Tuesday, January 5, 2010

E2 Levels Falling While On Follistim, Why? PCOS Patient Asks...


Hi, I am a 29/f with PCOS, secondary amenorrhea, non-IR, normal weight. We've done Follistim + Ovidrel + IUI 3 times and it never worked. Upon HCG administration my E2 was around 500 never higher. My RE works at a superbusy teaching hospital clinic.

This cycle we are doing the same thing with injectables. My E2 dropped from 400 to 60 but my follicles are still growing (dose never changed). Why is this? I tried doing some research and journal articles indicate that this is correlated to poor outcomes even in IVF. I also think that I have no LH in my body because before the cycles on Follistim my test line on the OPK's would be half as dark as the control, now I see absolutely no test line on all the days prior to HCG trigger.


If the E2 drops despite the follistim, that is an indication that the follicle is either not growing or deteriorating. It is the growing follicle that produces the estradiol. You are correct, this heralds a poorer prognosis. It is possible that you may need some LH in addition to the FSH (follistim).

You should discuss this with your doc. Keep in mind that it is difficult to get a PCOS (polycystic ovarian syndrome) patient to stimulate normally, and at a low rate with injectables. Most will overstimulate and produce too many follicles which necessitates that the cycle be cancelled.

For this reason, 85% of PCOS patients will eventually need to use IVF (in vitro fertilization) to be successful. It is the only way that we can control the number of embryos transferred into the uterus despite the ovaries over stimulating. At your age, your chances at succeeding at IVF with a positive pregnancy are very high and it is possible that there would be embryos to freeze as well for a future (cheaper) frozen embryo transfer if you would wish to have more children.

Good Luck!

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

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