Abstract
We need to find out factors which can predict the outcome of In vitro fertilization/ Intracytoplasmic sperm injection cycles so that couple can take correct decision before opting for assisted reproductive techniques. Our objective was to evaluate the role of serum estradiol level on the day of human chorionic gonadotropin administration as a potential predictive marker of outcome of IVF/ICSI cycles. This was a prospective study done in a tertiary care centre. Serum estradiol (E2) levels were obtained on the day of hCG administration. After 14 days of embryo transfer, serum beta hCG level was estimated and a value of 50 IU/L was taken as cut-off of positive cycle. The biochemical pregnancy rate was 31%. The mean value of serum estradiol was 1970.16 ± 1140.64 pg/ ml in the non pregnant group whereas that in the pregnant group was 2129.31 ± 787.91pg/ ml. (p= 0.34). The study population was divided into 5 groups based on the serum estradiol level (pg/ml) on the day of hCG administration. Number of follicles >14mm was significantly higher in groups with E2 values 3000-4000 and >4000 pg/ml (p<0.001). There was no significant difference in the endometrial thickness in the groups (p=0.131). The pregnancy rate was not found to be significantly different among the groups (p=0.34). The number of MII oocytes and the number of transferable embryos were significantly less in the groups with E2 level <1000 and 1000-2000 pg/ ml.
Therefore, serum estradiol level on the day of hCG administration was positively correlated with number of follicles with size more than 14mm obtained, metaphase II oocytes obtained, number of transferable embryos obtained. There was no association of serum estradiol level on the day of hCG administration with endometrial thickness on day of hCG and IVF outcome.
Keywords: Estradiol, Day of trigger, ART outcome, Pregnancy rate.
References
- Steptoe PC, Edwards RG. Birth after the re implantation of a human embryo. Lancet 1978; 2:366.
- Centers for Disease Control and Prevention, American Society for Reproductive Medicine. Assisted reproductive technology success rates, U.S. Department of Health and Human Services, Public Health Service, Atlanta, GA, 2003.
- Simon C, Cano F, Valbuena D, Remoshi J and Pellicr A. Clinical evidence for a detrimental effect of uterine receptivity of high serum E2 concentrations in high and normal responder patients. Hum Reprod 1995;10: 2432-2437.
- Ng E.H.Y. What is the threshold value for serum estradiol levels associated with adverse IVF outcomes? Fertil. Steril 2000;73: 1071.
- Mettler L and Tavmergen EN. Significance of E2 Values in IVF-ET under a combined GnRH analogue-desensitization and simultaneous gonadotropin stimulation for the outcome of pregnancies. Hum Reprod 4(Suppl 8) 1989; 59-64.
- Dor J, Seidman DS, Ben-Shlomo I, Levran D, Karasik A and Mashiach S. The prognostic importance of the number of oocytes retrieved and E2 leves in poor and normal responders in in-vitro fertilization (IVF) treatment. J Assist Reprod Genet 1992; 9: 228-232.
- Sharara FI and McClamrock HD. High E2 levels and high oocyte yield are not detrimental to in vitro fertilization outcome. FertilSteril 1999; 72: 401-405.
- Chen CH, Zhang X, Barnes R, Confino E, Milad M, Puscheck E and Kazer RR. Relationship between peak serum E2 levels and treatment outcome in in-vitro fertilization cycles after embryo transfer on day 3 or day 5. FertilSteril 2003; 80: 75-79.
- Chenette PE, Sauer MV and Paulson RJ. Very high E2 levels arenot detrimental to clinical outcome of invitro fertilization. FertilSteril 1990; 54: 858-863.
- Geletry TJ and Buyalos RP. The influence of supraphysiologic E2 level on humannidation. J Assist Reprod Genet 1995; 12: 406-412.
- Papageorgious T, Guibert J, Goffinet F, Patrat C,Fulla Y, Jansses Y and Zorn JR. Percentile curves of serum E2 levels during controlled ovarian stimulation in 905 cycles stimulated with recombinant FHS show that high E2 is not detrimental to IVF outcome. Hum Reprod 2002; 17: 2846-2850.
- D’Angelo A, Davies R, Salah E, Nix BA and Amso NN Value of the Serum E2 level for preventing ovarian hyperstim-ulation syndrome: a retrospective case control study. Fertil Steril 2004; 81: 332-336.
Corresponding Author
Dr Ramesh P
MCh Resident, Dept of Reproductive Medicine and Surgery, Amrita Institute of Medical Sciences, Kochi, India
Phone- 09249426575, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i9.39
