Falling estradiol levels as a result of intentional reduction in gonadotrophin dose are not associated with poor IVF outcomes, whereas spontaneously falling estradiol levels result in low clinical pregnancy rates

BACKGROUND: Although estradiol levels remain an integral part of monitoring in most IVF programmes, the effect of falling estradiol on IVF outcome has not been adequately quantified. The objective of this study was to evaluate the effect of falling estradiol levels prior to hCG on IVF outcome. METHO...

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Bibliographic Details
Published in:Human reproduction (Oxford) 2005-01, Vol.20 (1), p.84-88
Main Authors: Fisher, S., Grin, A., Paltoo, A., Shapiro, H.M.
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Case-Control Studies
Chorionic Gonadotropin - administration & dosage
coasting
Cohort Studies
estradiol
Estradiol - blood
falling estradiol
Female
Fertilization in Vitro - methods
Gynecology. Andrology. Obstetrics
Humans
Infertility - therapy
IVF outcome
Male
Medical sciences
Ovarian Hyperstimulation Syndrome - prevention & control
Polycystic Ovary Syndrome - therapy
Pregnancy
Prognosis
Retrospective Studies
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Summary:BACKGROUND: Although estradiol levels remain an integral part of monitoring in most IVF programmes, the effect of falling estradiol on IVF outcome has not been adequately quantified. The objective of this study was to evaluate the effect of falling estradiol levels prior to hCG on IVF outcome. METHODS: This was a retrospective cohort study carried out in a university-based fertility clinic. A total of 112 IVF patients in whom estradiol levels fell prior to the administration of hCG were matched for age and year of treatment with 112 control IVF patients. IVF outcomes including oocytes retrieved, fertilization rate, embryos for transfer, and pregnancy rates were compared between the groups. RESULTS: Seventy per cent of women in the falling estradiol group experienced spontaneously falling estradiol levels. Spontaneously falling estradiol was associated with fewer oocytes retrieved (median 5 versus 8, P=0.001), increased rates of failed fertilization (18 versus 6%, P=0.018) and lower clinical pregnancy rates (12 versus 26%, P=0.012) compared to controls. Despite marked decreases in estradiol levels, IVF outcomes for patients whose estradiol levels fell as a result of deliberate protocol modification had similar fertilization and clinical pregnancy rates as controls. CONCLUSIONS: Subtle (
ISSN:0268-1161
1460-2350
DOI:10.1093/humrep/deh543