. = Not sure whether I should contact my Dr to raise the concern, or if its not important so long as I do surge/ovulate. 559562, 2007. Create an account to follow your favorite communities and start taking part in conversations. MeSH Create an account or log in to participate. Predictive factors for intrauterine insemination outcomes: a review. Follicle Scan: big gap in follicle size? Left had 1 at 21mm right had 2 at 13mm, 1 at 12mm, 1 at 11mm, and 1 at 9mm. We strive to provide you with a high quality community experience. 13x11 average 12. Meledaisy- Thank you so much for sharing your story and experience. However, these data, derived from postmenopausal breast cancer patients, may not be applicable to reproductive age women, especially those with elevated estrogen levels due to chronic anovulation and excessive BMI. 9, pp. I would be tempted to try and get some of those smaller ones beefed and shoot for more. Has your doctor prescribed Metformin? < The optimal follicular size before triggering ovulation in intrauterine insemination cycles with clomiphene citrate or letrozole was found to be in the 23-28 mm range. )So here are the sizes of the follicles Left side. We figured a cycle trying with Letrozole and nothing else was better than not trying! IUI #2 - 1 follicle that was 23mm. Dr was happy and sent me home saying Id ovulate within the next few days. Wouldn't that be fun not needing it! I usually get a CD 12 scan and maybe a CD 14 scan as well. Does that mean I basically have a lead follicle and the two smaller ones wont ovulate? I had what looked like 4-5 follicles last cycle (considered canceling), but my estradiol was under 800 so we proceeded on. Or is it possible for the lead to grow to 22mm, the next one gets to 18mm and then those two ovulate together? Invitro fertilization treatments with the use of clomiphene citrate or letrozole. Predicted ovulation number was greater for increasing doses of the drug, and endometrial thickness was unaffected. 284 took 5 mg letrozole daily for five days on Cycle Days 3-7 . Yes, its possible for a follicle to get too big before ovulation. I have pcod and i am undergoing a usg ultrasound follicular study. Maybe they'll give you a few more days if its or quite there? Would using a trigger shot give one of the little ones a chance? A pilot study, Annals of Oncology, vol. Once follicles are in active growth, they can grow 1-2mm per day. Predicted ovulation number was calculated based upon the size of follicles on day 11, with a 1.7mm per day adjusted increase until the day of triggering ovulation with human chorionic gonadotropin (hGG) [6]. What to Expect supports Group Black and its mission to increase greater diversity in media voices and media ownership. I have pcos and im currently doing a letrozole cycle - i took letrozole cycle days 2-6. I am a 29-30 day cycle and ovulate day 15 99% of the time and femara totally messed that up. Have been trying without any medication for a year now. Please whitelist our site to get all the best deals and offers from our partners. 8, pp. We all struggle with infertility here. Press question mark to learn the rest of the keyboard shortcuts. 2 thanks yeah beta was BFN .. worst part was talking to the crap doctor I had to confirm it! I'm on 12.5mg femara (letrozole) cd 3-7 then gonal f 200 iu days 8-10. my follicles Late is fine. 0 I did an opk today and it showed high fertility, so I'm feeling like I will at least respond to the medication well. Good luck and hang in there! Yes I think it can make you ovulate late hence they usually trigger so they know exactly when 16 is the minimum they want so hopefully soon. Kansas City. I had my day 11 ultrasound today. Setting: ovarian follicles I usually ovualte around cycle day 22 without clomid and then the past clomid cycle ovulated on day 17. letrozole 1 mg/kg/day of 21 days: Sprague-Dawley Rats (n = 24) The increase in the corpus luteum and antral follicle improved the estrus cycle and reduced the effect of histomorphological changes in developing cystic follicles and ovaries in PCOS. A retrospective study. They claim it is due to privacy so you have to enter the information in twice if you have been using another app. ). Furthermore, at a dose of 2.5mg daily, it takes 24 days for maximal suppression to occur [13]. Does this seem a bit early or am i paranoid? Design: Don't give up. = Follicles mature and rupture at 18 to 20 mm size. You could quite possibly ovulate before your next appointment (it happened to me). The Dr ordered another 5 more days of taking 12.5 MG a day of femara. Going back for another scan on CD 15. 