30 Yr. Old TTC'r With Elevated Estradiol Levels- May Be Physiological Cyst

Question:

I am 30 years old and have been trying to get pregnant for 3 years. I have had 4 cycles of Clomid including 3 cycles of IUI. I ovulate on my own, have regular painless periods, and no apparent endometriosis. HSG shows clear tubes.

Bloodwork done 7 months before shows estradiol, FSH and progesterone within the normal range. My husband who is 32 has low sperm motility (about 47%) and morphology shows 71% abnormal sperm heads. We decided to go ahead with IVF+ICSI and since my RE thought I may not need to supress my ovaries too much, I was on birth control pills for only 2 weeks starting in the luteal phase. For my baseline appointment and bloodwork they discovered that I had elevated levels of estrogen (about 190) so I was called in after 4 days.

I did my second set of bloodwork today (had taken my lupron shot before going in) and my level was 185 which they thought was still high so they have canceled my IVF this month. Since I live in a small town and we have just one RE I have been scheduled for November. I am very disappointed and I wonder what went wrong. Can you please help me understand why the levels went so high.

Answer:

Hello, to answer your question as best I can without being able to evaluate your condition myself, an elevated Estradiol level is an indication of ovarian hormone production. The ovary needs to be down regulated prior to starting the stimulation medications. Usually a persistent elevated Estradiol occurs because there is a persistent cyst present in the ovary.

This cyst is producing the estrogen. If then continued the cycle, you would not stimulate well, and pregnancy would not ensue. I would have cancelled the cycle as well. I'm sorry that you have to wait until November, however.

I presume that your RE put you back on OCP's so technically you would be ready to start the cycle in September.

Follow Up Question:

Thank you so much Dr.Ramirez, however I have not been diagnosed with PCOS and my ovary did not seem to have a cyst during any ultrasounds. I was always told that the ovaries looked great and the lining was great.

Do you think it might have been missed?? :-( I have been reading on the internet and came across an article about how a weak liver can not filter the estrogens. I have had malaria thrice and maybe the meds I took made my liver weak? I have also worked in a research lab and handles a lot of teratogenic material..do you think that might have affected something?

I know I sound paranoid, but it's the first time I have had a test report that was not normal.

Follow Up Answer:

The cyst I was referring to is a physiologic cyst, not the cysts of PCOS. If there was no cyst at the time of your baseline ultrasound, then something is producing estrogen. There are very few things that produce estrogen. It is not from your history of malaria. The liver has to be in failure before it significantly affects the processing of hormones and medications. You would know if you were in liver failure!

Your history of working with teratogenic materials would also have no impact. Something else is producing hormones. You might want to ask your doc what it could be. Hormones can only be produced from hormone producing structures and the ovary is the only structure that produces estrogen. You are not taking estrogen from another source such as medication are you? The only non-ovarian source would be certain types of tumors.

If the estrogen level goes down after your course of birth control pills, then that would rule out any type of tumor. In that case you should be good to go.

Good Luck!

Edward J. Ramirez, M.D.

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Program

http://www.montereybayivf.com/

Monterey, California, U.S.A.