Rising then dropping E2 Levels: Follistim

[TheStarrs]

I am 36-yo women with a history of three miscarriages. No living children. All exploratory tests have proved unremarkable. My genetics were tested, as was my husband's sperm. All normal. I have some minor scarring from 4 D&Cs.

I have completed my first Follistim cycle. I began following a D&C in March 2015 that depleted my uterine lining. First I underwent 10 weeks of estrogen therapy, then immediately started a Follistim regime of 200 IU for four days, then 175 IU for 4 days, and finished with one day of 125 IU. We chose not to initiate a cleansing menstruation for fear that the lining would thin out once more. It was around 7mm prior to Follistim injections.

I was monitored for four sessions with vaginal ultrasound and E2 bloodwork. By day 10 (9/19) I developed a uterine thickness of 10.xx with two 18 mm follicles and 5+ more follicles of lesser size. Couldn't recall my first E2 level, but last three were 531, then 1246, then 500. With the decline of the E2 level, my RE speculated I was beginning to ovulate on my own. He instructed me to administer my HCG trigger shot (10,000 IU) that day (day 10, 9/19) and then have intercourse that night, the next night (9/20), and then every other night for five days. He also sent my blood to be tested for progesterone levels.

The results from the progesterone on 9/19 "could go either way." Meaning I could be setting to ovulate on my own or there is a problem with how my body was reacting. I am to retest the progesterone this Friday (9/25). I continue to feel bloated and like there is a bubble in my uterus, which has been somewhat uncomfortable during intercourse. In addition, the trigger shot has made my breasts sore and me feel a bit more tired.

I am concerned that I have not indeed ovulated. Many folks on various boards seem to report a rapid decline in E2 levels as the result of poor egg quality. Few mention ovulation starting on its own. What might your educated thoughts be about this?

[Dr. Wisot]

Based on this limited information I agree with your RE. The slight rise in progesterone and drop in E2 means you had your LH surge. Only an ultrasound would tell for sure you released the follicles, but you probably did.

The feeling you are having is probably from having multiple follicles instead of your usual one.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California