I am currently undergoing Follistim treatments. My first cycle did not work. I was supposed to start my next cycle today. However, I was told that I could not start because my estradiol level was too high. What exactly does this mean, and how will it affect my treatment cycle?

S.R.

Many physicians check an estradiol value at the start of a treatment cycle. Together with the FSH level, these blood tests can help determine ovarian reserve. A high value for FSH or estradiol may indicate age-related infertility and predict a poor outcome.

The high estradiol level may also indicate that ovarian corpus luteum cysts left over from the previous treatment cycles are still hormonally active. The corpus luteum is what remains of a follicle after an egg is released; for a short time after rupture, it continues to produce the hormones needed in the event of a pregnancy. This inappropriately timed hormone production can interfere with normal growth of the uterine lining and inhibit follicle selection and growth during the planned treatment cycle.

So, when the estradiol test is too high on the second or the third day of the cycle and a cyst is still present in the ovary, I will either ask the patient to take a month off and recheck at the beginning of the next cycle or try to suppress the ovarian cyst with birth control pills. If no cyst is seen, additional checking for age-related fertility problems must be considered.