Question About High Estrogen Levels Before ER But Low Egg Count

pnwcoffeeminer

Hello Ladies! 

I have a question hoping someone has been in a similar situation. I just had my 3rd and hopefully final ER. Each ER has resulted in a different protocol and this one they decided to do a luteal phase start priming with Lupron and started stims (300 Follistim and 150 Menopur) on the 4th day after starting Lupron with a total of 11 days. On the day of trigger my estrogen was almost 5300 and they had me trigger w/ 5000 units of HCG (half the dose of my last 2 cycles because my estrogen was double then it was previously) I took a different approach this cycle and was not neurotic comparing my numbers like I've done in the past. My RE was really excited about this cycle because I had more eggs and all were maturing fairly evenly. At my last US I had over 10 mature eggs with another 4-6 that were going to catch up by ER with another 3-4 that weren't going to catch up. During this time they never showed concern about my estrogen levels and were basically saying how perfect my levels were so I never once questioned it as, I was putting my trust in them. Well, last night before my ER I decided to look up the levels and everywhere I researched stated that it put my at high risk for OHS. This round definitely has felt different as far as discomfort/bloating and I've gained over 8lbs since I started stimming. I communicated this with my coordinator but she wasn't concerned and never mentioned me being at risk. Moving forward, today was the retrieval and they told my they only got 10 eggs and I won't know until tomorrow how many were mature and fertilized. Something just doesn't feel right and I feel that the team dropped the ball and had me trigger too late as I can't think of any other reason how I had so many follies at my last US but only ended up with 10 eggs. I personally am only quality focused so I know I'm still in the game. I would love any thoughts or input from all of the experts out there on what could've happened. They also told me told before the ER that I WAS at risk for OHS and not once did my RE or coordinator mention anything prior so, I'm also a little frazzled about that because I'm already showing symptoms and feel like if they communicated this to me prior, I could've gotten a jump start on the protein, electrolytes, high salt diet. But, it is what it is lol. Sorry for the lengthy post ladies, appreciate anyone who can bare to read through this to the end!

mayflower513

Hi there.  I can totally understand your concerns and discontent with their level of concern/communication about the risk.  I'm not sure why the level would be so high and the # of eggs would be lower than expected, what were the follicle sizes on the date of trigger?  Maybe they let some get too big or maybe some didn't catch up?  I know it's not a perfect science and sometimes you risk on either end to try to maximize the number of quality, mature eggs you end up with.  I know my clinic won't let you trigger with HCG if your estrogen is over 4,000 which yours clearly was.

As far as OHSS, my estrogen was 2,600 on the day of trigger so they let me trigger with HCG since my estrogen was under the 4,000 limit.  They got 15 eggs.

I didn't get OHSS after my retrieval, but I did get it when I got my BFP.

Hopefully you're able to avoid it (it was not pleasant at all!) and you have success on this cycle!

Holls214

I also got mild OHSS. I had higher estrogen levels. I’m not sure of the number though. I had 26-28 eggs and they retrieved I think 12-14. Just make sure to hydrate a lot and rest. It took a couple days to feel better... I was doing a freeze all cycle as I was doing PGS testing. 
Hopefully you got a lot of embabies.