Wednesday, August 22, 2012

CD3 Results Normal? Not Buying It!

It's amazing how fast my mood can change when I'm being analyzed like a lab rat. Here I was, having a hunky dory week and very content with the new game plan this cycle. I took it upon myself to request CD3 blood work (FSH & estradiol) to be done again, and I'm glad I did. After waiting for 5 days, I finally got the results back. That wait alone is nerve wracking!

I had my OB/GYN order the test, because I know if my RE orders it, insurance will deny my claim. Tricky little buggers! Little do they know, I have found a couple little tricks of my own to get around their endless claim denials.  I'm seeing my OB/GYN this cycle anyway in an effort to give Femara a try without having to pay the huge price tag of seeing my RE.  Again, visits to my OB/GYN are covered and visits to an RE are not. You may wonder why I would try to pinch pennies when I want a child so badly, but until you've experienced fertility medicine, you can't understand just how fast you can blow through extremely large sums of money. However, after today, I am wondering if it's a good choice to stick with my OB/GYN after all, despite the thousands in savings.

Without further adieu, here are my results:

FSH= 8.3 (normal)
estradiol= 16

Now, this is where my OB/GYN and I TOTALLY DISAGREE
. The nurse of my OB/GYN called me today to say, "We got your test results back and they look great!" A wave of relief washed over my body, and then I politely asked what those results were, because I keep track of all this stuff for my records.  Then she told me the above numbers. Hmmmmm

I knew the FSH was normal off the top of my head. However, once I got home I hopped on the computer to start fact checking their results. Can you tell I don't believe anything dr.'s tell me anymore at this point?  Low and behold, every single piece of info I can find on normal estradiol level tells me that a level of 16 on CD3 is absolutely NOT NORMAL. This is the type of thing I'm reading all over the freaking internet...

Estrogen (Estradiol) Levels:
Estradiol is the primary human estrogen -- and when your ovaries begin to fail, your circulating estradiol levels drop. This is why doctors often give you a serum estradiol concentration test to measure the amount of estradiol in your blood. In this case, the doctor is looking to see if your estrogen levels are lower than normal -- again, a signal of ovarian failure, or, in other words, early menopause.

• Normal estradiol Day 3 value -- 25-75 pg/ml
• Important note: If your FSH hasn't reached post-menopausal levels and your estradiol is on the low side, you are not considered POF or EM. There can be other reasons for low estradiol, including excessive exercise, low body fat, and diminished ovarian reserve. This is because estradiol levels tend to drop over time. During the first 2 to 5 years following menopause or ovarian failure, blood levels of estradiol drop to an average range of about 25 to 35 pg/ml. Women not on HRT generally will see this number drop even more over time; after about five years, it's common for menopausal women who aren't on HRT to have estradiol levels below 25.

Ok, so you tell me if I'm crazy, but a 16 is clearly not within the normal range for CD3 blood work right?  So, I call back and ask to speak with the nurse. I debate with her for at least 5 minutes. She claims that their "normal" range is (15-350) and says she asked both dr.s at the practice, who both say my labs are normal. They refuse to acknowledge my level is low at all, despite all the other info out there. Do a Google search and you will see why I'm freaking out here. I realize the internet isn't always right, but I'm seeing the same info on multiple websites, from doctors, fertility websites, etc.  Even if I went by my doctor's supposed normal scale, a 16 is still right at the bottom of their range. So frustrating! I feel like I'm talking to a brick wall.

I hang up the phone, completely dissatisfied with the response, and then start fixating and analyzing even more...You might notice in the info above, that the reasons listed for low estrogen (outside of menopause) are "excessive exercise, low body fat, and DOR." I'm pretty sure I don't have DOR. My RE has already ruled that out. And Lord knows I am no longer exercising excessively and my body fat is definitely not too low anymore....hasn't been for a year now. Of course, now I can't help but wonder if all the exercise that made me stop having my period for almost 3 years has also done irreparable damage to my hormones. Is that the reason for my low estrogen?? I wouldn't be suprised one bit. It screwed everything else up, so no telling. Ugh.

