How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr Chaithanya Your Own Question
Dr Chaithanya
Dr Chaithanya, General Physician, Medical Researcher, All medical and health questions answered.
Category: OB GYN
Satisfied Customers: 798
Experience:  General Physician, Family medicine, Internal medicine, all age groups.
88123236
Type Your OB GYN Question Here...
Dr Chaithanya is online now
A new question is answered every 9 seconds

I'm currently doing an agonist IVF cycle. After 9 days of

Customer Question

I'm currently doing an agonist IVF cycle. After 9 days of stims (300IU Gonal F + Synarel Spray twice a day) a scan on Friday revealed 5 follicles 13-15mm and Oestrogen 500 pmol/L (approx 1360 pg/ml). A further scan & blood test 3 days later on the Monday (after 12 days stims) showed follicles: [email protected], [email protected], [email protected] and [email protected], Oestrogen was 10,740 pmol/L (approx 2925pg/ml) Progesterone 4.2 nmol/L & LH 1.7 iu/L. I was triggered with Ovidrel (half of a 250mcg syringe) on that Monday evening (I took no more Synarel or Gonal F that day). I had an egg retrieval 36 hours later on Wednesday and got 6 mature eggs, 4 of which fertilised normally by ICSI. My primary concern is that I felt the effects of progesterone (tender breasts/headcahes/mood changes/slight temp increase) creeping in on the Saturday/Sunday prior to my trigger on Monday night and am worried I triggered a bit too late and that the rise in progesterone reflects this? What causes the rise, I thought it only rose AFTER ovulation? There seems to be an awful lot of articles about how elevated progesterone levels on trigger day can be detrimental to final IVF outcome and also affect endometrial receptivity causing it to become out of sync. I think I should have been triggered on Sunday due to my v high Oestrogen level and that Progesterone had started to rise (Oestrogen was over 10,000pmol/L on morning of trigger day which seemed very high for only 6 mature eggs? Also Progesterone at trigger day at 4.2 nmol/L seems high? I would have expected not to feel the effects of progesterone - i almost felt how I feel at a normal ovulation/one day after, but I still hadn't taken the trigger at that point so it seemed odd to me. I'd like to know if the elevated progesterone is a concern and whether I should contemplate freezing any embryos and transferring in a natural cycle instead, also thoughts as to whether you think the oestrogen level was too high for 6 mature eggs and I should've triggered a day earlier (Sun) and whether the endometrium will have been affected by this rise in progesterone prior to trigger and hence endometrial receptivity and pregnancy rate affected. I'd really appreciate someone's feedback as I didn't get the opportunity to speak to my doctor properly. Thank you for your time.
Submitted: 7 months ago.
Category: OB GYN
Expert:  Dr. SH replied 7 months ago.

Thank you for your question.

The most important thing to consider when a lady is having the IVF procedure is to see whether she is having mature eggs that can be used for excellent fertilization to happen with ICSI, which I think has happened in your case.

The symptoms that you mention i.e. tender breasts, headaches and mood changes are nonspecific changes and can happen very commonly in any lady who is undergoing treatment for IVF or going through the process.

Actually, you cannot compare normal fertility process with an artificial fertility process like IVF. Hormone levels can go up. Progesterone going up or being high does not at all indicate that you would be having reduced chances of fertility or anything.

I think that you should be okay and your endometrium should be as receptive as any lady who is having IVF.

I can also tell you this from my personal experience as well, as my wife had IVF and was blessed with twins, a boy and a girl.

Her hormone levels were also like yours.

So I would not worry whatsoever.

Let me know if you have more questions.

Please submit a rating when you are done.

Kindest regards

Expert:  Dr. SH replied 7 months ago.

I have referred your next question to a fertility expert who may take sometime to respond.

I would appreciate a rating on this thread, if that is okay with you.

Kindest regards

Expert:  Dr Chaithanya replied 7 months ago.

Hello

I'm Dr Chaithanya attending you

Thanks for requesting a new expert

I'm typing your answer[please wait]

Expert:  Dr Chaithanya replied 7 months ago.

Thanks for waiting

I have seen similar cases

Progesterone and Estrogen levels slightly fluctuation doesn't really matter much

Though there can be lot of internal factors playing and it is all individual variations how the body perceives to hormones at the receptor level

So, don't get worried

You will have high chances of positive results if everything goes well, irrespective of slight hormonal fluctuations

Hope this helps

Please leave a positive rating at the top right corner of the page, the only way we experts are compensated for answering you

Follow up questions can be asked even after the positive rating

You can get back to me any time here, http://www.justanswer.com/medical/expert-dr-chaithanya/

Any bonus is welcome and appreciated

Best Regards

Dr Chaithanya

Customer: replied 7 months ago.
Are you a specific fertility expert? I've already had to pay to receive a vague response to my question and you have replied very quickly and it covered all my points. I requested last time that I'd prefer to have an experienced fertility specialist answer my question who can specifically refer to IVF results from my many patients. Thank you.
Expert:  Dr Chaithanya replied 7 months ago.

Yes, I have worked very closely with IVF treatments.

What is your specific question bothering you? please ask

Expert:  Dr Chaithanya replied 7 months ago.

Also, request to leave a positive rating. Any follow up questions can be asked after the rating

Customer: replied 7 months ago.
Your answer is a bit too generic for what I was asking as I covered a lot in my question. I would ideally like to hear a fertiflity expert's thoughts on the issue of potential premature leutinisation/at what level of progesterone that can be seen to kick in at/what ng/ml of progesterone points to premature leutinisation/if my particular elevated level of progesterone is of a concern as some trials have indicated a level of over 0.8ng/ml can be too high. There is a huge amount about this online and I'd like an expert's view if possible. I'd be also interested to hear an expert's thoughts on whether retrieving slightly early than normal may help IVF success rate in women over 40 as I believe some new research last year has perhaps shown this due to the existence of increased progesterone which can be detrimental to the egg's granulosa cells, by retrieving eggs earlier this can potentially be avoided. So I was looking for feedback on my individual circumstances - your thoughts on my trigger day, if it was a little too late & thoughts on my individual results, not just a generic answer if possible. This site seems to be vague and a great rush shown in you wanting a rating so you get paid, but I need more detailed answers and am only too happy to pay when I feel an expert with in depth knowledge of IVF answers at a level of detail. Thanks
Expert:  Dr Chaithanya replied 7 months ago.

I really understand your concern

I'm a medical researcher as well

The answer what I have given is based on overall view that I got from seeing success and failure rates of different individuals who have undergone IVF

Now, as you want to have a specific answer, let me work out on it with your case, and based on your levels

This takes little time

I'm a medical researcher from 10 years, and I ahve access to various journals as well

Let me work out on it

Would you mind accepting a premium offer for medical research, it takes 1 to 2 hrs work for me

Thanks.

Customer: replied 7 months ago.
I'm sorry I don't think this is for me, I either feel pushed into quickly rating a response so a doctor gets paid or pushed into paying even more for research which I don't even believe would be helpful for me. Seeing as there seems to be no attempt at any answers to any of my particular questions from 2 doctors who have replied so far, I'd rather leave it there thank you as the site is giving me what I hoped for. Thank you for your time.
Expert:  Dr Chaithanya replied 7 months ago.

Ok, Please leave a positive rating at the top right corner, for the time I spent here. That is fine if you don't want to accept premium service offer. Only that way my answer counts here. Thanks a lot! Good luck to you!