Estradiol level on day 9 as a predictor of risk for ovarian hyperresponse during controlled ovarian hyperstimulation.
OBJECTIVE
To investigate the estradiol (E2) level in the mid-follicular phase during controlled ovarian hyperstimulation (COH) and evaluate it as a predictor of a high risk for ovarian hyperresponse.


METHODS
From January 1996 to October 2001, the records of a total of 146 patients undergoing 164 COH cycles were retrospectively reviewed. All patients received the long protocol of GnRH agonists from the previous mid-luteal phase and then hMG or FSH from day 3 of the menstrual cycle. The E2 level was evaluated on day 9. Ovarian hyperresponse was defined as 1) an E2 level on the day of hCG injection was > 4000 pg/mL, or 2) the necessity for coasting during COH to decrease the risk of ovarian hyperstimulation syndrome (OHSS).


RESULTS
Of the 52 cycles in which day 9 E2 level was > 800 pg/mL, 29 (55.8%) fulfilled the criteria for ovarian hyperresponse. None of patients whose day 9 E2 level was < 300 pg/mL met the criteria for hyperresponse. The pregnancy rate in the groups with day 9 E2 level < 300 pg/mL was 42.9%; for an E2 level = 300-800 pg/mL, 49.2%; and for an E2 level > 800 pg/mL, 32.7%. The corresponding implantation rates were 18.8,28.0, and 17.0%. The E2 level on day 9 did not correlate with clinical pregnancy rates or implantation rates.


CONCLUSIONS
A high E2 level in the mid-follicular phase was predictive of patients with a high ovarian response. An E2 level on day 9 of menstrual cycle of > 800 pg/mL suggests an increased risk for ovarian hyperresponse, and appropriate management should be instituted to decrease the risk of OHSS.
Ho
Hsin-Yi
HY
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, 92, Sec. 2, Chung Shan North Road, Taipei 10449, Taiwan.
Lee
Robert Kuo-Kuang
RK
Lin
Ming-Huei
MH
Hwu
Yuh-Ming
YM
D000328:Adult; D015415:Biomarkers / Q000097:blood; D010064:Embryo Implantation; D004958:Estradiol / Q000097:blood*; D005260:Female; D005498:Follicular Phase / Q000097:blood; D006801:Humans; D009865:Oocytes / Q000166:cytology*; D010062:Ovulation Induction / Q000379:methods*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013480:Superovulation / Q000502:physiology
D015415:Biomarkers; D004958:Estradiol