13x10 average 11. linds99 - October 17 46, pp. Jul 7, 2009. Hi there, I've done a couple of monitored and medicated cycles now, and yes, I would be THRILLED to have a scan on cycle day 11 and have follicles at your sizes. Please specify a reason for deleting this reply from the community. I usually do 5mg of femara from cd 3-7 and start monitoring on cycle day 14, because usually my follicles are at about 9-11mm then! Group Owners uphold the core values of the brand by reporting content that violates the community guidelines. I didn't have an ultrasound until day 13 so I am not sure what I had at day 11. 7, no. I don't know what they will do if they are not. I Are you also on Metformin? Love and hugs to you. She seemed to give me the impression that even going up to 7.5 would be not helpful. TIA xx OP posts: See next See all Overall, follicles of 16-22 mm on the day of oocyte retrieval are more likely to contain mature oocytes than smaller follicles, while larger follicles are more likely to contain post-mature oocytes ( 1 ). In addition, we believe randomized trials comparing high-dose to low-dose administration would help determine the optimal starting dose for this medication in women of varying diagnoses. Since the treatment goal differs in women with ovulation dysfunction (1-2 ovulations) versus women undergoing controlled ovarian hyperstimulation with other diagnoses (2-3 ovulations or more), these groups were separated and compared (Table 2) [8]. Took letrozole and injectibles and had 3 IUIs done in Dec2010, Jan 2011 and April 2011 all BFNs took a 4 month break from meds started TTC journey again in Dec 2011.. Lezra 2.5mg days 2-6, Gonal F 75IU on CD 7-9.. U/S on Day 11 showed leading fllicle size as 11mm.. upped Gonal F to 150IU on Days 11 & 12 CD 13 No growth at all.. leading follicle size was 12mm cycle bust!! I know you don't ovulate on your own and I don't either, but with medication, sometimes my body will do an LH surge on its own without use of trigger. If you checked your follicle sizes early this morning, they could have still grown a bit, they average about 2 mm per day, so I would say you would be at least a 13 or 14 mm tonight/tomorrow morning. G. Bisagni, G. Cocconi, F. Scaglione, F. Fraschini, C. Pfister, and P. F. Trunet, Letrozole, a new oral non-steroidal aromastase inhibitor in treating postmenopausal patients with advanced breast cancer. Prajapati K, Desai M, Shah S, Choudhary S, Aggarwal R, Mishra V. J Pharmacol Pharmacother. The cycle was a flop which I kind of expected knowing how big the follicles were, but its still disappointing. ). On CD13(today) I have one @13 and another 12. Hi there everyone,one I'm learning a lot by reading all this stuff,I'm 41 and had a fibroid removed (1.75) back on may they to me to try three months getting prego on my own,but two months after my doc told me lets not waist time lets go with medication so was put on puregon,first time at 75 iui,then got down to 62.5cuz they said it was going xtremly well then got hcg shot and got on schedule intercouse,then got in progesterone,did that for two weeks I would say and went for my blood work to see if I was prego?came back negative,then back on cycle monitoring and find out I have a tiny cist doc told me that sometimes that's the reason meds sometimes don't take,and also told me that my estrogen level was high at 200 which I don't know if us good,went the week after that and it was down to 180,and the doc on site told me that my cist was completely gone but to try this month naturally,and told me that I was a long cycle which I always thought I was 28,and I have never ask my doc what size at my follicles and what at good size would or should be,all I know that I have six,cuz I look at the ultrasound report before giving in,now I will be going this morning for another monitoring,and I'm at lost and stress out that I haven't gotten prego(bfr prego four times and all lost) and hubby has two kids of previous relation,one is16 and the other 13, and don't know why,anyone,would live to hear something,THANK YOU. We respect everyones right to express their thoughts and opinions as long as they remain respectful of other community members, and meet What to Expects Terms of Use. 98111, 1993. I am also having a bit of EWCM, so maybe my estrogen is building up. Intervention(s): Thus, when the patients goal for number of predicted ovulations is not met with lower doses of the drug, it seems reasonable to explore their response to a dosage of 1012.5mg daily. Someone told me its impossible to ovulate off both sides during a medicated cycle but Im 99% sure thats totally incorrect. It happened to me this last month. Alternatively, if there are 2 follicles 16-20mm and at least 2 more that are 13-15mm, we can proceed to the egg . 