Prognostic value of day 3 estradiol on in vitro fertilization outcome.
OBJECTIVE
To evaluate the prognostic value of day 3 E2 levels, independent of day 3 FSH levels, on responses to ovulation induction and subsequent pregnancy rates (PRs) in IVF-ET patients.


METHODS
Prospective, observational.


METHODS
University-based tertiary care and private reproductive endocrine-infertility units.


METHODS
A total of 225 patients underwent 292 IVF cycles with luteal phase GnRH agonist suppression and hMG stimulation.


METHODS
We evaluated response and outcome data including age, day 3 FSH and E2 levels from a menstrual cycle before IVF, ampules of hMG used, maximum E2 level, cancellation rates, and clinical PR.


RESULTS
Despite similar age, number of ampules of hMG, and peak E2 levels, patients with an elevated E2 level (E2 > or = 80 pg/mL) (conversion factor to SI unit, 3.671) on day 3 of a cycle before IVF-ET achieved a lower PR per initiated cycle (14.8% versus 37.0%) and had a higher cancellation rate (18.5% versus 0.4%) compared with those with E2 levels < 80 pg/mL. Even when patients with elevated FSH levels (FSH > or = 15 mIU/mL) (conversion factor to SI unit, 1.00) were excluded (leaving 279 cycles), those with an elevated day 3 E2 still had a lower PR per initiated cycle (14.8% versus 38.9%) and maintained a higher cancellation rate (18.5% versus 0.4%). When the day 3 E2 was > or = 100 pg/mL there was a 33.3% cancellation rate and no pregnancies were achieved.


CONCLUSIONS
Patients who presented with an elevated day 3 E2 (> or = 80 pg/mL) in a cycle before IVF-ET had a higher cancellation rate and achieved a lower PR independent of FSH level. A day 3 E2 level, in addition to a day 3 FSH level, appears very helpful in prospectively counseling patients regarding cancellation risk and ultimate IVF-ET success.
Smotrich
D B
DB
George Washington University, Division of Reproductive Endocrinology and Fertility, Washington, D.C., USA.
Widra
E A
EA
Gindoff
P R
PR
Levy
M J
MJ
Hall
J L
JL
Stillman
R J
RJ
D000328:Adult; D004958:Estradiol / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007246:Infertility / Q000628:therapy; D008297:Male; D008596:Menotropins / Q000008:administration & dosage / Q000627:therapeutic use; D010062:Ovulation Induction; D011247:Pregnancy; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
D004958:Estradiol; D008596:Menotropins; D005640:Follicle Stimulating Hormone