Abstract
Objective:To assess mid-luteal estradiol (E2) levels in poor and good responders and determine its effect on the outcome after intracytoplasmic sperm injection (ICSI).Methods:The current study was carried out in females who underwent ICSI from June 2011 to September 2013 in “Islamabad Clinic Serving Infertile Couples”. They were categorized into good and poor responders on the basis of female age ≤40 years, basal follicle stimulating hormone ≤12 mIU/ml, and antral follicle count >5, respectively. Their mid-luteal E2 measured on the day of embryo transfer was stratified into groups (A-E) on the basis of 20th, 40th, 60th and 80th percentile values. The outcome was categorized into non-pregnant with beta human chorionic Gonadotrophin (hCG) 5-25 m IU/ml, and clinical pregnancy with beta hCG>25 m IU/ml.Results:The conception rate was 12% (63/513) in poor responders and 72% (237/329) in good responders respectively. The mid-luteal E2 levels were higher in conception as compared to non-conception cycles (p<0.001) in good and poor responders.Conclusion:Maximum pregnancies in poor and good responders (53% and 98% respectively) with mid-luteal E2 levels above 80th percentiles confirm the role of the increase in mid-luteal E2 for augmentation in conception rate of females after ICSI.
Highlights
Infertility refers to the failure to conception by the couple and is perceived as a multifactorial syndrome in all cultures and societies.[1]
The measurement of peak and luteal E2 is done in these patients keeping in mind its importance for proliferation of endometrium and up-regulation of progesterone receptors required in in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles.[14]
Studies have shown that high peak and mid luteal E2 can predict the success of treatment after ICSI by the provision of optimal environment required for implantation of fertilized ovum and accomplishment of clinical pregnancy.[7,8]
Summary
Infertility refers to the failure to conception by the couple and is perceived as a multifactorial syndrome in all cultures and societies.[1] Out of the offered treatment procedures in reproductive clinics, in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are the advanced reproductive techniques (ART). In these procedures, ovaries are down-regulated and stimulated to produce eggs, which retrieved, and microinjected with spermatozoa.[2,3] The success of the procedure depends on quality of embryos and endometrial receptivity offered at the time of implantation.[4]. According to European Society for Human Reproduction and Embryology (ESHRE), poor ovarian response (POR) is designated with at least two of the following three features; “advanced maternal age or any other risk factor for POR, a previous POR with maturation of 3 oocytes in the previous cycle by COS protocol an abnormalovarian reserve test i.e. “antral follicle count (AFC) less than 5–7 follicles or anti-Mullerian hormone (AMH) below 0.5–1.1 ng/ml”.6 Discovery and trials of new hormonal preparations have resulted in number of modifications and variations in stimulation protocols with little improvement in oocyte and embryo quality and pregnancy outcome in poor responders
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