The effect of a fall in the serum estradiol level prior to egg retrieval on the outcome of assisted reproductive treatment in poor responder women

Abstract

OBJECTIVE: To investigate the impact of serum E2 decrease following HCG administration on the outcome of ART in poor responder (PR) women. DESIGN: A retrospective study. MATERIALS AND METHODS: Patient files were reviewed to reveal PR women in whom serum E2 level was observed to decrease on the day after HCG administration. A total of 315 PR women treated between 2003 and 2008 were included in the study. Poor response was considered when lower than five oocytes were retrieved. Three groups of patients were formed according to the rate of E2 decrease between the day of HCG administration and the day after HCG administration: group 1 (n=162) <10% decrease, group 2 (n=128) 10-30% decrease and group 3 (n=25) ≥30% decrease. Primary outcome measures were implantation, pregnancy and miscarriage rates. Chi-squared test and one-way ANOVA were used for statistical evaluation. RESULTS: No significant difference was found in implantation rate (14%, 12% and 11%), pregnancy rate per embryo transfer (24%, 20% and 16%) and miscarriage rate (49%, 46% and 25%) between <10%, 10-30% and ≥30% E2 decrease groups.Table 1Cycle characteristics and the outcome of poor responder women undergoing ART compared according to the rate of decrease between serum E2 level on the day of HCG administration and the day after HCG administration.<10% decrease10-30% decrease≥30% decreasePAge (years)37.1 ± 4.837.0 ± 5.337.6 ± 4.8NSE2 on the day of HCG administration (pg/ml)785 ± 334 f897 ± 529 g704 ± 6480.045Total oocytes, n2.6 ± 0.9 a2.6 ± 1.1 a1.9 ± 0.9 b0.005Fertilization, %83 ± 2485 ± 2586 ± 27NSImplantation, % (n)14 (37/267)12 (24/203)11 (3/28)NSβHCG positive PR/ET, % (n)24 (39/162)20 (26/128)16 (4/25)NSMiscarriage rate, % (n)49 (19/39)46 (12/26)25 (1/4)NSa vs. b; p=0.002, f vs. g; p=0.038. Open table in a new tab a vs. b; p=0.002, f vs. g; p=0.038. CONCLUSIONS: There is no significant effect of a decrease in the serum E2 level prior to egg retrieval on implantation and pregnancy outcome in poor responder women undergoing ART.