QuestionQUESTION: My wife and I have started the IVF process. She has been taking lupron for 11 days when we had our first ultrasound and blood test. The ultrasound was normal and no abnormality even though she did not have her period. The staff had a very difficult time trying to get blood from her. They had to attempt five times until finally with a thicker syringe (the butterfly needle was continually clotting and not getting blood) they were able to draw. They called back with estrogen levels reaching 500 and told her not to stimulate until estrogen levels drop to at least below 60. Could there possibly be a error because of the draw?
ANSWER: Hello Martin,
Certainly a level of 600 is very high and abnormal in that tie in her cycle. Usually it indicates that there is an ovarian cyst, but since you did not describe one, I presume none was seen on ultrasound. There must be some other source of the elevated estrogen. Did she take any medications or hormones to this point? I don't think that this is a problem with the draw or lab test but of course, I cannot be sure of this.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
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QUESTION: She takes aldemae for her blood pressure. The fertility specialist changed it to that because it is safer for pregnancy. Other than that, she is taking prenatals and they just brought her lupron levels back to 10 units. They did not find any ovarian cyst on the ultrasound. We have been going through months of tests that have all come out negative. They don't want us to stimulate until she has her period. What other ways can she get her estrogen levels down? Does some patients take a little longer for the lupron took take effect?
AnswerHello Again,
That high a level does not make sense. A normal peak estradiol level at ovulation in a natural cycle is around 200. Something has got to be producing the estradiol, or stimulating the ovaries. They need to keep looking.
In terms of other methods of suppression, the GnRH antagonists such as Ganerelix or Cetrotide might work better and more directly than the indirect path that Lupron takes.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
