Estradiol levels are essential for monitoring the progress of your in vitro fertilization cycle.
In this article you will find out
- What is the normal range for estradiol levels in an IVF cycle
- What level can be expected on a given day?
- What estrogen levels are considered high
Let's begin.
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What is a good estradiol level for IVF?
The actual level of your Estradiol (E2) during IVF is not as important as the overall trend and number of growing ovarian follicles.
The more follicles grow, the higher your estradiol levels will be.
We like to see approximately200-300 pg/ml Estradiol pro reifem Follicleuntil the day of the trigger shot.
For example, an E2 value of 1000 at oocyte retrieval could yield 3-5 mature oocytes(since not all follicles yield eggs).
*Note: Estrogen and estradiol are often used interchangeably.
What is the normal range for estradiol levels for fertility?
In general, your estradiol should rise regularly until it reaches its peak level, which is usually between 1,000 and 4,000 pg/ml in most patients.
At the beginning of your IVF cycle (around day 3 of the cycle), serum E2 levels should be below 80 pg/mL. At the end of your stimulation (the day of HCG administration), your estradiol can range from 200 pg/mL (if only one follicle is growing) to over 5,000 pg/mL (if you are growing 20+ follicles).
That being said, estradiol levels can vary significantly from person to person, even similar onesnumber of follicles.
How fast do estradiol levels increase?
On average, estrogen increases by 50-100% every 2 days.
For example, if you start an IVF cycle with an estrogen level of 50 pg/ml, you can expect it to rise to 75-100 on day 3 of stimulation.
The more follicles you have, the more estrogen is produced and the faster your E2 levels rise.
Average estradiol levels on each day
Below are typical estradiol serum levels that you can expect in the early follicular phase of your menstrual cycle (before you start stimulation) and throughout the treatment cycle.
Average estradiol level on day 3 or day 4 of your menstrual cycle? (Day 1 of stimulation)
In a patient with normal ovarian reserve, estradiol is typically below 80 pg/mL by day 3. Actual values can range from 20 pg/mL to >100 pg/mL on day 3.
Things that can increase a day 3 estradiol include:
- Decreased ovarian reserve(especially if you also have high FSH and low AMH)
- Recent use of birth control pills
- estrogen supplement
If you are contemplating starting an IVF cycle and your estrogen levels are elevated, we will generally delay starting until we have brought levels back into a normal range.
Mean estradiol levels on days 3-4 of stimulation
After 2-3 days of gonadotropin injections, your estradiol levels will approximately double from baseline.
The typical range is approx
- Low range: ~40 pg/mL
- Mid range: ~100 pgmL
- High range: ~150 pg/mL.
Mean estradiol levels on day 5 of stimulation
On day 5 of stimulation, estradiol levels can range from
- Low range: ~50 pg/mL
- Mid-Range: ~300 pg/mL
- High range: ~500 pg/mL.
Mean estradiol levels on day 6 of stimulation
On day 6 of stimulation, estradiol levels can range from
- Low range: ~70 pg/mL
- Mid-Range: ~500 pg/mL
- High range: ~1200 pg/mL
Mean estradiol levels on day 7 of stimulation
On day 7 of stimulation, estradiol levels can range from
- Low range: ~100 pg/mL
- Mid-Range: ~800 pg/mL
- High range: ~1400 pg/mL
Average estradiol levels on day 8
On day 7 of stimulation, estradiol levels can range from
- Low range: ~200 pg/mL
- Mid-Range: ~1000 pg/mL
- High range: ~2000 pg/mL
Average estradiol levels on day 11
On day 11 of stimulation (which is at the high end of the duration of an IVF cycle) Estradiol levels can range from
- Low range: ~500 pg/mL
- Mid-Range: ~1500 pg/mL
- High range: ~3500 pg/mL
Estradiol levels on IVF chart
The patients were divided into three groups:
Group A: <35 years old
Group B: 35-38 years old
Group C: >38 years old
The three groups were then further classified into
- Poor Responders: Patients in the lower 10th percentile for estrogen levels
- Normal Responders: Patients in the 50th percentile for estrogen levels
- High Responders: Patients in the 90th percentile for estrogen levels
Here's what they found:
| Stimulationstag | Bad answers (10%) | Normal Reply (50%) | High-Responder (90 %) |
|---|---|---|---|
| 5 | 50 | 100 | 480 |
| 6 | 100 | 400 | 1200 |
| 7 | 150 | 550 | 1400 |
| 8 | 250 | 800 | 2000 |
| 9 | 450 | 1100 | 2800 |
| 10 | 550 | 1500 | 3200 |
| 11 | 550 | 1500 | 3600 |
Why is my estrogen low during IVF?
