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  1. #1
    Athena
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    Why is estrogen so important with FETs but not with IVF?

    What's the deal with estrogen? I've been prescribed Vivelle patches that I start as soon as AF arrives which should be next Thursday.

    I think it suppresses ovulation, right? What does it do after conception has occurred?? I don't understand why estrogen has to be given after a pregnancy is confirmed. I talked to my RE's office yesterday and she said my RE is pretty adament about the estrogen patches until 10-12 weeks of pregnancy. I guess I just don't undstands why a FET pregnancy is that different then an IVF pregnancy??


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  3. #2
    tweety30
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    DD Ment'd

    Athena,

    With my Fresh IVF cycles, I took estrace (pill form of estrogen). I was fortunate enough to conceive DD on our IVF#2. I continued on the estrace until about 9 weeks of pregnancy.

    We are currently doing a FET and I am taking delestrogen shots this time and have been told they would also continue if I get pregnant.

    So, my RE has patients continue the estrogen with both fresh and frozen cycles.

    Tweety

    P.S. Athena, update your info on our Sept FET thread too. We would all like to know were you are in your cycle.


  4. #3
    dr j
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    Hi Kerri

    When you are doing a fresh cycle your ovaries/follicles are producing the estrogen- which is the hormone that is responsible for building your endometrial lining among other things. It doesn't prevent ovulation- in fact it's part of the mechanism that as it rises, helps trigger LH and ovulation. Most of the time during a fresh cycle your many follicles are actually producing "extra" estrogen- which can lead to hyperstimulation in some cases. In fact your E2 level is what they measure when the draw blood each day- it gives them an idea how your follicles are developing. Each mature follicle will produce 150-250 rise in E2.

    When you are doing an FET you are not stimulating your ovaries- in fact in many cases you are on something like BCPs then lupron to shut them down- then you don't use exogenous stimulation ( FSH- GOnal F, Follistim etc) and therefore your ovaries/follicles ( of which you don't have many or any) are not producing any estrogen- therefore it needs to be supplemented to build your lining and all the other fun things it does.

    Hope that makes sense. I used Vivelle patches too... I had the hardest time remembering to put them on/change them. My abdomen looked like a little kid playing with stickers!! LOL

    dr j
    Dr j
    4 IVFs and 6 FETs -6 pregnancies, lots of drama.
    AS, AJ and AA Born/Died 3/2000
    MJ born 5/10/01
    HT born 4/14/04 surviving twin.

    God is great, beer is good and People are crazy.


  5. #4
    Athena
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    Thank you both! Makes sense.


  6. #5
    Winterlily
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    Hi guys!

    Sorry for the barge...

    Estrogen actually can and does prevent ovulation if given at the start of AF and in the right doses. (Mostly because, in a natural cycle, estrogen is released after FSH and LH have triggered the follicles to start growing. Estrogen is what turns off FSH production. Then the rising estrogen triggers a surge of LH, which of course triggers the egg to be released. But, when you gave high enough doses of estrogen right from the start, it starts telling your body to stop FSH production before it ever begins, see? So if you never have FSH production, you never have growing follicles, so there are no eggs to be released. Basically you jumped to step 2 of a natural cycle, completely skipping step 1 - which was FSH triggering follicles to grow.)

    That's why some "medicated" FETs are minus Lupron and BCPs. (My own was done with only twice-weekly delestrogen injections starting on CD1 of my period, then progesterone suppositories starting some days before transfer. That's it. No Lupron, no other suppression.) The statistics are that, given that way and at the right levels, estrogen prevents ovulation in 90% of women. The other 10% will ovulate anyhow -- which is why, in those kinds of FET cycles, they will check your ovaries to make sure you aren't growing follicles. And is also why some clinics prefer to use something like Lupron, which doesn't have that 10% "failure" rate. (I was MUCH happier without the Lupron and willing to take the chance of one cancelled cycle in order not to have to deal with it!)

    To answer your other question: After conception, estrogen helps sustain the pregnancy, helps with the creation of the placenta, helps prepare your breasts for breastfeeding, increases uterine blood flow, and lots more.

    Hope that helps, and the best of luck!!

    Samantha
    After 6 years of heartache, my dream finally came true on March 1, 2006. His name is Julian!


  7. #6
    Athena
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    Thank you Samantha! I thought someone told me it supressed ovulation. I'm not on bcps or lupron. Just the estrogen patches starting with CD1.


  8. #7
    dr j
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    OK ladies then I have a question..... why suppress ovulation with an FET? If your timing is right it shouldn't matter if you ovulate at all. BCPs and lupron in an FET are more to control timing of an FET cycle than ovulation. For example my REs office planned all FET transfers for Fridays- and could do it that way most of the time.

    Samantha that does make sense too...

    I am personally one of the ones that will become a "runaway" train with a little bit of E2.... it's a challenge. I also have ovulated on Lupron.
    Dr j
    4 IVFs and 6 FETs -6 pregnancies, lots of drama.
    AS, AJ and AA Born/Died 3/2000
    MJ born 5/10/01
    HT born 4/14/04 surviving twin.

    God is great, beer is good and People are crazy.


  9. #8
    Winterlily
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    Hmm. As I understand this, they only like to do truly natural cycles in people with near-perfect cycles. (And there definitely are clinics out there doing natural cycle FETs.) For anyone else who is the least bit irregular, it becomes difficult to "catch" ovulation precisely so the transfer can be done at the right time. (It does matter a lot if and when you ovulate, because the transfer needs to be made however many days after ovulation as the embryos are old. So, if you have 5-day embryos, they need to be transferred 5 days after you ovulate to keep things as natural as possible. If you miss that, your body starts sending signals that there was no fertilization and at some point will start breaking down the lining. That's why they give progesterone as many days before the transfer as your embryos are old -- they're trying hard to mimic a natural cycle and keep your body working as it would normally/naturally.)

    Basically, in a medicated cycle using estrogen as suppression (but no Lupron), estrogen IS acting exactly as Lupron does (or, well, it should). So the cycle can be timed better and more under the clinic's control, which it never would be in a natural cycle. In my own, for example, my lining wasn't quite thick enough, so they extended the whole thing a week to give me more time to build a thicker lining. That never could've been done if I was doing a natural cycle.

    And yeah, Lupron is definitely used to control the timing of your cycle, but they do that through Lupron's ability (usually!) to "shut down" your cycle entirely so they can add everything back in from the outside -- thereby keeping it all (levels and timing) under their control. We're saying exactly the same thing.

    My question was always more of why Lupron is used at all in most people when the same thing can be accomplished with estrogen (assuming you're willing to take the 10% chance that you will ovulate anyhow and have to be cancelled that month.) Of course, that question is moot completely with anyone who essentially overstims with estrogen. So much better off with Lupron in that case!

    Samantha
    Last edited by Winterlily; 08-30-2005 at 06:01 AM.
    After 6 years of heartache, my dream finally came true on March 1, 2006. His name is Julian!


  10. #9
    Athena
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    Quote Originally Posted by BC-dr j
    OK ladies then I have a question..... why suppress ovulation with an FET?
    That would be my question, too.


  11. #10
    Winterlily
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    For women who ovulate regularly, the answer, which I'm trying really hard not to say here, is probably: For the doctor's convenience and control...
    After 6 years of heartache, my dream finally came true on March 1, 2006. His name is Julian!


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