottom of this and tweak your protocol accordingly. --- My phone is always open if you ever need to vent! *hugs*
Oh Melissa I am sorry your E2 level is high. It's so annoying that it can't just go smoothly!
I was on 10 units of Lupron for both my IVF's and FET and I never had an issue so its probably not the dose....but everyone's body is different so who really knows.
I hope your level lowers so that your cycle can get back on track. ((HUGS))
Thinking of you, Melissa! I'm sorry you're being thrown this hurdle. I wish I had some experience or words of wisdom to offer to you, but just know that I'm rooting for you and hoping for the best. Big hugs!!
I am *not* saying you are like me. BUT, just so you know, I was on 10IU of Lupron my first cycle, and then 20 my second. Neither dose suppressed me. My doctor thinks I am hyper-sensitive to the flare-up process. It caused me to recruit multiple follicles, all of which fizzled out (except the one which turned into a monster cyst).
But the antagonist protocol does NOT use Lupron and worked like a charm for me.
There are always options!
Noooooooooooo......stupid estrogen, why won't it ever cooperate?! Just to ease your mind a bit...I had set-back after set-back of my IVF cycle. No ovulation, then no period, then a cyst, then extreme levels of estrogen...every issue you could think of. Though it was a difficult cycle, I never got canceled and I got 50 eggs yesterday! So, just so you know....just because things don't go the way you hope (easy,) that doesn't mean you won't be successful! Hang in there!!!
Oh, I feel fully qualified to say that it could also mean that you just need a little more time to be fully suppressed and that's it. Go back in my posts for June 2009... and you'll see that the EXACT same thing happened to me- I was on Lupron for a longer time because my E2 wasn't low enough, and then after extra time, boom- it was. And remember the result? Yeah- Twins. So I can attest that it can mean very little too. I am hoping that this is the only speed bump in your IVF cycle and that things are smooth from here on out.
Or check out my TTC timeline link. Just breathe! You are in good hands!
For IVF #1, I took Lupron 10 and the same thing happened. My estrogen didn't drop like it should have, and it just delayed the cycle. I just took Lupron for a little longer and started my period a few days later. Turns out there was a cyst, but they continued on with the entire cycle.
For IVF #2, I took Lupron 20 and my estrogen dropped/period started as planned. There wasn't a cyst that cycle.
Like you said, every cycle is different...don't let Dr. Google freak you out! Everything will be just fine! Praying that everything goes okay on Thursday!
I'm so sorry for this possible delay--it sucks! I wish I had words of wisdom, one would think I could remember stuff like this after doing it so many times but I think I flushed my IVF stuff out of my brain after the final one...I'm sure all is not lost so do NOT lose hope! Just hang in there and we'll hope for better news on Thursday.
I, unfortunately, have no answers for you. I am not yet to that point. What I do know is that Dr. Google is EVIL. And more often than not, wrong. I sincerely hope that IVF will soon work for you and this is just a wonky cycle...Though I wish you hadn't had a wonky cycle.
Happy ICLW from a first timer!
I don't have any experience with this, but I do want to say that I hope that it all gets straightened out with little effect on your cycle.
My OB/GYN and RE both ordered me to "stay the hell off Google." It's nearly impossible (for me, anyway), but probably the best advice either of them has ever given me.
http://the-wheeler-family.net/aramelle_blog/
Oh man... what a pain in the arse! I concur with the previous comments - you most likely DO NOT have DOR and yes, it could very well be a pesky cyst that needs to be given the evil eye. I have only ever been on 10u of lupron the 200 IVF cycles, er, I mean 5 IVF cycles I've done.
Hang in there and the hardest, and I mean the hardest thing to do while in this process is to trust the process.
We are all here for you!!
I have no advice but I am sending you lots of pixies that you can keep going with this cycle!!
No relevant knowledge, but am thinking about you and pulling for you.
I agree with all the above commenters, and yes 10 units of lupron has been my dosag for IVF. I hope you do get to start, but it is important for them to get this all evened before you begin to stimm. This is all such a delicate balance that you would not want to proceed until everything is perfect. With that said, canceled cycles suck!!!!!!
Hang in there and keep us posted
I was also on 10 units and never dropped below 100 for my e2, 346 is a bit high but I would give it until thurs before freaking out, u prob just need a tiny bit longer on the lupron xx
So sorry this is happening. I hate saying this, but waiting is the best advice I have. I'm hoping the delay is short and you and your dr can sort out your protocol for a successful cycle!
ICLW
It's sucks I've been so busy this week - I should have seen this earlier and commented:
I HAD THE EXACT SAME THING HAPPEN TO ME - ON TUESDAY!!!
I had been on Lupron - 5 days at 20 units, then 3 days at 10 units. And my estrogen was 308, not under 60 like my doc likes. They put me on BCP for 2 weeks, and I'm supposed to go back and hopefully be suppressed.
You have no idea how nice it is that your body reacted in the same way... Not that I wish this on anyone, but it's nice to know I'm not a freak... :)
I just want you to know that you are not the first person this has happened to. I was on Lupron for an extra two weeks after BCP before I started stims because of a high E2. At first draw it was around 300 and then I went back every 3 days and it only went down 20-30 points each time. Finally I got below the threshold and started injections, I ended up pregnant that cycle so even with a crazy down regulation the cycle can work. I know I do not a diminished ovarian reserve because I have PCOS and have tons of dormant eggs waiting. I too was a Lupron does of 10 (no idea the unit measurement) and asked my doc about going higher, but he did not think it would make a difference.
Post a Comment