Estrogen can be low during an IVF cycle for one of two reasons.
Decreased ovarian reserve:
Estrogen is released from granulosa cells in growing follicles. If only a few follicles are growing, you have low estrogen levels.
In general, you can expect each mature follicle to produce around 200-300 pg/mL of estradiol.
If you grow two follicles, your estradiol levels may be between 300 and 600 pg/ml at their peak.
If your estrogen levels are below 200 towards the end of stimulation, it is possible that mature eggs will not develop.
Use of Estrogen Blockers:
In some patients it is necessary to maintain low estrogen levels (e.g. patients with estrogen-sensitive breast cancer).
In these situations we use a drug (Letrozole) to specifically suppress estrogen production.
Does low estrogen affect egg quality?
Low estrogen is associated with reduced success rates, mainly due to the fact that fewer oocytes are collected and therefore fewer embryos are created.
But that doesn't seem to apply to the general population.
A retrospective study from2018, conducted at Columbia University, found no significant difference in pregnancy outcome in oocytes collected from oocyte donors who had a “low estradiol response” to IVF stimulation compared to those with a “normal response”.
A low estradiol response was defined as <100 pg/mL per oocyte collected, and a very low estradiol response was <50 pg/mL per oocyte collected, which is much lower than the expected 200-300 pg/mL per mature oocyte.
What estrogen level is high for IVF?
An estrogen level above 3,500 pg/ml is considered high and a risk factor for side effects.
This is because high estrogen levels can lead to the development of ovarian hyperstimulation syndrome (OHSS), which is a potentially serious condition after IVF treatment.
Transferring an embryo as part of an OHSS can significantly worsen the condition and put you at risk for further complications.
Who is at risk for OHSS?
You are more likely to develop high levels of E2 and OHSS if you:
- have polycystic ovary syndrome (PCOS).
- have a highNumber of antral follicleson day 3
- are younger than 35 years
- have a BMI in the lower normal range
What happens if my estrogen level is above 5000 after IVF?
Estrogen levels above 5,000 pg/mL significantly increase your risk of developing OHSS during or after your IVF stimulation.
If you have scheduled a fresh embryo transfer, your provider will likely cancel the transfer andFreeze all your embryos.
You should monitor your symptoms closely and speak to your doctor if you have any of the symptoms of OHSS.
Common symptoms are:
- gas
- nausea/vomiting
- shortness of breath
- weight gain
What role does estradiol play in IVF?
Estradiol plays several important roles in IVF, such as:
- It thickens the lining of the uterus in preparation for embryo implantation
- It helps fertility doctors monitor your response to IVF stimulation and predict the number of eggs you could get at egg retrieval
- It plays an important role in endometrial receptivity and maintenance of pregnancy
Diploma
Estrogen is a key hormone that plays an important role in IVF success rates. This blood test should increase in a reasonably predictable manner as the menstrual cycle progresses, with the likelihood of pregnancy increasing as the egg count increases.
Unfortunately, low estrogen levels indicate a poor ovarian response to stimulation.
On the contrary, if you develop high levels of estrogen in your cycle, it is important that you work closely with your fertility doctor to discuss reducing the risk of OHSS.
Related articles:
- The Human Chorionic Gonadotropin (HCG) Trigger Shot: What You Need to Know
- Egg retrieval day: how to prepare for it
- The woman's biological clock: why older patients respond poorly to an IVF stimulation cycle
Make an appointment today with Dr. Robles to discuss your fertility options!