I broke down crying from the frustration twice tonight...partly because these weren't the estradiol results I was hoping for and partly because I feel like I'm already back to pulling teeth from dr.'s to get answers I can actually trust and understand; Answers that are based on my individual circumstances. I hate feeling this way, but every time I get a blood test that comes up low like this, it just makes me feel like a failure. Seeing the words "menopausal" to categorize my level of estrogen is so depressing! What a nice warm welcome back to the wonderful world of Western medicine.

For now, I'm stuck waiting until I go in for my CD13 ultrasound to ask my OB/GYN face-to-face how on God's green Earth does she think these levels are normal?   It will take a strong argument to convince me that 16 is a healthy level, but who knows, I may go in and see a fantastic response to the Femara; big fat follicles and a lovely thick lining that is picture perfect for conception. At that point, you can expect another mood swing from me in the other direction. I'll let you know when it's time to break out your butterfly nets, but as for now, you can keep them tucked away in the shed. Definitely no butterflies to chase here tonight.

I'm trying my best to relax and just see this cycle as an experiment; To see how my body responds to Femara on it's own, without any other added meds. There is just only so much that most OB/GYN's know with regards to more complex issues of infertility. I will use my OB/GYN to get what information I can this cycle...sort of a "baseline response to Femara" and leave it at that.  If I have a thin uterine lining (anything under 7 or 8 mm) at my CD13 ultrasound, this will verify my suspicion of low estrogen (since that is what builds the lining) even further. Furthermore, if I do not get pregnant this cycle, I'll at least know what my response what to this medicine and will be able to return to my RE with some new information to work with.


  1. i'm going through the same thing right now with my thyroid... i got my GP to run the test because my RE is booking two months out, and they came back "normal", TSH at 3.68 on a scale of 0.1-6.0 . the thing is that "normal range" for the last 10 years has actually been 0.3-3.0, but "optimal" for ttc is 1.0-2.0 ... and i had to find all of this out myself, i just got, "yeah, they're all normal".

  2. Yep, I also understand about the thyroid issues. Great example. Thyroid interpretation is so varied among doctors! Think my nutritionist said it best "All of your hormones function AND dysfunction together." My PCP says my results for thyroid are "normal" but my nutritionist (she's also an RN) tells me I have subclinical hypothyroid....that my thyroid hormones are not converting to active forms optimally.

    TSH = 0.7 range (0.3-5.1)
    Total T3= 90 range(90-200)
    Free T4= .99 range (.73-1.95)

    Here again, all at the low end of the spectrum on each range they give, especially T3 and TSH. I have an apt. 10/30 with an endocrinologist who specializes in thyroid disorders, but had to beg to get in, because my levels are "technically normal."

    I don't want to "create" a problem if it's not there, but I know there is obviously something keeping me from getting pregnant, and all of these low tests to me are an indicator that my hormones are not functioning as well as they do in most people. And none of them are showing results within optimal ranges for someone trying to conceive. I think it's really important to tryt to figure out exactly what the problems are, because if I'm going to incorporate fertility meds, I want to make sure I'm addressing the problem correctly and not just throwing tons of the wrong meds at a problem all willy nilly.

  3. I think you got a great game plan. Perhaps your labs are a bit low because you need those meds to help you back on track. You know you can get've done it once before its just a matter of getting one to stick.

    I was in the same position when my dr said my 10.2 p4 on a medicated cycle was great! I was like uhhh not according to everyone on the AT board and all over the internet. But he explained to me that it was great but showed that I only ovulated one good egg and not 2 like with the clomid. So natually my p4 was a little lower.

    I would bring it up too at the appointment and maybe she could explain herself more. I found that sometimes it was frustrating talking to the nurse because they are very impatient sometimes and dont know the whole story. Thats why I loved that I could message my dr myself through an online health service so I could go right to the source.

    Hopefully you respond well to the femara! I think you will! I think like you said being annov for 3 years really depleats your body and perhaps you need a few good cycles to really raise those hormones and get your body used to nice strong ovulation. I didnt realize that such heavy excercise could do that to your body! Once I started to taper off my running and took the meds it made all the difference for me! Even though I got pregnant the cycle AFTER all my months of meds I really think indirectly it helped in the longrun. I'll be looking forward to your ultrasound update!