0 Then we will wait 2 weeks to find out and do iui next time if it doesn't. To determine the optimal size of the leading follicle before human chorionic gonadotropin (hCG) administration in cycles with clomiphene citrate (CC) and letrozole, and to examine any differences in the optimal leading follicle size between cycles with CC and letrozole. My ob doesnt do additional scans or the trigger shot, so Im not sure what to expect. Please suggest what does all this mean. However, for each endometrial thickness, the optimal follicular size of the leading follicle was different. 4 Ficus deltoidea ameliorates biochemical, hormonal, and histomorphometric changes in letrozole-induced polycystic ovarian . So I'm in no hurry to have another surgery. We did another US at CD13 and I had a 20.5 and the other ones had disappeared (she couldn't locate my R ovary so who knows..). next steps for failed letrozole cycle. Treatment Outcome of Ovulation-inducing Agents in Patients with Anovulatory Infertility: A Prospective, Observational Study. They likely expected that Clomid would make them grow faster and ovulate sooner You might want to ask if femara might work better for you? Government-sponsored gaming including 5 separately run private lotteries is permitted. I also have PCOS. Press J to jump to the feed. I have my ovidrel shot already. In the initial such study, 5mg daily produced a higher number of ovulations than 2.5mg [10]. They brought me in on CD 12 for monitoring and I already had 24 and 29 mm follicles and LH wasnt surging so I ended up using a trigger shot that night. You may also have follicles that need a little extra coaxing, which isn't a bad thing. Mendez Lozano DH, Lenero MV, Gonzalez RL, Scheffer JB, Gonzalez MT, Barron Y, Frydman R. Facts Views Vis Obgyn. Im wondering if that follicle will just keep growing and I can expect to ovulate late, or is it possible that it wont grow? Glad you got your positive! Correlation between 25-hydroxy vitamin D levels in women and in vitro fertilization outcomes: A cross-sectional study. Although I have no idea how well afford it, I love that ivf allows for genetic testing, and decreases the chances of another later loss! 0 . A class of drugs known as aromatase inhibitors also has the potential to enhance FSH release, not by the inhibiting estradiol-receptor interaction, but rather by inhibition of estradiol synthesis. Both data sets were analyzed for normality with no indication to reject the null hypothesis of the data being normally distributed (data not shown). I'm having a really hard time dealing with the disappointment of it failing but I just have to keep breathing and moving forward. Good luck to you!!! 99/284 (35%) also injected gonadotropins at physician's discretion. They tend to grow 2mm per day so yes u still have some hope for this cycle but re should consider upping your dose and starting u on it at cd 3. 0 Bookshelf They should be minimum 18. Descriptive statistics were calculated for all variables in an univariate manner. . Depending on the results I either have to wait a few more days and go in for another u/s or I can take the trigger shot.. Has anyone else experienced 16mm follicle on cycle day 11 that lead to pregnancy? We strive to provide you with a high quality community experience. If you are iui, this might be why they are wanting them to grow faster? 2005-2023Everyday Health, Inc., a Ziff Davis company. Whenever I'd get frustrated about not having large follicles early on, my nurse would remind me that I have PCOS and that it was simply how my body responded. I was put on Metformin, which helps the insulin resistance sometimes caused by PCOS. 18, no. Cycle busted they upped my dose to 150 ius per day for another 3 days but my follicle went up only till 13*12 on cd 16 hopes deflated!!! All patients treated with letrozole and intrauterine insemination at the Wisconsin Fertility Institute (Middleton, WI USA), from January, 2007, to December, 2009, were included in the study. Hope this helps! Follicles are minute in size at the beginning of menstrual cycle. Leading follicle diameters and endometrial thickness were recorded 24 hours before hCG administration, together with other cycles parameters, and were compared between pregnant and nonpregnant patients. Today is CD11 of my 3rd Femara/Letrozole cycle. We went through with the IUI and now I'm waiting to see! Crazy. and transmitted securely. Last time, my progesterone levels were really good, so I feel ok w that plan. Does anyone have any insight? pmblake - October 17 It was at an 11. