A Decrease in Serum Estradiol Levels After Human Chorionic Gonadotrophin Administration Predicts Significantly Lower Clinical Pregnancy and Live Birth Rates in in Vitro Fertilization Cycles

Overview

Journal Hum Reprod

Publisher Oxford University Press

Specialty Reproductive Medicine

Date 2012 Jul 4

PMID 22752608

Citations 25

Authors

L A Kondapalli

T A Molinaro

M D Sammel

A Dokras

Affiliations

Soon will be listed here.

Abstract

Background: Although close observation of serum estradiol (E2) levels remains a mainstay of assessing clinical response to controlled ovarian stimulation, the prognostic value of any change in E2 levels after administration of hCG remains unclear. The objective of this study is to evaluate the relationship between serum E2 response after hCG administration and the clinical pregnancy and live birth rates in fresh IVF cycles.

Methods: We conducted a retrospective cohort study of women aged 21-45 years undergoing their first IVF cycle from 1999 to 2008 at a single practice. We compared the post-hCG serum E2 level with values on the day of hCG trigger. IVF cycles were stratified by post-hCG E2 response and appropriate parametric and non-parametric statistics were performed. Clinical intrauterine pregnancy and live births were the primary outcomes of interest. Multivariable logistic regression models were created to identify predictive factors associated with outcomes while adjusting for potential confounders.

Results: Among the 1712 IVF cycles, 1065 exhibited a >10% increase (Group A), 525 had a plateau (± 10%, Group B) and 122 showed a >10% decrease (Group C) in post-hCG E2 levels. While the E2 levels on the day of hCG were similar across groups, Group C had more patients with diminished ovarian reserve, required higher gonadotrophin doses and had the lowest implantation rates. After adjusting for age, total gonadotrophin dose, infertility diagnosis, number of oocytes and number of transferred embryos, the associations between post-hCG E2 decline (Group C) and clinical pregnancy [adjusted odds ratio (aOR): 0.53; 95% confidence interval (CI): 0.33-0.84, P= 0.007] and live birth (aOR: 0.40; 95% CI: 0.22-0.71, P= 0.002) were significant. We also found significant associations between E2 plateau (Group B) and clinical pregnancy (aOR: 0.73; 95% CI: 0.57-0.94, P= 0.013) and live birth (aOR: 0.74; 95% CI: 0.56-0.97, P= 0.032) when adjusting for the same factors.

Conclusions: In our study, >10% decrease in E2 levels after hCG administration was associated with 40-50% reduction in clinical pregnancy and live birth rates. Similarly, post-hCG E2 plateau (± 10%) lowered the clinical pregnancy and live birth rates by >25%. Our study suggests that the change in the post-hCG E2 level is another parameter that can be used by clinicians to counsel patients regarding their likelihood of success with assisted reproductive technologies prior to oocyte retrieval.

Citing Articles

Peri-implantation estradiol level has no effect on pregnancy outcome in vitro fertilization- embryo transfer.

Huang P, Ou Y, Tang N, Chen J, Wen Q, Li J Front Endocrinol (Lausanne). 2024; 15:1326098.

PMID: 38405138 PMC: 10885798. DOI: 10.3389/fendo.2024.1326098.

Serum and follicular fluid metabolome and markers of ovarian stimulation.

Hood R, Liang D, Tan Y, Ford J, Souter I, Chavarro J Hum Reprod. 2023; 38(11):2196-2207.

PMID: 37740688 PMC: 10628502. DOI: 10.1093/humrep/dead189.

The pathophysiological role of estrogens in the initial stages of pregnancy: molecular mechanisms and clinical implications for pregnancy outcome from the periconceptional period to end of the first trimester.

Parisi F, Fenizia C, Introini A, Zavatta A, Scaccabarozzi C, Biasin M Hum Reprod Update. 2023; 29(6):699-720.

PMID: 37353909 PMC: 10628507. DOI: 10.1093/humupd/dmad016.

Serum estradiol level on the day of trigger as a predictor of number of metaphase II oocytes from IVF antagonist cycles and subsequent impact on pregnancy rates.

Morales H, Guiot M, Lopez G, Cortes D, Maldonado B, Hernandez H JBRA Assist Reprod. 2021; 25(3):447-452.

PMID: 33900710 PMC: 8312303. DOI: 10.5935/1518-0557.20210007.

The effect of blastomere loss during frozen embryo transfer on the transcriptome of offspring's umbilical cord blood.

Wu Y, Dong Z, Li C, Zhou D, Zhang J, Wu Y Mol Biol Rep. 2020; 47(11):8407-8417.

PMID: 33068229 DOI: 10.1007/s11033-020-05878-6.

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