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Hi, I have seeing an Re in order to get pregnant. Cycle is 30 days and I ovulate regularly however I am producing follicles very early in my cycle in some cases before my period begins, and therefore according to my re the quality of my egg is poor. In order to get control of this we did the following:
Injection of ovidrel to induce ovulation, which was successful. That evening I started 14 day lupron injections. On the 14th day (yesterday) I started my period and my estrogen level instead of being at what he said should have been 0 to start my fsh injection was at 1200 and I already had produced a follicle.
Have you seen this happen?
Protocol now:
Yesterday evening (my day 14 of lupron I then began another injection of ovidrel to induce ovulation to get rid of follicle and then re said he will start me on lupron with vaginal progesterone followed by fsh, and iui and progesterone. Is this a normal protocol? Have you seen this be successful? I am 28 and very healthy.

Answer
Hello Lily from the U.S.,

Something doesn't make sense in your description.  Follicles are physiologically produced in the first 14 days of the cycle.  Once ovulation occurs, the follicle can refill and are now called a corpus luteum cyst.  This cyst produces the progesterone and other hormones that are important in implantation and support of the early pregnancy.  It is NOT a follicle.

An estrogen level of 1200 at the beginning of the cycle is indeed high.  If pregnancy does not occur, then when the period starts, the estrogen levels should be at its lowest level.  That is usually below 100.  If the level is high it is either because (1) it is the wrong time in the cycle or (2) there is an estrogen producing cyst or (3) you are pregnant.

If you have a good RE, he/she will figure it out.  Maybe the best way to proceed is to go on the birth control for the cycle preceding the treatment cycle.  This will put the ovaries at rest and allow the cycle to be started on time.  This is the protocol that most of us use.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
info@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.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at ejrmd@montereybayivf.com if you are interested in continuous access to me.

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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 19 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, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

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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