No follicle left behind

Last weekend, C & I went out with some local infertility survivor friends. (They conceived their daughter on their second IVF attempt). I was so excited to see them and ask for their advice and provider recommendations. They’ve been understandably busy with their little bundle of joy, and we hadn’t seen them since deciding to undergo IVF.

Early in our dinner, I was reminded of how different this journey is for each of us, when I started explaining my protocol to this friend and she interrupted me to offer some well-meaning advice,

“You just need to forget about all those stats and research and just believe that this is going to work!”

Um. Yeah.

C suppressed a laugh, and I quickly explained that, in fact, the only way I was going to make it through this was to read and research everything I could, because I like learning about stuff (especially stuff that, you know, matters this much…), because it gives me something I can do, and because by doing it I can regain some feeling of control.

To her credit, she quickly relented, “I forget. You’re such a scientist!” Yes, yes I am.


So, after asking for your book suggestions and reading your comments (Thank you SO MUCH for those by the way!), I got inspired to make the leap from nonfiction books on infertility (which were too general to answer specific questions about my IVF protocol or my diminished ovarian reserve) to the primary medical literature. It’s a far cry from my area of expertise, but I’m doing my best to find answers to some of my most pressing questions… But before I continue with what I think I know, let me offer an important disclaimer:

I am NOT an endocrinologist, or any kind of medical professional! This blog does NOT purport to offer medical advice, medical opinions, or recommendations. Please take this for what it is – the ramblings of an infertile woman trying to make sense of her complicated treatment protocol!


Now that I’ve got that out of the way, let’s talk about Estrace! I’m currently on day 16 of Estrace supplements. I take two tabs (4 mg total) each evening (and thanks to you bloggy friends, I make sure to silently thank Dr. Y each time for instructing me to take them orally. No smurf sex for me, thank you!)

As I’ve mentioned several times by now, Estrace is just estradiol (E2) – the most potent of the female sex hormones. So, why take estradiol?

Here’s what I think I know about E2:

1) Estradiol serves a similar purpose to that of birth control pills in traditional IVF cycles. That is, it suppresses pituitary signaling to keep levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) low. The idea here is to shut down ‘business as usual’, so that Dr. Y can take control of my hormones with the stims when he is ready.

I was confused by this at first, since in a lot of the hormone signaling diagrams that I got from Dr. Google, estrogens (including estradiol) are shown stimulating the pathway leading to FSH and LH (a so-called positive feedback effect). But upon further study, I learned that moderate levels of estrogens inhibit production of FSH and LH (a negative feedback effect), while high levels of estrogens (such as occur when there are a couple of big lead follicles spitting out estradiol) stimulate FSH and LH production. Endocrinology is weird (and cool…and confusing, but mostly weird).


Here’s some data I collected with a fertility monitor stick that corroborates this claim:


To fully appreciate the significance of this blank stick, you might check out this post about how the CBFM works. In brief, the absence of an LH line (left) shows that no LH is being detected, while the faint E2 line (right) shows the presence of ‘moderate’ circulating E2 levels… (In case you’re wondering, the monitor read ‘high’ fertility due to the estradiol; it doesn’t realize that I’m in the middle of an IVF cycle and won’t be ovulating normally this month…)

But why not just use BCPs like everybody else?

Apparently, it is thought that in some people,  the classic ‘long Lupron’ protocol with BCPs might lead to less responsive ovaries, suppressed ovarian function, and/or decreased egg yields. From what I can tell, this may be a particular concern for members of the DOR club (like me), who need all the ovarian function we can muster…

2) Estradiol helps make lots of EWCM. I can vouch for this side effect of the Estrace pills. However, this is irrelevant to my cycle, since we’re doing IVF. No sperm needs to travel through my cervix this month (via my sperm-friendly EWCM).

3) Estradiol helps to prep the uterine lining for implantation. (Progesterone plays a major role in this, but apparently E2 can help out.) This is also irrelevant for me right now, since we’ll be freezing any embryos and doing a frozen embryo transfer in August. (I’m interested to see if Estrace is part of my protocol for getting ready for the embryo transfer, though. If so, I’ll assume this is the reason.)

