Human Reproduction, Vol. 16, No. 11, 2476,
November 2001
© 2001 European Society of Human Reproduction and Embryology
Letters to the editor |
Value of mid-luteal oestradiol level: prognostic implications for IVF
Virginia Center for Reproductive Medicine, Vienna, VA 22182, USA
Correspondence: E-mail: fsharara{at}aol.com
Dear Sir,
I read with interest the manuscript by Ng et al., which showed opposite results from our prior paper (Sharara and McClamrock, 1999
; Ng et al., 2000). In their manuscript, Ng et al. retrospectively evaluated 763 women undergoing IVF and measured their serum oestradiol concentrations both on the day of HCG administration, and again 10 days later (6 days after embryo transfer since all embryo transfers were performed 2 days after oocyte retrieval). The authors found that the amount of decline of oestradiol concentration between HCG administration and 10 days later did not have a detrimental effect on IVF outcome, in contrast to our earlier findings. I have few comments to the authors.
Contrary to what the authors wrote in the discussion part, their paper was not `... the first study examining the role of oestradiol and the decline of oestradiol concentrations during the mid-luteal phase on implantation rate and pregnancy rates of these hyperstimulated cycles.' How could theirs be the first study when we published our manuscript (which the authors quoted multiple times in their paper) 11 months before?
In addition, we believe there are major differences between our results (Sharara and McClamrock, 1999) and those by Ng et al. (Ng et al., 2000). It is very hard to find a statistical difference among the two groups in the progesterone supplemented group (Table IV and Figure 1) when the clinical pregnancy rates are extremely low. Even with their rates, the authors noted a trend towards a lower pregnancy rate in the group with a ratio >5. I would recommend the authors keep evaluating their data, and hopefully with an improved pregnancy rate they will find a significant difference. In addition, obtaining an oestradiol concentration earlier in the luteal phase, i.e. in the mid-luteal phase (8 days after oocyte retrieval), may prove to be much more predictive of IVF outcome, as we have shown previously (Sharara and McClamrock, 1999). Hopefully, future studies will show whether there is any prognostic value to evaluating the decline in oestradiol concentration, and whether oestradiol supplementation in the luteal phase has any role in improving implantation rates in IVF.
References
Ng, E.H.Y., Yeung, W.S.B., Lau, E.Y.L., So, W.W.K., Ho, P.C (2000) A rapid decline in serum oestradiol concentrations around the mid-luteal phase had no adverse effect on outcome in 763 assisted reproduction cycles. Hum. Reprod., 15, 1903–1908.
Sharara, F.I., McClamrock, H.D. (1999) Ratio of oestradiol concentration on the day of human chorionic gonadotrophin administration to mid-luteal oestradiol concentration is predictive of in-vitro fertilization outcome. Hum. Reprod., 10, 2432–2437.
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