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About Edward Joseph Ramirez, MD, FACOG
Expertise
I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.
Experience
I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 15 years.
Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society
Publications
American Journal of Obstetrics and Gynecology
Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco
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You are here: Experts > Health/Fitness > Women's Health > Infertility/Fertility > Estrogen Levels
Expert: Edward Joseph Ramirez, MD, FACOG - 10/30/2009
Question
I am going through IVF and have had a huge surge in my estrogen levels from one day to the next (2400 one day and then 3800 the next). My understanding is that it needed to be under or around 3000 and mine is now at over 3800. They are trying to lower it now before going forward with retrieval of the eggs. Does this up and down of my estrogen levels have an impact on the egg quality? Is it reasonable to go forward with this IVF cycle?
Answer
Hello Donna from the U.S.,
As the ovary is stimulated and more follicles are recruited and they get bigger, they produce more estrogen. Hence, the estrogen level increases. The goal is for the estradiol level to be under 4000 so that there is minimal risk of hyperstimulation syndrome, an illness caused by over stimulation of the ovaries. The two risk factors for hyperstimulation syndrome are estradiol over 4000 and 20 or more follicles.
If your level is under 4000, and your lead follicles are at least 18 mms, then you can be triggered with HCG with minimal chances of developing hyperstimulation syndrome. However, if your level is 3800 and your follicles are not yet matured (18mms or more), then there is a high likelihood that your level will go over 4000 before you can be triggered. In this case, doctors will use a "drift" or "coast" to allow the levels to decrease to under 3000 before triggering. Again, this is done to prevent hyperstimulation syndrome. Estradiol levels double every two days (approximately).
If you have to undergo a drift/coast, a procedure whereby the stimulation medications are stopped, and you follow the estradiol levels on a daily basis until the level decreases to where you want them then trigger, some of the follicles will stop growing and the eggs within will begin to deteriorate, but the larger follicles and eggs should be okay.
Another way to decrease the risk of hyperstimulation syndrome, which I recommend, is triggering with Lupron, if you are not on the long protocol using Lupron to suppress the ovaries.
I hope this answers your questions.
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.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereybayivf
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