Abstract
BackgroudThis study’s objectives were to compare the clinical, perinatal, and obstetrical outcomes of patients with different estradiol (E2) levels in fresh single-blastocyst-transfer (SBT) cycles under an early follicular phase prolonged regimen on the day of trigger.MethodsWe recruited patients in fresh SBT cycles (n = 771) undergoing early follicular phase prolonged protocols with β-hCG values above 10 IU/L between June 2016 and December 2018. Patients who met the inclusion and exclusion criteria were divided into four groups according to their serum E2 level percentages on the day of trigger: <25th, 25th–50th, 51st–75th, and >75th percentile groups.ResultsAlthough the rates of clinical pregnancy (85.57% (166/194)), embryo implantation 86.60% (168/194), ongoing pregnancy (71.13% (138/194)), and live birth (71.13% (138/194)) were lowest in the >75th percentile group, we did not observe any significant differences (all P > 0.05). We used this information to predict the rate of severe ovarian hyperstimulation syndrome (OHSS) area under the curve (AUC) = 72.39%, P = 0.029, cut off value of E2 = 2,893 pg/ml with the 75% sensitivity and 70% specificity. The 51st–75th percentile group had the highest rates of low birth weight infants (11.73% (19/162), P = 0.0408), premature delivery (11.43% (20/175), P = 0.0269), admission to the neonatal intensive care unit (NICU) (10.49% (17/162), P = 0.0029), twin pregnancies (8.57% (15/175), P = 0.0047), and monochorionic diamniotic pregnancies (8.57% (15/175); P = 0.001). We did not observe statistical differences in obstetrics complications, including gestational diabetes mellitus (GDM), gestational hypertension, placenta previa, premature rupture of membranes (PROM), and preterm premature rupture of membranes (PPROM).ConclusionWe concluded that serum E2 levels on the day of trigger were not good predictors of live birth rate or perinatal and obstetrical outcomes. However, we found that high E2 levels may not be conducive to persistent pregnancies. The E2 level on the day of trigger can still be used to predict the incidence of early onset severe OHSS in the fresh SBT cycle.
Highlights
Assisted reproductive technology (ART), which largely utilizes controlled hyperstimulation (COH), has made the dream of parenthood a reality for many infertile patients (Hilbert & Gunderson, 2019)
We compared the patients’ clinical outcomes and perinatal and obstetrical complications according to the serum E2 levels on the day of trigger, baseline information, COH, and laboratory parameters
We found that there was no correlation between BMI, luteinizing hormone (LH) level, E2 level, P4 level and antral follicle count (AFC) on the first day of treatment; LH level, total E2 level, E2 level per follicle, P4 level and endometrial thickness on the day of trigger; or the initial and total FSH doses, days of stimulation and number of obtained oocytes, 2PNs, cleavage stage embryos, D3 embryos, good quality D3 embryos, D3 embryos cultured into blastocysts, blastocysts, and good quality blastocysts, rate of good quality D3 embryos, rate of blastocyst formation, rate of good quality blastocyst formation
Summary
Assisted reproductive technology (ART), which largely utilizes controlled hyperstimulation (COH), has made the dream of parenthood a reality for many infertile patients (Hilbert & Gunderson, 2019). A previous study found that live birth rates were not affected by E2 levels on the day of trigger during the pituitary down-regulation cycle (Huang et al, 2014). Gonadotropin releasing hormone agonist (GnRH-a) remains the most commonly-used peptide hormone in COH during ART treatments because it can obtain the most oocytes, prevent early-onset LH peaks, reduce luteinization, and improve cycle completion rates (Haydardedeoğlu & Kılıçdağ, 2016). Patients that have been treated with long-acting GnRHa during COH have shown good compliance and clinical pregnancy rates (Gao et al, 2014; Liao et al, 2015). Our previous study showed encouraging clinical outcomes for long-acting GnRH-a, regardless of the patient’s menstrual cycle time (Ying et al, 2019)
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