Alex Robles, MD
dr Alex Robles is a Spanish-speaking Latin American reproductive endocrinology and infertility specialist based in New York City and a board-certified OBGYN. He has a special interest in health, lifestyle and nutrition.Make an appointment today with Dr. Robles to discuss your fertility options!
references
- Theocharis Papageorgiou, Juliette Guibert, François Goffinet, Catherine Patrat, Yvonne Fulla, Yvette Janssens, Jean-René Zorn, Percentile curves of serum estradiol levels during controlled ovarian stimulation in 905 Cycles stimulated with recombinant FSH show that high estradiol levels favor IVF - result is not detrimental,human reproduction, Volume 17, Issue 11, November 2002, Pages 2846–2850,
- Mittal S, Gupta P, Malhotra N, Singh N. Serum estradiol as a predictor of in vitro fertilization success.J Obstet Gynaecol India. 2014;64(2):124-129. doi:10.1007/s13224-013-0470-7
- Li, Xin; Zeng, Cheng; Schang, Jing; Wang, Sheng; Gao, Xue-Lian; Xue, Qing Association between Serum Estradiol Level on the Human Chorionic Gonadotropin Administration Day and Clinical Outcome, Chinese Medical Journal: 20. Mai 2019 – Band 132 – Ausgabe 10 – S. 1194-1201doi: 10.1097/CM9.0000000000000251
- Palmerola KL, Rudick BJ, Lobo RA. Low estradiol responses in egg donors undergoing gonadotropin stimulation do not affect clinical outcomes.J Assist Reprod Genet. 2018;35(9):1675-1682. doi:10.1007/s10815-018-1192-7
FAQs
What is a good level of estradiol for IVF? ›
While total serum estradiol does not exert any positive or negative influence on IVF outcome, estradiol per mature follicle and retrieved oocytes do have an impact. Pregnancy rate is better when E2/fol is between 200 and 299.99 pg/ml.
What is a good E2 level for IVF? ›Loumaye reported that an E2/oocyte ratio of 70–140 pg/mL in long down-regulation protocol correlated with a significantly better pregnancy rate (4). Orvieto et al. (7) reported that in GnRH antagonist protocol, E2/oocyte ratio should reach the 100–200 pg/mL range to achieve the best IVF outcomes.
What is a good range for estradiol? ›Normal levels for estradiol are: 30 to 400 pg/mL for premenopausal women. 0 to 30 pg/mL for postmenopausal women. 10 to 50 pg/mL for men.
What should E2 level be on day 9 of IVF? ›Mean Estradiol level on day 9 is 1402.17 pg/mL.
What is ideal estradiol level for FET? ›Although estrogen levels in normal natural cycles reach 300–400 pg/ml before ovulation, a study on donor cycles revealed that the E2 requirement for embryo implantation is low (< 100 pg/ml)12.
What should estradiol level be on day 6 of IVF? ›Day 6 estradiol ≤75 pg/mL is predictive of cycle cancellation. When the estradiol level is low on Day 6 (no flare), early cancellation should be considered.
What is a good E2 level to get pregnant? ›Just before ovulation, normal estradiol levels can range from 110 to 410 pg/mL. Ideally, estradiol levels should reach about 400 pg/mL prior to ovulation.
What is a good E2 level? ›According to Mayo Medical Laboratories, normal levels of estradiol (E2) for menstruating women range from 15 to 350 picograms per milliliter (pg/mL). For postmenopausal women, normal levels should be lower than 10 pg/mL. Estradiol levels that are higher than normal may suggest: early puberty.
What should E2 be on day 4 of IVF? ›Cycle day 4 E2 levels below 110 pg/ml had an odds ratio of 6.05 (95% CI 2.33–15.7; p < 0.001) for embryo transfer. The early follicular response to ovarian stimulation can be anticipated with the cycle day 4 estradiol levels during COH.
What should your E2 level be before trigger? ›In good responders, triggering ovulation less than 4 days from an estradiol level of 400 pg/mL leads to higher blastulation and implantation rates and likely higher clinical pregnancy and live birth rates.
What does high E2 mean in IVF? ›
With a single follicle, peak E2 levels are about 200-300 pg/ml just prior to ovulation. These high E2 levels causes your cervical mucus to be copious. Estradiol levels during an IVF cycle. During an IVF cycle, we first downregulate you before starting superovulation.