Hi Everyone,

I'm attempting to start my first low-stim IVF with Co.oper this month. (I've done 4 high stim IVFs...always get embryos, they never stick.)

I usually have HIGH e2 on cd3, although lately it's been pretty much normal. I also stim fast and almost always have a dominant follicle. So Cooper wanted me to start taking estinyl about 5 days before AF to try and even out the follicular growth.

But AF was irregular this month (hopefully b/c of the lap I had in April) and I ended up taking estinyl for 9 days before AF officially came on Tuesday. I went in for blood work and u/s today and my fsh was 8.7 (ok, but higher than it's been when not taking estinyl lately) and my e2 was LESS THAN 20, so it actually went down from the blood work I had on Monday, one day before my real period...(I was spotting, so they were trying to figure out what the deal was.)

When I got the news, of course, C.ooper was closed and, of course, I flipped out. Dear, kind Erin talked me down off the ledge and helped me understand that all is not necessarily lost and I won't (necessarily)drop into menopause tomorrow.

But I still don't understand why the e2 is sooo low, considering I normally have much higher e2. Could I be over-supressed by the estinyl? How can they tell if I am? (They saw 7 follies on the u/s today, all under 10, the biggest at 6.8). The nurse at Co.oper said that I was going to start stims when my e2 was at 60....so I figured it would just go up, not DOWN! And what will they do now? Have me keep taking the estinyl and hope my e2 naturally goes up? But what if I'm over-suppressed?

Has anyone gone through this with Co.oper? What did you/they do?

I really didn't miss IVF.....sigh. It is so nerve-wrecking!!

Thanks so much,
Sara

Similar thing happend to me on EE as well. For my first IVF, I took it for 6 days prior to AF, went in for CD 3 b/w and my E2 was only 12!! They said this was definitely the EE at work, and I had 7 follicles under 8mm and for the first time ever, no leads. They told me to keep taking it before starting stims, and i did. (I was taking it every day). Even after I started stims (I think on CD 5 or 6?), my E2 was hardly rising...so they said i was oversupressed and i opted to go every other day on EE. As soon I took it every other day, my E2 started rising and follicles grew. So, I think for som people it can really oversupress...I eventually stimmed for 12 days. The 2nd time I took EE in the LP to prep for IVF, I took it every other day, and on CD3 my E2 was 25 so I wasn't nearly as supressed. i also told them there was no way I was taking it again while doing the stims, and they were okay with it. That time I only stimmed for 6-7 days.

i was going to do IVF this cycle so took EE again last cycle (we ended up NOT doing IVF this cycle though), this time every day again until AF...and I think it oversuprssed me again because I still haven't ovulated and I am on CD30! (i have a big follicle though ready to go now, so eventually things got going on their own)

So, don't worry too much! I think you are probably oversupressed, once you start the stims you should be fine. And maybe ask hem if you can do EE every other day (or not at all?). If you do a search you can find my frantic post about this back in March (around beginning to mid March) and see the responses about oversupression (I can't post links on this computer for some reason).

BTW, I posted to you below, not sure if you saw it, but I was curious about how your immune treatments are going and wishing you luck!

Nancy

Hi Sara-
My FSH is higher than yours and my AFC is lower, but this also happens to me. In fact it's happened in all but one cycle where I took EE. Like you my E2 is usually higher on CD2/3. I'm actually in the middle of a TI cycle taking EE and my E2 has been below 20 for almost 3 weeks. But, in all of my EE cycles, my E2 eventually started to rise and I developed a follicle and ovulated, and it usually happens quickly- like once it starts to rise it takes off. So we've learned that I need close monitoring on these cycles.

I've never done IVF on it so not sure if there's a difference here, but they've always told me they'd give me 4 weeks and if my E2 didn't rise they'd give me provera to bring on a bleed and start over.

I'm not sure why this happens. For me, because my FSH has been really high, I've thought that it wasn't that I was over-suppressed by the EE per say, but that it takes a while for my body to get used to the lower FSH level before it can respond if that makes sense.

Good luck and please update!

I think there's a fine line between "suppressed" (which is essentially the goal of EPP- suppress FSH and avoid lead follicles/encourage follies to grow together) and "over-suppressed". I think only time will tell which scenario this is, but as I told Sara, in my successful cycle, my E2 was 30.6 on CD5. I remember freaking out and thinking it would never rise, but I ended up stimming for 12 days (which I actually think is perfect in a low-stim cycle, especially after stimming for 18 days during my 2 high stim cycles!). My guess is that the E2 will rebound nicely (and perhaps taking the E2 every other day as Nancy suggested is a good idea- I'd push C.ooper on it and maybe see if you can get an MD callback to discuss). Always cheering you on and wishing you good luck Sara!!!

I just realized that my E2 was actually 30.6 on CD6 (not 5) and I had been on stims for 3 days already at that point! So, there's hope for anyone with low E2 in the early stages!

Thanks to everyone that responded. I'll do my best to write personals later today....

....right now I'm a little in traumatized b/c Dr. Ch.oe called me this morning and the first thing she said is, "Your estrogen is low because your ovaries are not work. It's premature ovarian failure." Uhhhh.....excuse me? That is how you start a conversation with me? By terrifying me that my worst nightmare has come true?

I screamed at her. I really did.

I also said that didn't make sense because I just had a period, have only slightly elevated FSH, an AFC of 7, and an AMH of 0.6. I said I'd be on estinyl for 12 days as well.

She said, "Oh, let me look at your chart....you were in the POF file."

ARE YOU KIDDING ME?! YOU TOLD ME I HAD POF BEFORE LOOKING AT MY CHART?! Yes, I actually yelled these things...

So she looks at my chart and says, "Oh, you have a lot of follicles for someone with POF. And your FSH wasn't very high before. Why did Dr. Check put you on estinyl?"

So I explained that he put me on it because I ovulate early and because I always get a lead follicle. She said, "oh, okay. Well, maybe it will be okay then. We can either have you stop estinyl and start stims when your e2 rises or stop estinyl and start stims today. It will probably be fine."

So I ask, "So, you don't think I have POF now?!" And she says, "No, I don't think so."


HOW DID THIS CONVERSATION EVEN HAPPEN?! I feel it is completely unacceptable to a) not look at someone's chart carefully before calling her; b) tell someone she has POF in the first sentence of a call - even if she does; c) have a random doctor who doesn't know my case just call me out of the blue when she doesn't even know the facts of my situation. Seriously, I'd rather one of the nurses call me.

In shock and awe,
Sara Q

Sorry I made a typo above. Dr. Cho.e said "Your ovaries are not working. It's premature ovarian failure." I was not making fun of or pointing out her language use; it was just a typo. I am bilingual and my mother-in-law has a lot of difficulty with English. So I'm almost positive this was NOT a translation issue. It was an issue of not being prepared when you call a patient and of very horrific "phone-side" manner.

oh my gosh, that is a horrible, horrible phone conversation!!!
I'm so sorry you had to go throught that and I totally agree that she should have never, ever mentioned POF without even looking at your chart!!! That's ridiculous!!

I have faith that your E2 will rise and it is just the estinyl suppressing you. Hopefully with the stims, you will get a big boost. Any updates?