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LH Levels during IVF- Need Input!

June 27 2011 at 6:01 PM
Lauren1228  (no login)

 
So the short of it is that I am on CD 7, 4 days of stimming under my belt and 5th tonight.

Estrodiol came back at 154, and we see around 7-8 follicles growing.

LH came back at 5.95. My research online tells me this is really high and anything over 4.0 is really comprimising egg quality. My doc says they don't add ganirelix until I go around 8.0 or so but everything online seems to say this is super high and that my chances are already diminished at this point. I believe it's a 10% pregnancy rate if it goes over 4.0 in the cycle?

But then I search here and read that it can go in the teens' in an IVF cycle. My nurse did admit it was high but not enough to cancel. I really wonder if we are going to continue this cycle and find really poor egg quality once I've already allowed my LH to go this high

ANY HELP? I'm so lost

 
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Anna
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My RE doesnt even monitor LH

June 27 2011, 6:13 PM 

your post makes me wonder why my RE doesnt monitor LH?? I am worried that they might not be a good clinic to work with.

 
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Anonymous
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Hi there, I didn't realize you were in an IVF cycle!

June 27 2011, 6:23 PM 

I am really hoping this works out for you, haven't seen you on the boards but remember your story.

I remember my clinic wanting to start ganirelix (sp?) when the lead follicle hits 14mm, and they did not base it off of an LH number. Your LH is not near a surge level (yet), what was your FSH and LH at the beginning of the cycle?

 
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Lauren1228
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Re: Hi there, I didn't realize you were in an IVF cycle!

June 27 2011, 6:36 PM 

Yeah! We started a few days ago, stimming started last Thurs.

We did 6 straight weeks of low dose birth control, estinyl form, and my FSH came back on day 3 at a 6. I know it's artificially suppressed, but it was at least suppressed. LH was a normal 3.14 and E2 was 45.

We were super happy with those numbers and felt ready to start. So today when LH came back pretty high I felt kinda knocked on my arse. I just called my nurse at home to see if we should drop my Menopur at all but they felt ok with this level.

I'm going to stop Googling at some point but it's really hard to just look the other way and not investigate, when I can potentially stop the cycle and start over with a diff protocol

 
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Mrs. A
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not much time to post but wanted to say "calm down"

June 27 2011, 7:01 PM 

no worries. An LH of 5.95 on CD7 is NOTHING to worry about. I am not sure where you've seen that a 5.95 is considered "really high"??? I don't even think you're anywhere near a surge - in the traditional sense - when your CD3 LH was 3.14. Gotta give this a few more dayes to play out. Good luck!

 
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Lauren1228
(no login)

Re: not much time to post but wanted to say "calm down"

June 27 2011, 7:25 PM 

OK I'll totally take that! I will breathe, I will not keep researching and I will calm down.

I need it frankly put sometimes, and I thank you!

I will post the research articles later that I'm referring to for future readers, but for now I'll leave them be until my cycling is done.

If anyone wants to look on their own, look up endogenous LH levels during IVF

 
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Jamie
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I agree with Mrs. A

June 27 2011, 9:10 PM 

That LH is no problem, don't worry! Are you cycling with Dr. Gill? So exciting, good luck!

 
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Lauren1228
(no login)

Re: I agree with Mrs. A

June 27 2011, 9:27 PM 

Yes I am still with Dr Gill! I adore their practice, really, it's fantastic, from the nurses, to all the doctors to the online system. Which office did you go to the most? We are at Willowbrook for our regular visits

 
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Jamie
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wonderful!

June 28 2011, 9:13 AM 

I went to the Piney Point office the most, but you are right--it's a top notch organization in all aspects (and I went to four in four states, including CCRM, but I think HFI is better than all of them). I am so excited for you! Please keep us posted!

 
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Cee
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Re: not much time to post but wanted to say "calm down"

June 28 2011, 6:33 AM 

I was going to say, if they consider that LH high then I'm in trouble!!! My LH at the start of a cycle is usually anywhere from 8-16 and my highest surge was in the 60s!

 
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Anonymous
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Actually, I recall you are an excellent researcher

June 27 2011, 7:37 PM 

And are very good at digesting technical research papers, and you may find some conflicting studies. I'm not so sure you should stop investigating and asking these questions, at this point you are probably better read than most REs would be. I don't think anyone here knows how LH affects egg quality, except for cases where LH is high because FSH is high too.

Isn't menopur one of the injectable stims that contains LH, and if so can you switch to Bravelle or something without the LH component for the rest of the stim phase?


 
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Lauren1228
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Re: Actually, I recall you are an excellent researcher

June 27 2011, 8:01 PM 

From what I've both read and understand, the Menopur is mixed in it's outcomes, just like pure FSH cycles. However, apparently pulling the Menopur at this point will theoretically cause my rising LH to start to plummet... not good either. The plan that we devised tonight on the phone with my nurse, who also called my doc, is that we add in the Ganirelix, it should drop my LH pretty quickly to fairly normal levels. This is the hope at least. We can't drop the Menopur totally at this point or my body will respond, again theoretically, in a bad way. And the research seems to back that as well.

