QuestionHi,
I am in the middle of an IVF cycle and my LH has risen. The highest it has been is 18.8. It is now down to 9.55. I have only one measurable follicle which is at 13.5mm. My E2 is 157. My RE has said that there is a chance the follicle may have been damaged. He says that the follicle could not be damaged by the LH before it reaches 12mm. Unfortunately, the follicle grew from 8mm to 13.5 just at the time the LH went down so we don't know. He is willing to go to retrieval with one egg. I have insurance as I live in Massachusetts and I am wondering if I should just stop this cycle and try again next month because I have had better cycles than this one. I have been pregnant twice (both miscarriages due to chromosomal abnormalities) and I am concerned about going back down that road again if my egg is damaged. What do you think? Also, at the beginning of the cycle, my E2 was under 20 and had a hard time rising. Would you hold off on the stims until the E2 rises? What do you think?
Thanks so much for all your help.
-Kris
AnswerHi Kris from the U.S.,
Let me answer your last question first. The E2 rises because the follicle is growing. It does not rise without follicular growth. We check it at the beginning of the cycle to make sure there is no exogenous E2 production, such as by an ovarian cyst.
There is no reason to suspect that the egg is "damaged". No one can know that and I don't know why your doc is checking the LH. In any case, you have the option of trying with this cycle or canceling the cycle. I will usually not cancel a cycle. The reason is that every egg that is matured is unique. It could be a good egg or a bad egg. We know that not all the eggs in the ovary are good eggs, and that is one reason women don't become pregnant every month they try. What I worry is, what if this is the good egg and we allow it to be wasted? You could certainly convert the cycle to an intercourse or IUI cycle, but then your chances of pregnancy would go down drastically because they are natural processes. Why not give yourself the best chance of pregnancy even if it is only one egg?
The only other consideration, of course, is a financial one. You are lucky that you live in a state where fertility treatment is covered. Here in California it is not. So in addition to the above, you have to decide if you want to use up one of your covered IVF procedures. Certainly your chances of pregnancy are less with only one follicle and one egg, but I have had many pregnancies with only one follicle and one egg. In fact, nationally, there is a move toward single embryo transfers (one follicle, one egg). If you don't do the IVF, then your chances for a pregnancy in this cycle are even lower.
I hope this helps,
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
