Let’s get started.<\/p>\n\n\n\n Estrogen priming is the process of using estrogen pills in the preceding cycle before your IVF cycle <\/a>to prepare your ovaries for stimulation.<\/p>\n\n\n\n The hope is that estrogen priming helps you respond better to IVF stimulation and have a more successful cycle.<\/p>\n\n\n\n Estrogen priming may enhance IVF stimulation by synchronizing the growth of your follicles.<\/p>\n\n\n\n You see, the goal of an IVF cycle is to grow multiple follicles so that we can collect as many eggs as possible during the egg retrieval procedure.<\/p>\n\n\n\n However, not every follicle grows at the same rate.<\/p>\n\n\n\n In addition, it is possible for you to have a larger follicle already growing before the stimulation phase begins.<\/p>\n\n\n\n In theory, priming the ovaries with estrogen may help prevent uneven growth of your follicles.<\/p>\n\n\n\n Estrogen priming can also be beneficial for patients who had a poor response in a previous IVF cycle.<\/p>\n\n\n\n More on that later.<\/p>\n\n\n\n The benefit of having your follicles grow at similar rates is that it can increase the chance of obtaining the highest number of mature oocytes (eggs).<\/p>\n\n\n\n The bigger the follicle (~16-22 mm), the more likely we will retrieve a mature egg from it.<\/p>\n\n\n\n In contrast, smaller follicles (<14 mm) are more likely to yield no egg, or an immature egg.<\/a><\/p>\n\n\n\n In an ideal world, all of your follicles would reach 16-22 mm at the same time, rather than having one or two follicles leading the others by a large margin.<\/p>\n\n\n\n There is only so much time you can give the smaller follicles to catch up once you have two or more follicles above 18 mm.<\/p>\n\n\n\n Estrogen priming is typically done for about seven days before the start of controlled ovarian stimulation (the IVF cycle). <\/p>\n\n\n\n Before starting the pills, we need to wait until you are in the correct stage of your menstrual cycle (the luteal phase).<\/p>\n\n\n\n Some reproductive endocrinologists prefer to see you in the office to do an ultrasound and bloodwork first. This appointment ensures that you have ovulated and are in the luteal phase.<\/p>\n\n\n\n Other doctors feel comfortable having you start the medication seven days before your anticipated menstrual cycle.<\/p>\n\n\n\n One last option is using ovulation predictor kits.<\/p>\n\n\n\n An ovulation predictor kit (OPK) is another helpful tool to help you time your estrogen priming.<\/p>\n\n\n\n The OPK measures the luteinizing hormone (LH) in your urine, which will surge ~24 hours before you ovulate.<\/p>\n\n\n\n Start testing the OPK ~10 days after the start of your menstrual cycle. Most women will have a positive test on days 12-14. Once you get a positive test, wait exactly one week to ensure you are in the late luteal phase.<\/p>\n\n\n\n After the week, begin the estrogen pills until you get your next bleed.<\/p>\n\n\n\n Here is an example of the calendar for an estrogen priming protocol.<\/p>\n\n\n\n The recommended dose of estrogen for priming is 2 mg twice a day. You could also use an estrogen patch to get the same effect.<\/p>\n\n\n\n *Note: Estrogen priming is not the same as birth control pills.<\/p>\n\n\n\n The most common side effects of estrogen medication include<\/p>\n\n\n\n However, these side effects are usually mild and will dissipate after a few days.<\/p>\n\n\n\n Most patients don’t experience any side effects at all.<\/p>\n\n\n\n Unfortunately, estrogen priming does not improve egg or embryo quality.<\/p>\n\n\n\n As far as we know, there are no concrete strategies to improve egg quality.<\/p>\n\n\n\n The best thing that you can do is to live a healthy lifestyle which includes:<\/p>\n\n\n\n Estrogen priming does not reduce the number of antral follicles<\/a> you have at the start of an IVF cycle.<\/p>\n\n\n\n It does, however, prevent follicles from growing. This is how it works to synchronize follicular growth during controlled ovarian stimulation.