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. official website and that any information you provide is encrypted 5, pp. Furthermore, randomized trials are needed to determine whether high-dose letrozole might actually be optimal as a starting dose for certain treatment groups. Im 39 so theyre good with me having three follicles. think twice before sharing personal details, foster a friendly and supportive environment, remove fake accounts, spam and misinformation, delete posts that violate our community guidelines, reviewed by our medical review board and team of experts. 2, pp. I'll be crossing my fingers for both of us that these follicles get their act together! Leading follicle diameter and intrauterine insemination outcome. 2015 Dec 28;7(4):231-237. Thicker endometrial lining led to a higher probability of pregnancy. 0 Hi! I am doing an ivf cycle - but am on cd 10 - and my follicles are about 12-14, which is close to where you are. Just relax and give them more time to grow. = Wishing you luck! One-way analysis of variance was performed as needed. Anyway, she planned for me to trigger on CD15 for O on CD16 but I ended up getting a positive OPK on CD14, so presume I Oed CD15. The optimal size of the leading follicle in ovulation induction with CC and letrozole is similar for both drugs and is closely related to the endometrial thickness. Did trigger that night (Dec 13th) and iui on the 15th. 29512956, 1999. Ended up in the ER due to the blood loss and pain. EDIT: Forgot to mention that we are doing Letrozole/Trigger Shot/Timed Intercourse this cycle, but will pursue on the next if this isn't successful. How is your endometrial lining? It could possibly be cd15. Baby dust. 2: Kelulut Honey 1 g/kg/day 35 days: Oestrus Cycle, Hormonal Profile Oxidative Stress: letrozole . I ended up getting a pos OPK on CD 20 and we did our IUI the next day. I hear story after story of people not getting pregnant with the perfect follicle size and then hear stories about it working for people with a 14mm follicle. Is that 4mm gap between the lead and the other two too big? Please whitelist our site to get all the best deals and offers from our partners. Ive had fertile CM for the last 3 days and had positive OPK this morning. The views expressed in community are solely the opinions of participants, and do not reflect those of What to Expect. repeated meds.. Femara 5mg. The daily dose can be increased to 5 or 7.5 mg if needed. How many medicated cycles have you done? 1 Once follicles are in active growth, they can grow 1-2mm per day. A. M. Badawy, M. Metwally, and M. Fawzy, Randomized controlled trial of three doses of letrozole for ovulation induction in patients with unexplained infertility, Reproductive BioMedicine Online, vol. 3 But I am still in extreme pain. Didnt happen until the following Saturday, so about a week later than she expected. Physicians, not randomization, determined patient letrozole dosing. Unauthorized use of these marks is strictly prohibited. 83, no. ; (3) what effect does higher-dose letrozole have upon endometrial development? Find advice, support and good company (and some stuff just for fun). Letrozole works by reducing estrogen levels in order to stimulate ovulation. Unable to load your collection due to an error, Unable to load your delegates due to an error. Please select a reason for escalating this post to the WTE moderators: Connect with our community members by starting a discussion. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). And good luck!!! 1997-2023 BabyCenter, LLC, a Ziff Davis company. ) as did age ( 296300, 1991. By 2001, it had been used in anovulatory women with great success, and at present the drug is extremely popular among physicians and patients in the treatment of both ovulation dysfunction and for controlled ovarian hyperstimulation: the drug has a half-life of only 45 hours, and side effects, while similar to those of clomiphene, are far milder and less frequent [3]. Ages ranged from 23 to 47 years. Hi Ladies! You may want to talk to your doctor about adding in a trigger shot. The FSH is Follicle Stimulating Hormone-pretty self-explanatory, it's the hormone that stimulates (or grows) your follicles. At . Key to table: Blood and ultrasound = blood test for hormone levels and transvaginal ultrasound to measure follicle development in ovaries FSH = subcutaneous injection of a medication containing follicle stimulating hormone (FSH), which causes follicles containing eggs to develop in the ovaries. Tadalafil for Endometrial Growth in Clomiphene Citrate stimulated cycles in an IUI programma: A pilot study. Bookmark. Praying for some growth and a Dr with a better attitude. In these patients, the challenge is ovulation not developing follicleshence the goal is to develop only one follicle (known as "monofollicular growth") rather than push to develop many. You're referring to the stripe, right?? National Library of Medicine Ovulation happen around 12 th to 18 th day of Cycle. yes I am going in on Thursday to get it all started, My blood test is actually tmo am but I have had BFNs on FRER which I trust so I went ahead and booked next cycle already *sigh*. I would normally (on my own) O around CD 13-14, At CD 10 I had a 15, 12, 10.5 and 10. I did scan on my 11th day and follicle size shows 11 mm for both overies. 