I can LOWER my Menopur, which we think we might do after my Wed blood tests. And a big drop in LH will affect my E2 levels which are rising normally. I don't want that to happen either.

I also found some studies a bit ago that said that as long as the follicles are still under a certain size, there won't be huge impact to quality from either rising E2 OR LH. So if it starts to jump on Day 7-8, while the follicles are small, the impact is minimized. Thus when I start Ganirelix Wed, and my LH is back to a suppressed but normal level, I "should" be fine.


I also found similar info for FSH in case anyone was interested.


The Follicle-Stimulating Hormone (FSH) Threshold/Window Concept Examined by Different Interventions with Exogenous FSH during the Follicular Phase of the Normal Menstrual Cycle: Duration, Rather Than Magnitude, of FSH Increase Affects Follicle Development1


Results from the present study suggest that a brief, but distinct, elevation of FSH levels above the threshold in the early follicular phase does not affect dominant follicle development, although the number of small antral follicles did increase. In contrast, a moderate, but continued, elevation of FSH levels during the mid to late follicular phase (effectively preventing decremental FSH concentrations) does interfere with single dominant follicle selection and induces ongoing growth of multiple follicles. These findings substantiate the FSH window concept and support the idea of enhanced sensitivity of more mature follicles for stimulation by FSH. These results may provide the basis for further investigation regarding ovulation induction treatment regimens with reduced complication rates due to overstimulation.

So basically a surge, for a short window, will have little impact, if it "comes back down" to a normal window. So hopefully I met that window.

 
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Anonymous
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Sounds like a good plan and a relief

June 27 2011, 8:13 PM 

Catching this while your follicles are still small is great according to the research you found! Glad you got to review this with the RE himself too, sometimes nurses tend to push patients off telling them not to worry and calm down and follow directions, I never liked that much either happy.gif

I have seen on here many times that when the ganirelix is started, the E2 stalls or slows at first (causing freak outs) it will be interesting to see how it affects your LH at the same time.

Just curious, did they ever discuss using lupron like they do for most egg donor cycles (instead of ganirelix to prevent ovulation donors use lupron usually), just asking because of your young age how you decided on a protocol.

 
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Lauren1228
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Re: Sounds like a good plan and a relief

June 27 2011, 8:22 PM 

Two more studies for anyone searching in the future

The studies:
GnRH antagonist-induced inhibition of the premature LH surge increases pregnancy rates in IUI-stimulated cycles. A prospective randomized trial.
http://www.ncbi.nlm.nih.gov/pubmed/17032732
total of 104+ women, ~300 cycles, 44 pregnancies: "According to these data, we found that no pregnancy was obtained when the LH serum level, on the day of hCG administration, was >10 mIU/ml, in both groups."

Study of Positive and Negative Consequences of Using GnRH Antagonist in Intrauterine Insemination Cycles
http://www.ijfs.ir/library/upload/article/article10%203.pdf
60 women, 8 BFPs, "The serum LH level was less than 10 mIU/ml in all women with a subsequent pregnancy." (LH at 16mm)

Basically, if it goes over 10 in the cycle, the chances are greatly decreased. I'm at a 6 right now, so if I start Ganirelix, hopefully we'll decrease before we ever cross that threshold

You know we never discussed Gan vs Lupron. I should ask why we ended up picking it over Lupron but we never really discussed that part because I was comfortable with Ganirelix.

My nurse is SUPER supportive and I email her constantly, as does my husband. We get called back and sometimes even emailed the same answers, and they have no problem with you calling after hours. In fact she's always encouraged me to call after hours to talk to whomever is on call if we need to. In some cases, they'll get in touch with the doc (whos' wife also had high FSH and had a successful pregnancy). I go to the same clinic that Jamie went to for her IVF (And for her successful pregnancy and baby). Dr Gill in Houston Tx.

 
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Anonymous
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I had no idea that LH 10 was D-day. Very sobering.

June 27 2011, 9:36 PM 

Especially since high FSH goes hand-in-hand with high LH, often in a 1:1 ratio. 10 doesn't seem all that high and not surge level! Pregnancy rate of 0?

This is very good information to know about, thanks for posting about it.

 
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Lauren1228
(no login)

Level 10 LH

June 27 2011, 9:40 PM 

I think the level 10 is only bad if it's prolonged, as in a week before egg retrieval. I don't go to egg retrieval until this coming weekend, so having prolonged LH at a level 10 starting early is when it's bad. Kinda like cooking your food is a good plan, but on high heat for a long period of time is no bueno. It needs to surge closer to actual follicle maturity. Mine isn't necessarily through the roof or anything, but rising to 10 in the next few days might not be good either.

Does that make sense? It's been hard for me to parse some of that out in the literature. Because you need a level 20-30 at some point... it's WHEN that level is acceptable and for how long that has been fairly hard to decipher.

