From the Guidelines
Given your current hormone levels and the potential risks associated with IVF, particularly the risk of thrombosis due to elevated estrogen levels, it is crucial to consider prophylactic anticoagulation therapy, especially if you have any underlying conditions such as antiphospholipid antibody syndrome (APS) or other thrombophilic conditions. Your hormone levels during IVF treatment appear to be progressing normally. An estradiol level of 1195 indicates good follicular development, while your progesterone level of 0.6 suggests you haven't yet ovulated, which is appropriate during the stimulation phase. The LH level of 2.20 is also within expected range during controlled ovarian stimulation.
Key Considerations:
- The risk of thrombosis is a significant concern in patients undergoing IVF, particularly those with elevated estrogen levels 1.
- Prophylactic anticoagulation with heparin or low molecular weight heparin (LMWH) is conditionally recommended for asymptomatic antiphospholipid antibody–positive patients during ART procedures to mitigate this risk 1.
- The use of LMWH, such as enoxaparin at a prophylactic dose of 40 mg daily, started at the beginning of ovarian stimulation and withheld 24–36 hours prior to oocyte retrieval, is a common approach 1.
- It's essential to discuss the optimal duration of prophylactic LMWH and the specifics of anticoagulation therapy with your reproductive endocrinology and infertility specialist, considering your individual risk factors and the protocol for ovarian stimulation 1.
- Monitoring for signs of ovarian hyperstimulation syndrome (OHSS), such as severe abdominal pain, shortness of breath, or excessive bloating, is critical, as this condition can increase the risk of thrombosis 1.
- Adjustments to your medication protocol should only be made under the guidance of your fertility team, taking into account your response to the treatment and any potential risks or complications 1.
From the Research
Hormone Levels During IVF
- Estradiol level of 1195 and progesterone level of 0.6 are within the range of expected values during IVF treatment, as hormone levels can fluctuate significantly during this process 2, 3.
- The LH level of 3LH2.20 is not directly comparable to the studies provided, as they report LH levels in different units (e.g., IU/L) 2, 3.
- It is essential to consider the timing and dosage of hormone administration, as well as individual patient responses, when evaluating hormone levels during IVF treatment 2, 4.
Impact of Hormone Administration on IVF Outcomes
- The optimal timing and dosage of recombinant luteinizing hormone (rLH) supplementation during IVF cycles can significantly impact ovarian response, embryo quality, and pregnancy rates 2.
- Administration of rLH at 150 IU/day, starting from GnRH-antagonist administration, may improve ovarian response, embryo quality, and pregnancy rates, while also enhancing endometrial thickness 2.
- The use of rLH in combination with follicle-stimulating hormone (FSH) may offer benefits compared to human menopausal gonadotropin (hMG) in terms of pregnancy rates and implantation rates 4.
Luteal Phase Support and Embryo Implantation
- The mode of ovulation trigger (hCG or GnRH agonist) can affect luteal phase endocrinology and embryo implantation, with hCG trigger associated with significant timing deviation from physiology 5.
- A thorough understanding of time-sensitive events during the luteal phase is crucial for achieving embryo implantation and pregnancy, and a single 1,500 IU hCG dose administered 48 hours post-oocyte retrieval may be sufficient for luteal phase support 5.