Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

The Determination of Estradiol to Cumulus Oocyte Complex (COC) Number Ratio: Does it Predict the Outcomes of ART Cycles?

Authors
Fatemeh Taheri 1
Marjan Omidi 1
Mohammad Ali Khalili 1
Azam Agha-Rahimi 1
Mojdeh Sabour 1
Azita Faramarzi 2
Esmat Mangoli 1
1 Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
Abstract
Background: The aim of this study was to assess the impact of total serum E2 on the day of human chronic gonadotropin (hCG) administration and the serum E2 per oocyte ratio on the outcomes of assisted reproductive technology (ART) cycles. Methods: A total of 205 women were categorized into 3 groups according to the serum E2 levels: 1: ≤1500 pg/ml; 2: 1500-3000 pg/ml; 3: >3000 pg/ml. Another categorization included 3 groups according to E2/oocyte ratio: A: ≤150 pg/ml per oocyte; B: 150-200 pg/ml per oocyte; and C: >200 pg/ml per oocyte. The outcome compared between groups included laboratory and clinical characteristics. One-way analysis of variance (ANOVA), chi-square and Kruskal-Wallis, and multiple logistic regression model were performed, and appropriate differences were considered significant at p<0.05. Results: There was a significant difference between the groups based on the E2 levels with respect to laboratory parameters. In group C, the rates of chemical pregnancy (54.1%), clinical pregnancy (50%) and live birth (45.8%) were significantly higher, when compared to other groups. Moreover, according to E2/oocyte ratio, the rate of live birth was higher in group C compared with group A (18.3%, p=0.04), and group C (29.7%, p<0.0001). Logistic regression showed the number of good quality embryos was a positive predictor for live birth (odds ratio=2.03, 95% CI=1-4.1), but the level of E2 on day of HCG was a negative predictor (odds ratio=0.99, 95% CI=0.99-1). Conclusion: Supraphysiological levels of E2 had no adverse effects on the quality of the embryos in IVF cycles, but may have adverse effect on live birth in fresh transfer. Also, it is confirmed that both the pregnancy and live birth rates were elevated with E2/oocyte ratio ≥200 pg/ml.
Keywords
E2/oocyte ratio
Estradiol level
IVF
Live birth rate
Leão Rde B, Esteves SC. Gonadotropin therapy in assisted reproduction: an evolutionary perspective from biologics to biotech. Clinics (Sao Paulo). 2014;69(4):279-93.
Anifandis G, Koutselini E, Louridas K, Liakopoulos V, Leivaditis K, Mantzavinos T, et al. Estradiol and leptin as conditional prognostic IVF markers. Reproduction. 2005;129(4):531-4.
Yu Ng EH, Yeung WS, Yee Lan Lau E, So WW, Ho PC. High serum oestradiol concentrations in fresh IVF cycles do not impair implantation and pregnancy rates in subsequent frozen–thawed embryo transfer cycles. Hum Reprod. 2000;15(2):250-5.
Ng EH. What is the threshold value for serum estradiol levels associated with adverse IVF outcomes? Fertil Steril. 2000;73(5):1071-2.
Peña JE, Chang PL, Chan LK, Zeitoun K, Thornton MH 2nd, Sauer MV. Supraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles. Hum Reprod. 2002;17(1):83-7.
Friedler S, Zimerman A, Schachter M, Raziel A, Strassburger D, Ron El R. The midluteal decline in serum estradiol levels is drastic but not deleterious for implantation after in vitro fertilization and embryo transfer in patients with normal or high responses. Fertil Steril. 2005;83(1):54-60.
Mitwally MF, Bhakoo HS, Crickard K, Sullivan MW, Batt RE, Yeh J. Estradiol production during controlled ovarian hyperstimulation correlates with treatment outcome in women undergoing in vitro fertilization–embryo transfer. Fertil Steril. 2006;86(3):588-96.
Kosmas IP, Kolibianakis EM, Devroey P. Association of estradiol levels on the day of hCG administration and pregnancy achievement in IVF: a systematic review. Hum Reprod. 2004;19(11):2446-53.
Simón C, Cano F, Valbuena D, Remohí J, Pellicer A. Implantation: clinical evidence for a detrimental effect on uterine receptivity of high serum oestradiol concentrations in high and normal responder patients. Hum Reprod. 1995;10(9):2432-7.