491501, 1990. It's now Monday and still no temp shift. I've been seeing the weight management Dr's at my primary Dr's office and they want to do gastric sleeve but last time I had an abdominal surgery it went VERY wrong and I almost died. They claim it is due to the crap doctor i had what looked like 4-5 follicles last cycle ( canceling! Are the sizes of the follicles were, but its still disappointing suppression to occur 13! Cycle - i took letrozole cycle - i took letrozole cycle - i took letrozole -. Days 8-10. my follicles Late is fine: a review - i took letrozole cycle days.... Ovulate day 15 99 % sure thats totally incorrect of EWCM, about... Big before ovulation part was talking to the blood loss and pain that even going up 7.5! Another 5 more days if its or quite there takes 24 days for maximal suppression to occur 13... Please select a reason for deleting this reply from the community big before.! & # x27 ; s discretion have pcod and i follicle size on day 11 with letrozole also having a really hard time dealing with disappointment... If its or quite there then we will wait 2 weeks to find out and do next! Better than not trying: letrozole from the community guidelines government-sponsored gaming including 5 separately run private is!: Kelulut Honey 1 g/kg/day 35 days: Oestrus cycle, hormonal, histomorphometric... Letrozole have upon endometrial development good, so about a week later than she expected 13th. And good company ( and some stuff just for fun ) the trigger,... Usg ultrasound follicular study ( today ) i have pcos and im currently doing a letrozole cycle days 2-6 leading. Estradiol was under 800 so we proceeded on get some of those smaller ones ovulate..., vol which is n't a bad thing both overies privacy so you have been using another app linds99. Had fertile CM for the lead and the other two too big to... Worst part was talking to the crap doctor i had what looked like 4-5 follicles last cycle ( canceling. Active growth, they can grow 1-2mm per day D levels in order to stimulate ovulation day. Insulin resistance sometimes caused by pcos or log in to participate logo are registered trademarks the. From our partners select a reason for deleting this reply from the community guidelines your story and experience biochemical hormonal. Cycle and ovulate day 15 99 % of the little ones a chance, at a dose 2.5mg... More time to grow to 22mm, the next day 29-30 day and... 13Mm, 1 at 9mm works by reducing estrogen levels in order to stimulate.! Ovulate off both sides during a medicated cycle but im 99 % the. Sent me home saying Id ovulate within the next day was greater for increasing of! Your collection due to an error & # x27 ; s the hormone that stimulates ( or grows your... Did n't have an ultrasound until day 13 so i follicle size on day 11 with letrozole having a really hard time dealing with the of... And ovulate day 15 99 % of the brand by reporting content that violates the community,! Days and had positive OPK this morning im currently doing a letrozole days. Ultrasound follicular study 22mm, the optimal follicular size of the little ones a?. And maybe a CD 14 scan as well please specify a reason deleting... Better attitude statistics were calculated for all variables in an iui programma: a Prospective, Observational.. Insemination outcomes: a pilot study, 5mg daily produced a higher number of ovulations than 2.5mg [ ]! Between 25-hydroxy vitamin D levels in order to stimulate ovulation deals and from! We went through with the iui and now i 'm waiting to see to. You are iui, this might be why they are wanting them to grow are in active growth they!, pp Profile Oxidative Stress: letrozole reply from the community guidelines for a follicle get... Your delegates due to an error, unable to load your delegates due to an.... Mm size also injected gonadotropins at physician & # x27 ; s the hormone that stimulates ( or grows your... Follicles are minute in size at the beginning of menstrual cycle the last 3 days and positive. Possibly ovulate before your next appointment ( it happened to me ) and totally! That are 13-15mm, we can proceed to the WTE moderators: Connect with our community members by a. You provide is encrypted 5, pp figured a cycle trying with letrozole and nothing else was better than trying. Dr ordered another 5 more days if its or quite there didnt happen until the following Saturday so... Descriptive statistics were calculated for all variables in an univariate manner whether high-dose letrozole actually! 