All About E2

I found this online and thought it was interesting and explains it a lot better than my doctor did:

"Estradiol: What It Is and What It Tells Us.
The level of estradiol is measured in almost every blood sample taken during the monitoring of almost every type of assisted pregnancy. It is arguably the most informative of the three tests. Because of this, we will spend more time and space on estradiol. Don't worry-- the other two won't be nearly as long.

Estradiol is a hormone that stimulates the lining of the uterus, causing the lining to grow, and to make itself ready for embryo arrival. (This is not estradiol's only function, but for us, it's the important one). Estradiol is tied into pregnancy by it's method of production: oocytes (eggs) contain follicles. These developing follicles contain 'granulosa cells'. These granulosa cells synthesize the estradiol and release it into the blood circulation.

This means that more follicles produce more estradiol. This helps measure how many follicles are actively developing. The longer they continue to develop, the longer the estradiol level continues. As they develop, the level continues to rise. This rise can further indicate that the oocyte within the follicles is reaching its maturity.

An example of the use of estradiol level is when it is measured during down-regulation cycles. In down-regulation we expect low levels of estradiol: below 30pg/ml. If levels are not this low, this suggests that the ovaries are not yet suppressed, and that the down-regulation should continue a little longer, until they actually are suppressed.

Estradiol And Ultrasound Scans
Blood estradiol is also used in combination with ultrasound scans. Taken together they help indicate how (and if) the ovaries are responding to stimulation. Is there a response? Is it adequate? Is it excessive? To tell us this, the blood level has to be viewed in relation to the stage of pregnancy and the day in the cycle in which the level is being taken.

For example, a level of 1500 pg/ml on day eleven might be considered acceptable in a stimulated cycle, as reflecting the presence of a reasonable number of mature follicles. However, if this level were present on day eight, it would be considered unacceptably high. It would almost certainly reflect the presence of an excess of follicles. At this stage (day eight) they would still be Immature ones. Their quantity, however, would suggest that continued stimulation would carry an unacceptable risk of developing OHSS-- ovarian hyperstimulation syndrome.

Don't Expect Easy Comparison
Before we continue, one important point: levels of estradiol are not the same from person to person. They cannot simply be compared from one to another. People vary-- everyone is slightly different, and everyone responds to a different degree. Some more so than others. A level that is dangerously high in one person-- or dangerously low in a second-- might be normal and healthy for a third. This is why blood levels can't just simply be compared. It's also why blood levels can't always be interpreted with complete certainty in the first cycles. Without prior cycles to 'calibrate' the levels, the meaning of a level can only be determined as to what it usually means-- what it 'probably', or perhaps even 'almost certainly' means.

Despite individual variation, estradiol level does provide very useful information.

A Rough Rule-of-Thumb for Good Estradiol Levels.
Exact figures are not possible. As a rough guide, however, a level in the range of 150 to 500 pg/ml is generally considered reasonable for the eighth day of a stimulated cycle. An approximate doubling of this level every 48 hours is considered promising, as a sign of continued good follicle development.

When the Estradiol Level Stays Flat or Begins to Fall.
Occasionally, the level of estradiol fails to rise during a cycle, or even falls. If this happens it strongly suggests that the follicles are not responding appropriately, and that the oocytes within will not be of good quality. Under these circumstances our advice is almost invariably to cancel the cycle, because a change in stimulation protocol may yield more oocytes-- and healthier ones-- in a later attempt.

Low Estradiol Not Always a Problem
A more common situation is when the level is low in the early part of the cycle. The choice then is to either carry on with the same amount of stimulation, to increase the amount of stimulation, or to cancel the cycle. This decision has to be based on a number of factors. These include:
the previous response to stimulation chronological age how low the level is
the ultrasound appearance of the ovaries is there a pressing need to ensure that an optimal number of oocytes are obtained, as in the case for couples with male factor infertility?

How It All Comes Together with Estradiol.
It should be clear from all of the above that estradiol levels do not tell the entire story by themselves. One level leads us to advise a couple to cancel. The same level in another couple leads us to suggest continuing.

We've already discussed levels that are low. When levels are high, we have the same choice: change the stimulation (reduce it), or cancel the cycle. The criteria to consider are the same as for low levels. The one additional factor is that with high levels we also think carefully about OHSS (ovarian hyper-stimulation syndrome). When assessing the risk of OHSS we look to previous cycles, if there are any. Any suggestions from these cycles of OHSS problems would quite definitely weigh heavily towards cancelling the cycle.