 
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Mrs. A
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do not focus on that level 10 - that's not what the study said. n/t

June 28 2011, 6:26 AM 


 
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Lauren1228
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Re: do not focus on that level 10 - that's not what the study said. n/t

June 28 2011, 6:49 AM 

Ok so as far as other numbers, i'm good, so help me understand the levels for lh because this part is still foreign. My nurse did admit it was high but not too high yet, and i keep finding reports of lh levels in ivf over 3.0 but at this point I have no idea what to interpret

http://m.humupd.oxfordjournals.org/content/12/1/3.full

In the prospective GnRH agonist study (Humaidan et al., 2002), the chance of ongoing pregnancy was significantly lower if endogenous LH levels were 1.5 IU/l on day 8 of stimulation, compared to
Based on the currently available evidence, it can be concluded that low endogenous LH levels during ovarian stimulation for IVF using GnRH analogues are not a rationale for LH supplementation to improve the probability of ongoing pregnancy beyond 12 weeks. On the contrary, it appears that the higher the level of mid-follicular endogenous LH during down-regulation in IVF cycles, the lower the probability of ongoing pregnancy. This was the finding in prospective studies involving either GnRH agonists (Humaidan et al., 2002) or GnRH antagonists (Kolibianakis et al., 2004).

 
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Mrs. A
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I think you are misunderstanding these studies - YIKES!

June 28 2011, 6:23 AM 

When I click herehttp://www.ncbi.nlm.nih.gov/pubmed/17032732 I see:

CONCLUSION: The use of GnRH antagonist in COS/IUI cycles improves pregnancy rate, preventing the premature LH rise and luteinization

This is known. Using an atagonist, e.g. Cetrotide/Ganireliex, prevents LH surge. Unless you're currently using Lupron (an agonist), you too will be given Cetrotide/Ganireliex to prevent an LH surge. But you're not near a surge, at least not based on just looking at CD3 and CD7 LH results.
What are the sizes of the 7-8 follies in play?

Also, I don't see where it says about "no pregnancy was obtained when the LH serum level, on the day of hCG administration, was >10 mIU/ml". Other thing to note about this study...it was done with women using recombinant FSH. Menopur is not recombinant FSH. So can't compare one to one with your cycle in that aspect.


Re: the other link you postedhttp://www.ijfs.ir/library/upload/article/article10%203.pdf

Couple of things to note here is that you're not doing Clomid+Menopur this cycle, so again, a different protocol than used in the study. Other thing, the criteria to participate in the study only placed cut-offs for FSH (normal basal FSH (less than or equal to 10 mIu/L) but placed no baseline levels for LH, the hormone you are concerned about.

Also, the study notes: "Meanwhile, premature LH surge was checked with a mid day urine
sample by using a urinary LH surge kit and those with positive results were excluded from the study." In other words, women who were surging (what you think you're going through right now but really aren't) were NOT included in the study. You are misunderstanding the quote that says "The serum LH level was less than 10 mIU/ml in all women with a subsequent pregnancy".

Go to page 2 where it says "and those with positive results were excluded from the study. For confirmation, all patients with positive results plus half of those with negative results (randomly chosen) were sent to the laboratory on the same day to check for LH serum levels." See this last sentence? To validate that they were properly excluding the postive OPK patients, they sent all the positive OPKs PLUS half of the negative OPKs for b/w to check for serum LH levels to determine that in fact the OPKs were accurately detecting the urinary LH levels and therefore the true positives were being excluded from further study.

When you move on to page 3, and read "Patients with positive urinary LH results had serum
LH levels greater than 20 mIU/ml and half of the patients with a negative LH result had serum LH levels between
0.9-12 mIU/ml. The serum LH level was less than 10 mIU/ml in all women with a subsequent pregnancy." All this is doing is giving you the back-up data that they did properly exclude the positive OPKS based on the serum LH level results. Where women had a positive OPK their serum LH wsa greater than 20 meaning they really were surging. Where women had a negative OPK, their serum LH was less than 12, meaning the OPK was right, they were NOT surging, and could therefore remain in the study. Of the women that remained in the study and got pregnant, that's where they noted "The serum LH level was less than 10 mIU/ml". The study does not make ANY conclusions on pregnancy rates when the LH was greater than 10, 12, 30, whatever, because all women with a positive surge were eliminated from the study altogether. We don't know if those women went on to have babies or not; they weren't studied.

If anything, the study found that using an antagonist was not useful one way or the other. "We did not find any benefit from suppression of LH surge due to the small sample size in our study. It seems tha natural events such as LH surge do not have any detrimental effect on IUI cycles and the importance of these events should be considered before any inappropriate intervention."

 
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Lauren1228
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Re: Sounds like a good plan and a relief

June 27 2011, 8:22 PM 

And REALLY good to remember that E2 might stall out, thank you thank you for that reminder so I don't have a repeat of tonight's freak out!

 
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