QuestionHi Dr. Ramirez,
I am a 34 year old women. I have been diagnosed with diminshed ovarian reserve and have had 3 failed IUIs and 1 unsuccessful IVF. My FSH was 9.9 when first tested which was last year. I would like to go ahead with a 2nd IVF process, but for the past 3 months my estrogen level has been above 80. My insurance company does not accept an estrogen level higher than 80 and therefore I am not being approved for IVF. This concerns me tremendously. Could you help me understand why I would have high estrogen levels 3 consecutive months and is there a way to lower these estrogen levels.I am not the type that gives up hope and I certainly hope that something can be done about this for me to go ahead with 2nd IVF process. Also my RE has not tested for endometriosis, PCOS and so I am wondering if these are contributing factors? I want to move forward this and it frustrates both my husband and I that we are not able to. Your answers will provide some insight.
AnswerHello,
First of all, basseline estrogen levels should be tested on cycle day # 2 or 3 only. Estrogen levels vary in the cycle and increase in mid-cycle, so if it is drawn at the wrong time, you would get an elevated level.
Secondly, estrogen levels should not be elevated without a cause. In most cases, it is because there is a functional ovarian cyst present that is producing the estrogen. An ultrasound is required to make this diagnosis. These types of cysts are usually treated by going on the birth control pill for one to two months. The pill will suppress the cyst. You can then check the estradiol level with onset of the subsequent period. Other tumors can also cause an elevated estrogen level, so again, an ultrasound needs to be done.
Finally, there are many ways to suppress estrogen. Medications such as Lupron, Femara and birth control pills can be used to do this. In fact, many IVF programs use lupron starting 14 days prior to the start of an IVF cycle for this purpose. Your doctor should know all about this if they are doing IVF and be able to help you. If they don't, then I would be leery about going to them.
Sincerely,
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.