When the decision is to proceed, levels of estradiol continue to be monitored. If they continue to exceed acceptable levels, even with reduction in stimulation, we might reassess the cycle, and once again advise cancelling. If however they do return to normal levels, then the cycle will continue.

What is the limit of acceptable estradiol level? Acceptable levels vary-- it's not possible to give a definite, absolute number. However, any level of 4000 pg/ml or above does require careful consideration. Levels that are much in excess of this usually do lead to cancellation, though not always.

What about the lower limit? This too involves many factors. However, if the estradiol level has not reached a minimum of 600pg/ml then our usual policy is to discontinue the cycle. In practice we usually don't proceed unless the ultrasound shows three or more mature follicles. Since estradiol levels and the total number of follicles are related (as discussed in the beginning of this essay), this by itself eliminates most of the possibility for levels at or below this lower limit. Three or more mature follicles will, under most circumstances, secrete enough estradiol by themselves to give a level in excess of this minimum."

Slow but rising

The nurse called, my E2 levels are slow but rising and my follicles are slow but growing! So for now nothing is cancelled and let's pray my levels keep going up.

My lazy ovaries

After another 6 am doctor visit and a 2 hour wait in the waiting room, it looks like I am not responding to the max dosage of meds they can give me. My right ovary is growing one follicle, the rest are stagnant. The one follicle would be growing with or without the meds. The doctor I saw today said that by this time, something should be happening in there, and if my bloodwork results come back showing my hormone levels stagnant, then they will probably just cancel this cycle! I don't understand. My RE originally told me that it might take longer for me to stim because of how long I was on BC pills (3 months versus the typical 1 month they put you on). I have to wait for my nurse to call me this afternoon and tell me what to do...keep taking my meds or stop them altogether. But even if I continue taking them for another 2 days, I am losing hope that anything is going to grow in there. If I can't even grow an egg, how am I ever going to grow a baby? :(

So far so good

Everything is going according to plan so far, just one minor blip. I apparently have hypothyroidism. Where this came from, I don't know. The nurse tells me it is genetic, yet no one in my family has it. I seem to be the first of many things in my family tree...and not in a good way! The only reason I even believe this new diagnosis is that I have the worst night sweats where I wake up and am drenched in sweat, almost like I stepped out of a cold shower. But I don't feel sluggish in general. I read that if left unchecked, hypothyroidism can cause miscarriages. So I will diligently take my meds now but I can't promise I will stay on them for life (luckily they are only $5...in case I do have to).
At my last u/s, they found an 8th follicle, so that's good. The more, the better the chance of more eggs. I go in again tomorrow morning to be monitored.
I am still on the same meds, with no side effects (yay!) but now my belly is starting to get bruised and tender from all the shots. I have been doing 3 shots a night, even though it is 2 meds. They overfill one of the vials, so you can always squeeze out a little more from one vial but it means not getting an exact dose so you have to do a second injection from a new vial to get the correct dosage. It's worth it considering one vial costs $700.
I think someone else I know is pregnant. I don't know for certain, but my pregnancy intuition has kicked in.

I shot myself up...

...twice...all by myself! I am very proud of myself, not that I am afraid of needles (if my piercings and tattoos didn't give that away) but I was very afraid I was going to do it wrong. The instructions are WAY more detailed than they need to be, and after reading them for the umpteenth time, I realized 90% was about keeping everything sterile. easy!
Our bloodwork and ultrasound went well this morning. Gene and I left the house at 5:45 am and got there a bit before 6 and there were already at least 10 people there waiting! But they move quickly, especially for that time of day! Bloodwork/urine were fine and then the ultrasound showed I have 7 follies (follicles which we want to mature to release eggs) to start with which is o.k. Anything above 5 is acceptable to start IVF. So 7 is by no means spectacular, but it is a starting point. I THINK the Follistim I am injecting is supposed to make more follies but I am not sure, it may only be meant to mature the ones I already have there to begin with. I'll have to google that and find an answer.
Tonight I injected my first dose of Follistim (450 units, which is the max dose) and 15 iu of low dose HCG, which is the pregnancy hormone, so it seems they want to trick my brain into thinking it is pregnant...again, not sure why...I'll have to read up on that too.
I feel okay so far, just all tingly in my belly but that could all just be in my head, or it could be from the injection site, or it could be the menstrual cramps I am having, or the endo pain which has reared its ugly head again, only 4 days after being off BC pills. And I am really thirsty, which is more likely my dinner from Panera than a side effect of either drug.
Tomorrow and Monday I get to do my shots again, and then on Tuesday I'll be going back in for another ultrasound to see how my follies are growing (let's hope) or not growing (which would be bad given I am on the max dose of meds).
Grow follicles, grow!!

