Bissken Info zu FSH/E2 und Eierstockreserve...

... etc.
Leider nur in Englisch:
Ovaries with diminished reserve still have eggs that can turn into a pregnancy; unfortunately those ovaries respond to the most aggressive stimulations we know of by responding at a baseline level only. One of my colleagues compares the situation to a car that runs perfectly well at 30 miles per hour, and when you push the gas pedal all the way down, it goes??30 miles per hour.
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Und nun das, was ich immer befürchtet habe (warum z.B. meine ICSIs nicht so erfolgreich waren): Hochstimulierte ALTE EZ sind FRAGILE (ergo empfindlich) und werden sie in vitro befruchtet entwickeln sie sich schlechter als in vivo (das "in vivo"-Ergebnis habe ich ja seit mehr als 19 Monaten)
Further, the eggs produced by ovaries with diminished reserve seem quite fragile. The tools we use, particularly HMG and IVF are often too much of a stress on these fragile eggs. Many fail to mature at all, many quickly move from immaturity to postmaturity (a sort of over cooking) and the few that withstand fertilization outside of the body rapidly dissolve away into numerous fragments since the ability of the resulting embryo to foster even cell division is compromised. The body, when left on its own, can still gently nurture some of these fragile eggs towards maturity in an effective way, and pregnancy is still feasible (although not nearly as common as we would like). When we bombard these same eggs with FSH or FSH and Lupron, or try to develop them in the in vitro environment, they do very poorly..
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Und was dazu, weshalb FSH und E2 BEIDE nicht erhöht sein sollten an ZT 2-4
Actually there are two. Recall that a finely tuned communication between the ovary and the brain will result in a low FSH value on days 2,3, or 4 of the cycle. We have noted that the same fine tuning results in a low estradiol (estrogen) level at the same time. Further, an abnormally high estradiol level can artificially decrease the FSH and lull us into a false sense of security about the ovarian reserve. For these reasons we usually look at the estradiol (a.k.a. E2) level when testing FSH. And while there is no specific E2 level that precludes successful infertility treatment the way FSH levels can, E2 levels that are high (above 100 is a good benchmark) are good indications to look beyond just one FSH level for reassurance that the ovarian reserve is ok.
It is also important to measure the estradiol on day 3. Day 2 is fine. The reason its day 3 is 15-20 years ago, the IVF medications were always started on day 3. So everyone who started an IVF cycle had Estradiol and FSH measured on day 3. Pregnancy rates were checked against different levels of FSH and Estradiol, and that?s how the original work was done. I did research with the day 3 Estradiol level when I was a fellow.
If the estradiol level is high, the FSH level will be artificially lowered, and the FSH level will therefore not accurate. For example, I may have a patient with an FSH an 18 and an
estradiol level of 45. Next month the FSH is 8, but the Estradiol is 92. This is just as bad as her first test. Once the estradiol is over about 50, the FSH will be lowered. Just because the FSH becomes lower does not mean the patient is more fertile. If the estradiol is elevated month to month, this is as bad as the FSH being elevated month to month.
Why does the Estraddiol level become elevated? For some women, the cycle gets shorter as their ovaries age. So that by day 3, when the follicle should not yet be growing, the follicle has already started to grow and produce estradiol, and for reasons we don?t yet understand, this is bad. Taking estrogen pills to lower the FSH level does not help. It?s like taking Tylenol to lower your temperature if you have appendicitis. Your temperature may come down, but there is still a problem. Some doctors say there is a benefit to lowering the FSH level with estrogen. They say that when the FSH is high, the ovary become resistant to FSH and can't be stimulated by fertility drugs(which contain FSH). The theory is that by lowering FSH levels with estrogen, the ovary will respond when high doses of FSH are added(in the form of the fertility injections). It sounds reasonable, however there is no literature to support these claims, i.e. there is no evidenced based medicine.
Sorry, dass ich nichts adequates in Deutsch gefunden habe.
Aber die ein oder andere versteht sicher auch, worum es geht, oder.
Links zu FSH und E2 (mit ausführlichen Infos) sind - gleich - im Profil.
LG,
orni