Paulson RJ, Sauer MV, Lobo RA. Embryo implantation after human in vitro fertilization: importance of endometrial receptivity. Fertil Steril. 1990;53(5):870-4.
Chenette PE, Sauer MV, Paulson RJ. Very high serum estradiol levels are not detrimental to clinical outcome of in vitro fertilization. Fertil Steril. 1990;54(5):858-63.
Blazar AS, Hogan JW, Frankfurter D, Hackett R, Keefe DL. Serum estradiol positively predicts outcomes in patients undergoing in vitro fertilization. Fertil Steril. 2004;81(6):1707-9.
Var T, Tonguc E, Dogan M, Mollamahmutoglu L. Relationship between the oestradiol/oocyte ratio and the outcome of assisted reproductive technology cycles with gonadotropin releasing hormone agonist. Gynecol Endocrinol. 2011;27(8):558-61.
Loumaye E, Engrand P, Howles CM, O'Dea L. Assessment of the role of serum luteinizing hormone and estradiol response to follicle-stimulating hormone on in vitro fertilization treatment outcome. Fertil Steril. 1997;67(5):889-99.
Yang JH, Chen HF, Lien YR, Chen SU, Ho HN, Yang YS. Elevated E2: oocyte ratio in women undergoing IVF and tubal ET. Correlation with a decrease in the implantation rate. J Reprod Med. 2001;46(5):434-8.
Orvieto R, Zohav E, Scharf S, Rabinson J, Meltcer S, Anteby EY, et al. The influence of estradiol/follicle and estradiol/oocyte ratios on the outcome of controlled ovarian stimulation for in vitro fertilization. Gynecol Endocrinol. 2007;23(2):72-5.
Lai Q, Zhang H, Zhu G, Li Y, Jin L, He L, et al. Comparison of the GnRH agonist and antagonist protocol on the same patients in assisted reproduction during controlled ovarian stimulation cycles. Int J Clin Exp Pathol. 2013;6(9):1903-10.
Rocha JC, Passalia F, Matos FD, Maserati MP Jr, Alves MF, Almeida TG, et al. Methods for assessing the quality of mammalian embryos: How far we are from the gold standard? JBRA Assist Reprod. 2016;20(3):150-8.
Diedrich K, Fauser BC, Devroey P, Griesinger G. The role of the endometrium and embryo in human implantation. Hum Reprod Update. 2007;13(4):365-77.
Erzincan SG, Esmer AC, Baysal B. Does the estradiol level on the day of human chorionic gonadotropin administration predict the clinical outcome of controlled ovarian hyperstimulation? Clin Exp Obstet Gynecol. 2013;41(6):709-12.
Kara M, Kutlu T, Sofuoglu K, Devranoglu B, Cetinkaya T. Association between serum estradiol level on the hCG administration day and IVF-ICSI outcome. Int J Reprod Biomed. 2012;10(1):53-8.
Mittal S, Gupta P, Malhotra N, Singh N. Serum estradiol as a predictor of success of in vitro fertilization. J Obstet Gynaecol India. 2014;64(2):124-9.
Valbuena D, Martin J, de Pablo JL, Remohí J, Pellicer A, Simón C. Increasing levels of estradiol are deleterious to embryonic implantation because they directly affect the embryo. Fertil Steril. 2001;76(5):962-8.
Simon C, Cano F, Valbuena D, Remohí J, Pellicer A. Clinical evidence for a detrimental effect on uterine receptivity of high serum oestradiol concentrations in high and normal responder patients. Hum Reprod. 1995;10(9):2432-7.
Forman R, Fries N, Testart J, Belaisch-Allart J, Hazout A, Frydman R. Evidence for an adverse effect of elevated serum estradiol concentrations on embryo implantation. Fertil Steril. 1988;49(1):118-22.
Loutradis D, Beretsos P, Arabatzi E, Anagnostou E, Drakakis P. The role of steroid hormones in ART. J Steroid Biochem Mol Biol. 2008;112(1-3):1-4.
Vaughan DA, Harrity C, Sills ES, Mocanu EV. Serum estradiol: oocyte ratio as a predictor of reproductive outcome: an analysis of data from> 9000 IVF cycles in the Republic of Ireland. J Assist Reprod Genet. 2016;33(4):481-8.
Journal of Reproduction & Infertility
Volume 21, Issue 1
Winter 2020
Pages 11-16