Abstract
BackgroundThe impact of elevated estradiol on the day of human chorionic gonadotropin (hCG) administration on in vitro fertilization (IVF) outcomes has been debated for over 25 years. Some investigators have shown a positive effect, others a negative effect; while most have shown no effect. Few studies have expressed their findings based on live birth. This study examined the relationship between estradiol level and other IVF cycle response parameters in relation to pregnancy, with a focus on live births after controlling for embryo quality.MethodsWe performed a retrospective cohort study on 489 patients <40 years old that underwent an initial IVF cycle. Estradiol concentration on the day of hCG was categorized as; low <2000 pg/ml), mid (2001-4000 pg/ml) and high (>4000 pg/ml) to determine how estradiol level on the day of hCG affected response variables during the IVF cycle. We performed a subgroup analysis restricted to patients with good/fair quality embryos transferred (n = 428), to control for embryo quality and assessed pregnancy outcome. The association between estradiol and live birth (LB) was then evaluated after identifying and controlling for confounding factors. Multivariate analysis was used to identify significant main effects and interactions in the model. Estradiol levels were also compared in patients having a LB or not (NLB) in both populations.ResultsWe found that estradiol was significantly related to + hCG, clinical pregnancy rate, age, and most other IVF cycle response variables. After performing the subgroup analysis controlling for embryo quality, we found that LB rates were not different. Only the main effects of average embryo quality at transfer (AEQS), age and transferring two embryos influenced LB. Estradiol levels were also compared in patients having a LB or NLB in both populations and was found to be higher/not different in LB patients. LB rates and AEQS were also not different in a subgroup of patients having an elevated level of estradiol (>4200 pg/ml) on the day of hCG in patients having embryo transfer on day 3 or day 5.ConclusionsAfter controlling for embryo quality, elevated estradiol on the day of hCG had no effect on LB.
Highlights
The impact of elevated estradiol on the day of human chorionic gonadotropin administration on in vitro fertilization (IVF) outcomes has been debated for over 25 years
IVF-embryo transfer Following follicle aspiration, oocytes were held in modified human tubal fluid + 5% human serum albumen (HSA) (In Vitro Care; IVC) until placed into individual drops of Human tubal fluid (HTF) + 5% Human serum albumen (HSA) with oil overlay (Sage) in a humidified atmosphere of 6% CO2 and 94% air maintained at 37° until intracellular sperm injection (ICSI) or conventional IVF was carried out 4 to 6 hours following oocyte retrieval
Response variables We evaluated if the estradiol level on the day of human chorionic gonadotropin (hCG) was associated with biochemical pregnancy (BCP), Clinical pregnancy (CP) and live birth (LB), in patients undergoing their initial IVF cycle
Summary
The impact of elevated estradiol on the day of human chorionic gonadotropin (hCG) administration on in vitro fertilization (IVF) outcomes has been debated for over 25 years. In IVF cycles, high responding patients are characterized as having a large number of follicles that are associated with elevated levels of estradiol and frequently by elevated levels of progesterone on the day of hCG administration. The purpose of this study was to determine the relationship between the levels of estradiol on the day of hCG administration and pregnancy outcomes, with emphasis on live birth rate after controlling for embryo quality. We addressed this by initially categorizing patients according to the level of estradiol on the day of hCG administration, which has been the basis of the majority of previously published studies. We tested if the day of embryo transfer made a difference in live birth (LB) rate in patients with an elevated level of estradiol on the day of hCG since some prior studies [17,20,22] had suggested that elevated estradiol only had an adverse effect on pregnancy outcome when embryo transfer was conducted on day 3
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