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Hum. Reprod. Advance Access originally published online on August 11, 2009
Human Reproduction 2009 24(11):2902-2909; doi:10.1093/humrep/dep290
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Does the estradiol level on the day of human chorionic gonadotrophin administration have an impact on pregnancy rates in patients treated with rec-FSH/GnRH antagonist?

D. Kyrou1,5, B. Popovic-Todorovic1, H.M. Fatemi1, C. Bourgain2, P. Haentjens3, L. Van Landuyt4 and P. Devroey1

1 Centre for Reproductive Medicine, Dutch-Speaking Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium 2 Department of Pathology, Dutch-Speaking Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium 3 Centre for Outcomes Research, Dutch-Speaking Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium 4 Department of Embryology, Dutch-Speaking Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium

5 Correspondence address. V.U.B/C.R.G., Laarbeeklaan 101, 1090 Brussels, Belgium. Tel: +32-2-4776699; Fax: +32-2-4776333; E-mail: mimikyrou{at}yahoo.gr

BACKGROUND: The purpose of this prospective observational study was to evaluate the association between estradiol (E2) levels on the day of human chorionic gonadotrophin (hCG) administration and pregnancy rates in a recombinant FSH (rec-FSH) antagonist fixed protocol.

METHODS: A group of 207 patients (≤39 years of age), treated by IVF/ICSI, received 200 IU/day rec-FSH from Day 2 of the cycle and daily GnRH antagonist starting on Day 6 of stimulation. The criteria for hCG administration included only the presence of ≥3 follicles of ≥17 mm diameter. One to two embryos were transferred on Day 3 after oocyte retrieval.

RESULTS: The area under the curve (AUC) for E2 on the day of hCG could not distinguish between pregnant and non-pregnant women (AUC:0.5; 95% confidence interval (CI): 0.42–0.59). No significant difference was observed between the three percentile groups of E2 values on the day of hCG administration [group 1, lower 25th percentile (<1142 pg/ml); group 2, medium 50th percentile (1142–2446 pg/ml) and group 3, higher 75th percentile (>2446 pg/ml)] for the ongoing pregnancy rates (P = 0.52). On the contrary, the linear regression model showed that higher E2 values on the day of hCG administration significantly improved the scores of transferred embryos (P = 0.01) as well as the total embryo score (P = 0.02). Yet subgroup analysis only in this high responders group revealed lower E2 and progesterone levels on the day of hCG in pregnant women compared with the non-pregnant (P = 0.01).

CONCLUSIONS: E2 concentrations on the day of hCG administration in GnRH antagonist cycles are not associated with pregnancy rates. A potential deleterious impact of estradiol on endometrial receptivity is shown for the high responders who have high E2 levels and improved embryo quality without a concomitant rise in pregnancy rate.

Key words: estradiol/GnRH antagonist/IVF/pregnancy rate/implantation

Submitted on April 9, 2009; resubmitted on July 10, 2009; accepted on July 15, 2009.


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