Abstract
Purpose of Investigation: To examine if the potential changes in progesterone (P) and estradiol (E2) levels during the luteal phase can predict the outcome in IVF/ICSI cycles. Material and Methods: A prospective study of 282 patients with infertility undergoing IVF/ICSI have been included. Serum E2 and P measurements at day of hCG triggering and days 6 and 10 after embryo transfer in conception and non-conception cycles. Results: The ROC curve in predicting clinical pregnancy was calculated at 0.864 (95% CI: 0.841-0.92). A maximum reduction of ≤ 32 % demonstrated sensitivity of 84.3% and specificity of 80.4%. The corresponding ROC curve for percentage change in P levels was 0.733 with 95% CI: 0.334-0.96. Conclusion: A maximum reduction of 32 % in E2 levels between days 6 and 10 after embryo transfer demonstrated a predictive ability for clinical pregnancy after IVF/ICSI of 86.4% with sensitivity 84.3% and specificity 80.4%.
Highlights
The use of GnRH analogues to achieve pituitary down regulation and prevent a premature LH surge in order to improve the outcome of IVF/Intracytoplasmic sperm injection (ICSI) cycles has been used in assisted reproduction techniques (ART) daily practice [1]
A mean reduction of absolute E2 levels of 1407.5 ± 1118.4 ng/ml and of 73% ± 28.8, between days 0 and six post-embryo transfers were found, but none were associated with the outcome of IVF/ICSI
The mean levels and the absolute difference between E2 and P levels and the percentage change of P on days 6 and 10 post-embryo transfer had no correlation with the outcome of IVF/ICSI (Table 2)
Summary
The use of GnRH analogues to achieve pituitary down regulation and prevent a premature LH surge in order to improve the outcome of IVF/ICSI cycles has been used in assisted reproduction techniques (ART) daily practice [1]. During the luteal phase of these ART cycles, an abrupt decline of steroids levels between the ovulation triggering day and the midluteal phase has been reported, but it is not deleterious for implantation after in vitro fertilization and embryo transfer [3]. All studies examine the outcome of the IVF/ ICSI cycles in relation to the mean estradiol (E2), peak E2 levels, and mean progesterone (P) and FSH levels in the luteal phase, and an association with mean E2 levels has been suggested, no cut- off values could be recognized that could distinguish achievement of pregnancy on an individual basis
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