Our story is finally being written

We begin our first IVF cycle this Saturday!
I feel like I know so many people who have gone through this (not IRL, my online friends) and I have seen so many different outcomes and reveled in so many different emotions (I am highly empathetic and feel like everyone's battles are my own battles). I can't believe that it is finally time to write our story. I know that this story isn't guaranteed to have a happy ending, but to have the chance alone makes it all worthwhile. I feel like we've been trying to write this story of ours for so long, but our pen was out of ink. Someone just handed us a new pen, filled with ink, and for that I am so grateful.
I am very optimistic right now. I (re)started acupuncture today and feel my inner strength slowly returning. I feel like there is no obstacle I can't overcome. I wonder if this over-optimism is going to do me in. Maybe I should be more realistic? Should I anticipate the worst and hope for the best? Or is it possible to fool your mind into making your body work the way you want it to? Mind over matter?
So my meds are ordered, and they'll be here on Wednesday. My doctor is letting me order portions at a time to try and keep costs down (they usually order more than necessary and you end up with a ton leftover which you can't return) PLUS my doctor is donating 1500 iu's of one medication to me which is $1000 worth. What a huge help! They get donations from patients who over-ordered and pass them along to OOP patients. I guess my timing was finally right on for something!
Saturday I go in (at 6 am! ugh! wait...no complaining allowed here!) for baseline bloodwork and ultrasound. If everything looks good, I can go ahead and start my injections that night. What I mean by if everything looks good is if all my hormone levels are within the normal range. My RE already warned me if my FSH has skyrocketed, IVF is out of the question...it wouldn't be worth it. So I will be crossing my fingers for a reading of less than 14.4, which was my highest level to date.
What a journey this is going to be!

Privacy Please

My blog is no longer public, so if you are reading it, feel special :) It is VIP and by invitation only. Okay, you can now cross the metaphorical velvet rope.
This past week has been crazy! After talking in depth with our RE, we have decided it is in everyone's best interest (okay, just mine and Gene's) to move forward with IVF. It seems we have a lot working against us. If it was just one issue, with me, or if I were fine and Gene had one issue, we would have a lot more choices. Continue trying on our own, or even start off with IUI. My RE sadly told us we just have bad luck. That someone my age should not have to be facing all these obstacles. He said if we wanted to use donor eggs we would have a lot more time to work with. We could dilly-dally until I'm 40. But if I want this to be OUR (genetic) baby, we have to move and move quickly. My eggs are what they consider to be "aging." Actually I think he said "old" but let's just call them aging. Given that, plus my endo, plus Gene's poor morphology, our chances to get pregnant on our own are probably 1-5% and with IVF less than 50%. I don't have a plan beyond this one cycle. I told Gene that if this doesn't work we should just take it as a sign, and spend the rest of our lives by ourselves traveling. I don't think I really mean that, but it makes me feel better to THINK I would be okay with this. I am trying to fool my own subconscious!
I am staying positive about the whole situation and trying not to get whiny and ask "why me?" I deeply believe this is all unraveling the way it is meant to.
This week has been spent calling different pharmacies and getting prices on all the meds I will need to be on. The list is overwhelming:

DOXYCYCLINE 100 MG CAPSULE

METHYLPREDNISOLONE 16 MG TA

MONOJECT .5ML SYRN 28GX1/2

B-D NEEDLES 18G 1.5

PLASTIPAK 3ML 22GX11/2

PROGESTERONE OIL 50 MG/ML V

OVIDREL 250 MCG/0.5 ML SYRG

GANIRELIX ACET 250 MCG/0.5M

FOLLISTIM AQ 900 UNIT CARTR

LOW DOSE HCG 10IU/0.15CC

FOLLISTIM AQ 600 UNIT CARTR

FOLLISTIM AQ 300 UNIT CART

The goal is to inject myself with lots of hormones and grow and mature as many eggs as possible so they can "harvest" them. I've heard they can get as few as 4 and as many as 30 eggs. The more eggs, the better chance that there will be some high quality ones in there!

I'll probably be ordering the meds on Monday and once I get all my consent forms signed and notarized and then get financially cleared, we'll be ready to start.

Overwhelming but very exciting! Please send your positive thoughts and vibes our way!