Why Do I Need to Use Estrace During my IVF Cycle?

Female doctor showing medicine to a patient
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If you and your partner are about to undergoing In Vitro fertilization (IVF), chances are your doctor has prescribed estrogen to help you conceive. Given that many women with PCOS are estrogen dominant, this may come as a surprise. Estrogen supplementation during an IVF cycle involving gonadotropins and/or gonadotropin-releasing hormones is now commonly used by many infertility specialists.

One of the major hormones of pregnancy, estrogen helps maintain the endometrial lining of the uterus.

Reproductive Endocrinologists (REs) prescribe estrogen supplements to help support the growth of the endometrium.

A meta-analysis published in Medicine looked at 11 studies involving estrogen supplementation plus progesterone as luteal phase support in patients undergoing IVF. They concluded that taking both progesterone and estrogen supplements during IVF treatment after the egg retrieval was associated with a higher clinical pregnancy rate than progesterone alone in women undergoing IVF, but other outcomes such as ongoing pregnancy rate, fertilization rate, implantation rate, and miscarriage rate were found to be the same for both treatments.

Estrace, or estradiol, is the form of estrogen most commonly prescribed. Dosages of 2 mg two to three times a day are typical. Some REs may instruct you to insert the pill into the vagina instead of taking it by mouth. It is the same pill, just given in a different manner.

It is important to know a few things if you take Estrace vaginally. First, you may notice a blue-green discharge. This is nothing to be concerned about; it is only the pill fragments breaking. Second, you should lay down for at least a half hour after insertion to prevent the pill from falling out. And third, if you are having difficulty with insertion, you can wear a latex glove to prevent the pill from breaking up under your fingernail.

Your doctor will probably want you to be periodically monitored through blood testing and/or ultrasounds. Periodic adjustments may be needed to optimize your hormone levels and endometrial lining. Make sure to follow your RE’s recommendations regarding estrace dosing.

Sources:

Zhang XM1, Lv F, Wang P, Huang XM, Liu KF, Pan Y, Dong NJ, Ji YR, She H, Hu R.Estrogen supplementation to progesterone as luteal phase support in patients undergoing in vitro fertilization: systematic review and meta-analysis.Medicine (Baltimore). 2015 Feb;94(8):e459. 

"Estrogen plus progesterone supplementation for luteal phase support in in vitro fertilization and embryo transfer." S. Chen, H. Li, L. Kong, L. Zhu, X. Zhang, F. Xing. Fertility and Sterility - September 2004. Vol. 82, Pages S191-S192.

"Estrogen addition to progesterone for luteal phase support in cycles stimulated with GnRH analogues and gonadotrophins for IVF: a systematic review and meta-analysis." E.M. Kolibianakis et al. Human Reproduction - June 2008. Vol. 6, pages 1346-54.

Updated by Angela Grassi, MS, RDN, LDN

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