Effects of estradiol pretreatment during follicular period on outcome of in vitro fertilization and embryo transfer treatment for poor ovarian responder with high FSH level

Abstract

TO observe the effects of estradiol pretreatment during follicular period on outcomes of in vitro fertilization and embryo transfer (IVF-ET) treatment for poor ovrian responder(POR) with high FSH level. A prospective randomized controlled study. A total of 323 POR with high level who have undergoing IVF-ET treatment were randomly divided into the pretreatment group(n=163) and non-pretreatment group(n=160) acording to whether the estradial pretreatmen (oral administration with 17- β estradiol for 4mg-6mg/d at the second day to the fourth day of menstrual cycle) were conducted before super ovulation induction.General information and indices relevant to the outcome of IVF-ET treatment of two groups were compared. In the pretreatment group, serum follicle-stimulating hormone (FSH)(13.77/14.17IU/ml, p=0.53)levels on the second day of menstruation(D2) and the fifth day(D5) were statistically significant；The D2 serum FSH in the non-pretreatment group was also statistically significant compared to that of the FSH in D5 (13.94/8.85，P=0.00).However,there was no statistical significance in comparing D2 FSH (13.98/13.94IU，P=0.51) and D5 FSH (8.79/8.85IU，P=0.45) values between the two groups.The differences of age (37.93/37.56years,P=0.5),BMI (22.13/21.80Kg/m2,P=0.16),AMH (0.89/0.91ng/ml,P=0.57),basal antral follicle count ( AFC ) (3.57/3.59,P=0.23),the number of retrieved oocytes (2.68/2.25,P=0.70) ,unovulated rate(15.34/13.13,P=0.569), endometrial thickness (10.49/10.49mm，P=0.41),the number of embryos transferred (1.60/1.63,P=0.12),transplant cancellation rate(28.21/31.90%,P=0.474) and clinical pregnancy rate (13.30/11.70%,P=0.10) were not statistically significant between the two groups. Estradiol pretreatment in follicular phase at POR patients with high FSH level did not increase the number of MII eggs rate and clinic pregnancy rate.On the contrary, an increase in the Gn dosage and extended treatment period can impose unnecessary burden on a patient, both financially and mentally. To some extent, the level of FSH only reflects the function of the ovary. Therefore, reducing the blood FSH level cannot increase the number of eggs nor improve the clinical pregnancy outcome.