High Levels of Estrogen & Using Fertility Drugs

During in vitro fertilization treatments, a woman's estrogen level is an essential piece of information that doctors will monitor to determine her response to the medications. Additionally, the estrogen level can help physicians gauge her risk for developing complications. A high estrogen level is not the sole indicator for these complications, but it is one of the risk factors.

What is Estrogen

• Estrogen is the main reproductive hormone found in women and is responsible for the development of secondary sex characteristics and regulation of the menstrual cycle. Secreted by a developing egg follicle in the ovary, estrogen levels normally rise until about the time of ovulation. The levels then drop once ovulation has occurred.

What is IVF?

• In vitro fertilization, or IVF, is a form of infertility treatment where a woman's ovaries are stimulated to produce many eggs. The eggs are removed surgically and combined with sperm in the lab. The resulting embryos are then transferred back into the uterus a few days later.

  The process of stimulating the ovaries, known as Controlled Ovarian Hyperstimulation, is essential to the success of an IVF cycle. Because so many egg follicles are produced, it is common to have higher than normal levels of estrogen. Doctors use a woman's estrogen level and the results of other testing to determine how she is responding to the medication and make necessary adjustments to the dosage.

Measuring and Monitoring Estrogen Levels

• Estradiol, a form of estrogen, levels are measured through routine blood testing that should be performed on a frequent, even daily, basis when having infertility treatment.

  Each doctor will have her own process for evaluating estrogen levels, but it should rise by approximately 50 percent each day.

Ovarian Hyperstimulation Syndrome

• Having a high estrogen level during IVF puts you at a greater risk for Ovarian Hyperstimulation Syndrome (OHSS), one potential complication of IVF. This usually occurs after the administration of HCG, or human chorionic gonadotropin, which is used to trigger the final maturation of the developing eggs. Once the eggs are released, either naturally or surgically, large amounts of estrogen, progesterone and cytokines are released. This causes the capillaries to become more porous, which can cause large amounts of fluid to shift out of the blood vessels and into the abdomen or lungs.

Preventing and Treating OHSS

• Catching the syndrome early is one of the best ways to minimize the effects. The first signs are usually profound weight gain and bloating. Make sure to report any such symptoms to your doctor immediately. Also, resting during your cycle and up to the pregnancy test is really essential to helping prevent this disease. Avoid heavy exercise or cleaning and spend as much time as possible sitting or lying down quietly.

  Sometimes a medication, like ganirelix acetate, cabergoline or parlodel, is given in an effort to prevent OHSS from developing. It is important to know that these medications are not indicated for this purpose, and not all physicians will consider using it. Please speak with your doctor if you have any concerns.

  The syndrome is characterized as mild, moderate or severe according to certain clinical markers. In most mild to moderate cases, treatment is bedrest and aggressive monitoring for dehydration or further complications. If it progresses to the severe form, you may need to go to the hospital for intravenous hydration or medication.