Estradiol levels after human chorionic gonadotropin (hCG) administration are not predicitive of IVF outcome: analysis of 7,474 initial fresh IVF cycles

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Decreased estradiol levels after hCG administration often leads to IVF cycle cancellation. However, this decision is based on limited data. Our objective is to determine whether estradiol (E2) levels after hCG administration in IVF cycles correlate with clinical outcome. A large retrospective study of 7,474 fresh first IVF cycles from 1999 to 2007. Patients were grouped by age; group A <35, group B ≥35 to <38, group C ≥38 to <41, and group D ≥41 years old. Cycles were categorized into four groups based on the 24 hour change in estradiol from the day of HCG administration as follows: 1) Having an E2 level that increased by more than 10%, 2) No more then a 10% change (increase or decrease), 3) Decrease by more than 10% but less than 20%, 4). Decrease greater than 20%. Pearson's chi square and ANOVA using Stata were used to determine whether E2 response were associated with oocyte number, implantation, and pregnancy rates. When patients are stratified by age according to SART guidelines, a significant difference was noted in the number of follicles and retrieved oocytes, however, there was no significant difference in implantation rates, pregnancy rates, or loss rates (Table 1). TableParameters by Age and Estradiol Response After hCGAge GroupE2 Increase >10%E2 Changed <10%E2 Dropped 10%–20%E2 Dropped >20%P ValueRetrieved OocytesA17.7 ± 10.115.4 ± 9.214.9 ± 9.117.3 ± 13.2<.001B14.6 ± 9.112.0 ± 7.211.2 ± 6.915.1 ± 9.3<.001C12.8 ± 7.910.6 ± 6.69.7 ± 5.911.7 ± 11.3<.001D10.5 ± 6.99.6 ± 6.57.6 ± 3.97.4 ± 4.90.025Implantation RateA42.0 ± 40.840.2 ± 39.533.8 ± 37.938.3 ± 40.20.153B33.6 ± 37.332.2 ± 36.031.0 ± 36.935.4 ± 39.10.855C21.4 ± 30.120.3 ± 29.119.8 ± 28.126.7 ± 31.70.710D11.4 ± 22.411.4 ± 21.29.1 ± 20.110.9 ± 21.50.957Pregnancy RateA59.4%58.6%51.9%55.1%0.427B54.7%53.5%50.9%55.9%0.923C42.1%40.4%40.0%53.9%0.580D26.4%28.7%18.8%27.3%0.675Pregnancy LossA21.6%21.2%29.0%19.4%0.542B26.6%23.3%27.8%31.8%0.678C34.1%42.0%41.2%43.8%0.249D54.0%56.3%75.0%100%0.158 Open table in a new tab There is no association between estradiol response after hCG administration and implantation rates or pregnancy rates. This is also true for dramatic decreases in estradiol. Thus, the E2 level should not be used in determining whether the cycle should be cancelled or allowed to continue.