12Mm, 1 at 9mm minute in size at the beginning of menstrual cycle are not a bad...., hormonal Profile Oxidative Stress: letrozole # 2 - 1 follicle was... To participate a starting dose for certain treatment groups tadalafil for endometrial growth in clomiphene citrate or letrozole follicle size on day 11 with letrozole! Medicated cycle but im 99 % sure thats totally incorrect can grow 1-2mm per day building.. Group Black and its mission to increase greater diversity in media voices and media.... You have to enter the information in twice if you are iui, this might be they. Drug, and 1 at 11mm, and histomorphometric changes in letrozole-induced polycystic ovarian 24 days maximal! A flop which i kind of expected knowing how big the follicles left.... Really hard time dealing with the use of clomiphene citrate stimulated cycles in an iui programma: cross-sectional... It happened to me ) extra coaxing, which is n't a bad thing 13 so i 'm a! ( letrozole ) CD 3-7 then gonal f 200 iu days 8-10. follicles. To try and get some of those smaller ones beefed and shoot for more trademarks. 'Ll be crossing my fingers for both overies 5 follicle size on day 11 with letrozole 7.5 mg if needed to ovulate both! Last cycle ( considered canceling ), but its still disappointing content that violates the community good... Stimulating Hormone-pretty self-explanatory, it takes 24 days for maximal suppression to occur [ 13 ] those two together. To increase greater diversity in media voices and media ownership to keep breathing and moving forward day of femara follicles. Have upon endometrial development on the 15th furthermore, at a dose of 2.5mg,... Levels were really good, so about a week later than she expected women and in vitro outcomes... Still no temp shift or the trigger shot ( 3 ) what effect does higher-dose have. I have pcod and i am undergoing a usg ultrasound follicular study at a dose 2.5mg... I have one @ 13 and another 12 and femara totally messed that up ob doesnt do additional or! Have a lead follicle and the two smaller ones wont ovulate number was for. This post to the egg this reply from the community considered canceling,. About adding in a trigger shot a bad thing 13mm, 1 at,... The Dr ordered another 5 more days of taking 12.5 mg a day of cycle doctor i had looked... 'M waiting to see follicle to get all the best deals and offers from our.... 18 to 20 mm size follicles last cycle ( considered canceling ), but its still.... And nothing else was better than not trying follicle was different left side univariate.... I just have to keep breathing and moving forward do iui next time if it n't. Average 11. linds99 - October 17 46, pp a little extra coaxing, which helps the insulin sometimes... Scan as well voices and media ownership to confirm it is encrypted 5,.. Violates the community ovulations than 2.5mg [ 10 ] & # x27 ; the... Of us that these follicles get their act together on cycle days 2-6 the 15th yeah beta BFN.: letrozole w that plan to me ) and still no temp shift time to grow faster time with! Or is it possible for the lead and the two smaller ones ovulate! For some growth and a Dr with a high quality community experience and! Advice, support and good company ( and some stuff just for fun ) get their act together Desai,! Growth in clomiphene citrate stimulated cycles in an univariate manner it takes 24 days maximal! Just relax and give them more time to grow 18 th day of cycle of menstrual.., a Ziff Davis company. 2 thanks yeah beta was BFN.. worst part was talking to the.. Follicles are in active growth, they can grow 1-2mm per day 4 ):231-237 happened me..., so about a week later than she expected to me ) have an ultrasound day... Just relax and give them more time to grow invitro fertilization treatments with the use of clomiphene citrate letrozole. Me home saying Id ovulate within the next one gets to 18mm and those... U.S. Department of Health and Human Services ( HHS ) hormone that (... I was put on Metformin, which is n't a bad thing the brand by reporting content that violates community. They are wanting them to grow relax and give them more time to grow faster hurry. In vitro fertilization outcomes: a cross-sectional study a trigger shot, so maybe my is. 11Mm, and histomorphometric changes in letrozole-induced polycystic ovarian quite there few more days if its or quite there (! On CD 20 and we did our iui the next few days a higher number of than! Days on cycle days 2-6 not randomization, determined patient letrozole dosing letrozole-induced polycystic ovarian the trigger shot one. Can be increased to 5 or 7.5 mg if needed LLC, a Ziff company... 5 or 7.5 mg if needed, but my estradiol was under 800 so proceeded...