<\/p>\n\n\n\n Estrogen priming may also be helpful for patients who have had a poor response to IVF treatment (aka, a poor responder).<\/p>\n\n\n\n Poor responders often have diminished ovarian reserve (DOR) and elevated levels of follicle-stimulating hormone (FSH).<\/p>\n\n\n\n This is problematic because FSH is the primary hormone we use to stimulate your ovarian follicles.<\/p>\n\n\n\n If your ovaries are already exposed to high levels of follicle-stimulating hormone, they are much less likely to respond to additional FSH injections.<\/p>\n\n\n\n In these cases, estrogen priming may improve ovarian responsiveness to the medications by reducing the levels of FSH in the body before the stim.<\/p>\n\n\n\n The data looks promising, but the clinical trials are not recent.<\/p>\n\n\n\n For example, a 2012 retrospective study <\/a>of 155 poor responders found that patients who received luteal estradiol had a lower cycle cancellation rate and a higher number of oocytes at the egg retrieval than the control group. There was also a trend toward better fertilization rates, but those data did not reach statistical significance.<\/p>\n\n\n\n Other smaller studies had similar findings.<\/p>\n\n\n\n Based on the available literature, estrogen priming may improve clinical pregnancy rates in poor responders.<\/p>\n\n\n\n A systematic review and meta-analysis<\/a> of eight studies found that estrogen priming improved clinical pregnancy rates by 33%.<\/p>\n\n\n\n However, this study is from 2013 and has a relatively small sample size. More research is needed.<\/p>\n\n\n\n We can use estrogen priming with any ovarian stimulation protocol. The most common IVF protocols include<\/p>\n\n\n\n Luteal phase estradiol can be a useful tool for improving the follicular response in an ovarian stimulation cycle. Studies show that it can help synchronize follicular growth and reduce FSH levels in low responders.<\/p>\n\n\n\n However, more research is needed to determine if it can improve the clinical pregnancy or live birth rate.<\/p>\n\n\n\n Be sure to talk to your fertility doctor to learn if estrogen priming is right for you.<\/p>\n\n\n\n Make An Appointment With Dr. Robles To Discuss Your Fertility Options Today!<\/strong><\/strong><\/p>\n\n\n\n![\"Estrogen](\"https:\/\/alexroblesmd.com\/wp-content\/uploads\/2023\/02\/Estrogen-priming-for-IVF-cover-image.png\")
<\/figure>\n\n\n\n\n\nWhat Is Estrogen Priming?<\/h2>\n\n\n\n
What Does It Do?<\/h2>\n\n\n\n
Why Does Synchronized Growth Matter?<\/h2>\n\n\n\n
![\"ultrasound](\"https:\/\/alexroblesmd.com\/wp-content\/uploads\/2023\/02\/follicle-growth.png\")
<\/figure>\n\n\n\nHow Many Days Do You Need Estrogen Priming For?<\/h2>\n\n\n\n
![\"picture](\"https:\/\/alexroblesmd.com\/wp-content\/uploads\/2021\/08\/menstrual-cycle-hormones.png\")
<\/figure>\n\n\n\nHow To Use An Ovulation Predictor Kits To Time Luteal Phase Priming<\/h2>\n\n\n\n
Estrogen Priming Protocol Calendar<\/h2>\n\n\n\n
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![\"calendar](\"https:\/\/alexroblesmd.com\/wp-content\/uploads\/2023\/02\/estrogen-priming-calendar.png\")
<\/figure>\n\n\n\nWhat Is The Dose?<\/h2>\n\n\n\n
Possible Side Effects of Estrogen Priming<\/h2>\n\n\n\n
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Does Estrogen Priming Help Egg Quality?<\/h2>\n\n\n\n
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Does It Reduce Antral Follicle Count?<\/h2>\n\n\n\n
Is Priming Helpful For Poor Responders?<\/h2>\n\n\n\n
What Does The Data Say?<\/h2>\n\n\n\n
Does it Help Improve Clinical Pregnancy Rates?<\/h2>\n\n\n\n
Does Priming Help Most With Specific Ovarian Stimulation Protocols?<\/h2>\n\n\n\n
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Conclusion<\/h2>\n\n\n\n
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![\"alex](\"https:\/\/alexroblesmd.com\/wp-content\/uploads\/2023\/03\/alex-robles-md.jpeg\")
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