4) The most interesting – and from what I can tell, least certain – effect of estradiol is that it in theory (C does a great impression of Dr. Y gesturing with both hands as he tilts his head to the side and says “in theory,…”)

Anyway, in theory, estradiol promotes the gradual, coordinated growth of follicles, which hopefully will yield more, high quality embryos. We don’t want one or two show-off follicles running ahead of the pack. It’s sort of a “No follicle left behind” situation.

Here’s hoping it works!

Leave a comment


  1. Endocrinology is weird… but then again so are endocrinologists… I’ve met my share… they are all nut cases. I hope this protocol works well for you. Hope you get lots and lots of non-showy-offy-let’s-work-as-a-team-and-all-graduate-together kind of follicles this cycle!!

  2. I hope everything works for you! Question – and I may have missed this in a past post, – but why are you doing a frozen transfer in August instead of a fresh transfer right after IVF? (if you don’t mind me ask)

    • Thanks! And I don’t mind at all! (In fact, thank you for reminding me to add links to my post.) In brief, my doctor says that for poor responders, there may be a slight benefit to waiting and letting the drugs clear out of my system for a month and then going for the FET. I think the fact that Clomid is part of my protocol makes this more true (since Clomid tends to dry up the uterine lining…) Here’s more about my protocol, in case you’re interested:

      • Thanks for explaining. I figured you had already talked about it, but couldn’t remember 😀

  3. You make a very good point that we each have a different journey. It’s crazy that while we’re going through IF, most women know that. Then something happens after the baby comes and they forget it. I’m glad your friend was cool about it.

    I’m somewhere in between. I have to have a positive attitude and believe that it will happen, but I have to know why and how. I’m a firm believer in knowledge is power (thank you School House Rock!). 🙂

    • I agree about trying to be BOTH positive and informed. I actually feel _more_ optimistic the more I feel like I have a handle on what’s going on. Also, School House Rock is awesome!

  4. I’ve suppressed with varying amounts of BCPs on both previous IVFs and always had a runaway follicle or two. I think we’ll be trying estrogen priming next time round to stop this very thing from happening. Really interesting info!

    • Definitely take it with a grain of salt…I have no idea how to evaluate the credibility of particular journals or anything, since I’m not in the field. I’m basically just doing PubMed searches for any studies that help me validate Dr. Y’s choice of protocol…

      If you’re interested, I’m happy to send reference info, or pdfs that I find.

  5. stupidstork

     /  June 6, 2013

    Yay! Exciting!

    And good Lord thank Gawd he is having you take it orally… Everytime I’ve had to take anything the more creative way I’ve ended up wanting to burn panties in my backyard.

    • Indeed. I thought the progesterone suppositories were gross (seriously, how many washes does it take until my underwear stops feeling like they’re made out of Wikki Stix?! Estrace sounds so much worse!

  6. Endocrinology is weird… I’m a medical professional, and I’m still somewhat mystified by it!

    Hoping the estrace does the trick, and you don’t have any over-achieving follies developing in there. So very exciting!!!

  7. Good luck with this cycle!!! I have a feeling it will work magic for you (as it did for me) . :). And you are correct, e2 Will be a part of your FET and you’ll continue with it along with progesterone until week 9 or so. I didn’t know this and can’t wait to get these stickers off my belly!!!

    • Good to know!

      I’m so excited to have found a ‘protocol buddy’…and a successful one at that! I had started to think my RE was just inventing protocols on the fly, since I hadn’t seen any others like it…

  8. Another wonderfully informative post. I’m with you: research the heck out of it. If nothing else, at least you’ll know what’s going on. Good luck.

  9. This post is soooo good. Loved it. Thanks!

  10. It’s interesting how every RE is different. Mine is not even putting me on Estrace because she’s afraid that it will also oversuppress me. I’m going to start Menopur directly. Will be exciting to see how estrace will help you.

  11. I am so excited to see that you’re using Estrace too! I’ve been stressing out about my protocol because I’ve not seen any others like it online or in the forums. I don’t have the exact protocol yet, but just the list of meds he has me looking at had me confused. Your explanations in this post made me feel A LOT better. Thank you so much for sharing!

  1. A rousing game of ‘Guess Dr. Schoolcraft’s Answer’ | the infertile chemist

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: