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Hum. Reprod. Advance Access published online on October 15, 2004
Human Reproduction, doi:10.1093/humrep/deh543
© 2004 by European Society of Human Reproduction and Embryology
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Received June 23, 2004
Accepted September 10, 2004

Article

Falling estradiol levels as a result of intentional reduction in gonadotrophin dose are not associated with poor IVF outcomes, whereas spontaneously falling estradiol levels result in low clinical pregnancy rates

S. Fisher 1*, A. Grin 2, A. Paltoo 2, and H.M. Shapiro 2

1 Genesis Fertility Centre, 555 West 12th Avenue, Suite 550, Vancouver, British ColumbiaV5Z 3X7 and
2 Reproductive Biology Unit, Mount Sinai Hospital, Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, 3rd Floor, 700 University Avenue, Toronto, Ontario M5G 1Z5, Canada

* To whom correspondence should be addressed. E-mail: sfisher{at}genesis-fertility.com.


  Abstract

BACKGROUND: Although estradiol levels remain an integral part of monitoring in most IVF programmes, the effect of falling estradiol on IVF outcome has not been adequately quantified. The objective of this study was to evaluate the effect of falling estradiol levels prior to hCG on IVF outcome. METHODS: This was a retrospective cohort study carried out in a university-based fertility clinic. A total of 112 IVF patients in whom estradiol levels fell prior to the administration of hCG were matched for age and year of treatment with 112 control IVF patients. IVF outcomes including oocytes retrieved, fertilization rate, embryos for transfer, and pregnancy rates were compared between the groups. RESULTS: Seventy per cent of women in the falling estradiol group experienced spontaneously falling estradiol levels. Spontaneously falling estradiol was associated with fewer oocytes retrieved (median 5 versus 8, P=0.001), increased rates of failed fertilization (18 versus 6%, P=0.018) and lower clinical pregnancy rates (12 versus 26%, P=0.012) compared to controls. Despite marked decreases in estradiol levels, IVF outcomes for patients whose estradiol levels fell as a result of deliberate protocol modification had similar fertilization and clinical pregnancy rates as controls. CONCLUSIONS: Subtle (<10%) spontaneous decreases in estradiol levels are associated with very poor IVF outcomes.

Keywords: coasting; estradiol; falling estradiol; IVF outcome.
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R. L. Gustofson, J. H. Segars, and F. W. Larsen
Ganirelix acetate causes a rapid reduction in estradiol levels without adversely affecting oocyte maturation in women pretreated with leuprolide acetate who are at risk of ovarian hyperstimulation syndrome
Hum. Reprod., November 1, 2006; 21(11): 2830 - 2837.
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