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HomeAnswersInfertilityestradiolI am four weeks and four days pregnant. Yet, my estradiol levels are not increasing. Why?

Should I be worried about my stable estradiol levels during the fourth month of pregnancy, as I had recurrent miscarriages in the past?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Sameer Kumar

Medically reviewed by

iCliniq medical review team

Published At January 28, 2023
Reviewed AtJanuary 30, 2023

Patient's Query

Hello doctor,

I am four weeks and four days pregnant and have had recurrent miscarriages. I had three blood tests for hCG this week. The first was 76 mIU/mL, the second was 223 mIU/mL, and the third was 596 mIU/mL, all within 48 hours of each other. I am on progesterone 200 mg vaginally per day. My concern is that my estradiol levels do not seem to be increasing. I have been testing my hormone levels, and my progesterone has stayed pretty consistent since being on the supplement, but the estradiol seems all over the place. My levels are around 200 to 250 pg/mL and have been that way since I tested positive. Is this normal or an indication of a potential problem?

Thank you.

Answered by Dr. Sameer Kumar

Hello,

Welcome to icliniq.com.

There has been a rise of 63 percent above in each hCG (human chorionic gonadotrophin) value done after 48 hrs each, which confirms a viable pregnancy and that you are progressing naturally. Estriol levels tend to lower with increasing weeks, and the hCG levels serve as a marker for viability which is fine in your case.

Thank you.

Patient's Query

Hello doctor,

Since I am so early, I thought it would still be estradiol instead of estriol, and everything I saw said they were supposed to increase. Is there a “normal” range of estradiol levels at this point?

Thank you.

Answered by Dr. Sameer Kumar

Hello,

Welcome back to icliniq.com.

Estrogen plays a role in initiating an LH (luteinizing hormone) surge before ovulation and also have been known to play a role in better endometrialization and implantation. Still, as the pregnancy grows, the early placenta starts secreting hCG (human chorionic gonadotrophin), which is adequate to maintain the pregnancy, and progesterones secreted by corpus luteum, which, if more than 21 to 40 ng/dl, is considered healthy for developing pregnancy. Although estrogen levels in normal, natural cycles reach 300 to 400 pg/ml before ovulation, a study on donor cycles revealed that the E2 (estradiol) requirement for embryo implantation is low (less than 100 pg/ml). But high peak estriol levels have been associated with lower implantation rates and a higher rate of miscarriages. Hence high estriol levels are not considered good in clinical practice. However, studies are still correlating the rising estradiol levels during pregnancy to viability and healthy progression of pregnancy, but no definite conclusion has been drawn yet.

In clinical practice, HCG support is offered until seven weeks of gestation and followed by progesterone support once the fetal heartbeat arrives to support the pregnancy further.

Hope this helps.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sameer Kumar
Dr. Sameer Kumar

Obstetrics and Gynecology

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