What do the day 10 blood results mean?

According to some extensive blood work I had done, I do not ovulate consistently.  I have been blessed with irregular periods.  

However, we have been TTC#2 and I just finished the CCCT whereby I took 100mg of Clomid (first time) on cycle days 5-9.  I had my blood drawn and both FSH and Estradiol levels tested on day 3 and again on day 10.  The levels on 3/22/10 (day 3) were:  FSH:  4.5 and Estradiol 59.  The levels yesterday 3/29/10 (day 10) were: FSH: 9.7 and Estradiol 163.  

I am using OPK's per the direction of my fertility doctor on cycle days 12-21 (I started early and have been getting negative results - not surprising since I know that it might be too soon to ovulate).

Does anyone know how to interpret these day 10 results?

Thank you!

[Mariana101]

Interpreting day 3 FSH blood test results - what are normal FSH levels?
In our fertility center we currently use an assay made by DPC that is run on an Immulite machine. We consider normal FSH level to be anything less than 9. As levels go above 9 we often see a reduction in response to ovarian stimulating drugs - as described in the table below.

If your FSH levels were run using a different assay, you can not compare your results to those shown below with confidence. For example, with some assays an FSH of 12 is normal.

Day 3 FSH level FSH interpretation for DPC Immulite assay
Less than 9 Normal FSH level. Expect a good response to ovarian stimulation.
9 - 11 Fair.  Response is between normal and somewhat reduced (response varies widely). Overall, a slightly reduced live birth rate.
11- 15 Reduced ovarian reserve. Expect a reduced response to stimulation and some reduction in embryo quality with IVF. Reduced live birth rates on the average.
15 - 20 Expect a more marked reduction in response to stimulation and usually a further reduction in embryo quality. Low live birth rates. Antral follicle count is an important variable.
Over 20 This is pretty much a "no go" level in our center. Very poor (or no) response to stimulation. "No go" levels should be individualized for the particular lab assay and IVF center.

More issues regarding day 3 FSH testing
In general, your ovarian reserve is as bad as your worst FSH. If you have an FSH of 15 in one cycle and then a a 7 in another cycle - the situation is not improving. Some women "bounce around" with FSH levels in the normal to abnormal range. However, they tend to respond and have chances for pregnancy as predicted by their highest FSH level.

Waiting for a menstrual cycle with a lower FSH level and then stimulating right away for IVF is not of any proven benefit.

Young women (under 35) with elevated FSH levels tend to stimulate better and have a much higher IVF success potential than "older" women. The better egg quality in the younger women can compensate for the quantity problem.

More about egg quality, egg quantity and fertility problems

Day 3 estradiol testing
A blood estradiol level on day 3 (we do it on any day between days 2 and 4) of the menstrual cycle is a way to potentially discover some of those women with a normal day 3 FSH that may in fact have decreased egg quantity and quality.
What we want on day three is a low FSH level in conjunction with a low estradiol level. If the FSH is normal but the estradiol level is elevated, the elevated estradiol will often be artificially "suppressing" the FSH level down to the normal range.

The idea of using day 3 estradiol levels as an adjunct in evaluating egg quantity and quality is relatively recent. Clearly defined cutoff values for normal are not well established. We like to see the day 3 estradiol less than about 80. We repeat borderline or abnormal results in another menstrual cycle to try to get a "true" FSH.

There is some evidence that an elevated day 3 estradiol indicates a problem with ovarian reserve. This is sometimes the case, but often the issue is just that the elevated estrogen level is "masking" the potential for detecting low reserve by suppressing FSH into the normal range.

Clomiphene challenge test
A clomiphene challenge test is a dynamic type of test that can discover some cases of poor ovarian reserve that are still showing a normal day 3 FSH.

This test is done by:
Obtaining a day 3 FSH and estradiol
Take 2 tablets of clomiphene (100 mg) on days 5-9 of the cycle
Repeat an FSH level on day 10 of the cycle
The normal Clomid challenge test result is a low FSH on day 3, a low estradiol on day 3 and a low FSH on day 10.

Cut off values for the day 3 and the day 10 FSH values are assay dependent and must be determined by experience with the lab being used.

[sadiejo0306]

Thank you for your response.  I have read that information online, too, but I was unable to determine a reasonable answer for my day 10 labs that were taken.  I guess what I'm wanting to know is, with my day 10 values, is it possible to ovulate and/or conceive?  I'm not sure what the estradiol values are "supposed" to be on day 10 after taking the CCCT.  Any thoughts or insight to that would be appreciated.  Thanks!!

[sadiejo0306]

FYI, I've been also taking 2000mg Evening Primrose Oil Supplements along with Robitussin DM to help reduce the likelihood of hostile CM and to hopefully help my body thin out the CM to help with ovulation by increasing more EWCM.  (TMI, sorry)...

[Mariana101]

In the normal menstrual cycle, estradiol levels measure typically <50 ng/ml at menstruation, rise with follicular development (peak: 200 pg/ml), drop briefly at ovulation, and rise again during the luteal phase for a second peak. At the end of the luteal phase, estradiol levels drop to their menstrual levels unless there is a pregnancy.


************** So basically your numbers are GREAT!!!

Estradiol: Day 3: should be less than 80
               Day 10: peak is 200 (follicle development)
FSH: Should stay low (less than 9 is the best)

HUGS:)

GOOD LUCK:)

[sadiejo0306]

Thank you!  That is what I was looking for!  Do you even have any idea how hard it is to find information that says exactly what you summed up for me (I'm sure you do!)?!  Thank you so much.  What a relief...