HIGH ESTRADIOL PER RETRIEVED OOCYTE LEVEL PREDICTS POOR IVF OUTCOME IN PATIENTS WITH LESS THAN 15 OOCYTES

Abstract

Response to follicular stimulation may give some insight into expectations following IVF treatment. Estradiol levels often correlate to follicular number, with a mature follicle often corresponding to ∼200-300 pg/ml of estradiol. Lack of synchrony between follicular response and estradiol levels may indicate an issue with egg quality and result in poor embryo development. This study examined outcomes based on estradiol level per oocyte number retrieved. DESIGN: Retrospective data analysis Fresh oocyte retrieval cycles over a 24-month period were analyzed. Estradiol level on the day of trigger and oocyte number on the day of retrieval were used to calculate the “Estradiol per egg” (E2/egg) level. Various parameters were plotted with the E2/egg to find correlation. The cycle performance was compared in patients with high E2/egg ( >400pg/ml) or low (≤400 pg/ml). Statistical analyses were done by t-test or Fisher’ Exact test. Comparisons were made between two treatments with significance at p < 0.05. The E2/egg level was not related to female age, total FSH stimulation dose or length of stimulation. A high level of E2/egg (>400pg/ml) was related to low egg number per retrieval (0-15 eggs, mean=5.9). When cycle performance in the patients with ≤15 eggs on TVOR were examined, >400 pg/ml E2/egg was correlated with lower egg number, lower egg maturity rates and fewer good quality blastocysts to cryopreserve. Furthermore, >400 pg/ml E2/egg was correlated with a higher incidence of no eggs retrieved and no embryos to cryopreserve.Tabled 1E2 per egg<=400>400N8160Average E2269.2*625.3*Average Age36.137.1Average total IU of FSH3842.23714.1Average stim days10.210.1Average egg # on retrieval8.8*5.9*% of no egg0.0% (0/81)5.0% (3/60)Average mature egg #7.0*4.5*Average mature rate78.2%75.8%% of no mature egg1.2% (1/81)*11.7% (7/60)*Average # of D5 cryopreservation2.4*1.4*% of no cryopreservation20.0% (15/75)*38.9% (21/54)* Open table in a new tab These data indicate that a higher E2/egg level (>400mg/ml per egg) was negatively related to the IVF cycle performance. This discordant E2/egg ratio might indicate an imbalance of the hyperstimulation and patient response, hence predicts suboptimal egg quality and fewer embryos available for cryopreservation. Due to the limitation of sample size, further study is needed to confirm this observation and identify the underlined causes.