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
Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
Correspondence: E-mail: nghye{at}hkucc.hku.hk
Dear Sir,
I would like to thank Dr Sharara for the interest shown in my manuscript (Ng et al., 2000a
) before responding to the comments raised in the letter.
Indeed, it is the first study in the literature addressing the role of oestradiol and the decline of oestradiol concentration around the mid-luteal phase in hyperstimulated cycles, i.e. serum oestradiol concentrations on the day of HCG >20 000 pmol/l. The maximum serum oestradiol was only 19427 pmol/l in the paper by Sharara and McClamrock, which was cited a number of times in the introduction and discussion of my manuscript (Sharara and McClamrock, 1999). The differences between the two studies have already been highlighted in the discussion. It is too speculative to suggest that checking serum oestradiol concentration 8 days after the HCG injection is more predictive of IVF outcome than 10 days after the HCG injection.
I agree that there was a trend towards a lower pregnancy rate in the group with a ratio >5 but the difference did not reach statistical significance. More hyperstimulated cycles have to be included before a firm conclusion can be drawn. Because our previous study (Ng et al., 2000b) showed a significant impairment in pregnancy rates when serum oestradiol concentration on the human chorionic gonadotrophin day was >20 000 pmol/l, patients having these excessive responses are now strongly advised to cancel the fresh embryo transfer and to cryopreserve all embryos for later transfer. Because of this change in policy, it is apparent that the number of fresh embryo transfers in these hyperstimulated cycles is getting less and less.
References:
Ng, E.H.Y., Yeung, W.S.B., Lau, E.Y.L. et al. (2000a). 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.
Ng, E.H.Y., Yeung, W.S.B., Lau, E.Y.L. et al. (2000b) High serum oestradiol levels in fresh IVF cycles do not impair implantation and pregnancy rates in subsequent FET cycles. Hum. Reprod., 15, 250–255.
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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