title: 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.
abstract: OBJECTIVE
  To determine the impact of the peak E(2) level and its midluteal decline on IVF-ET outcome in a group of normal- and high-responding patients.
  
  
  METHODS
  Retrospective analysis of IVF-ET data.
  
  
  METHODS
  Tertiary-care, university-affiliated teaching hospital.
  
  
  METHODS
  A total of 100 patients aged </=38 years and receiving up to three embryos per transfer who underwent a similar standard controlled ovarian hyperstimulation for IVF-ET.
  
  
  METHODS
  Morning blood was collected on days 0 (hCG day), +9, and +14.
  
  
  METHODS
  Treatment cycle hormonal characteristics and percent midluteal E(2) decline in conception and nonconception cycles.
  
  
  RESULTS
  Among all cycles, a mean decline of 95.0% in serum E(2) was observed at the midluteal phase. No significant differences were found in various parameters comparing conception with nonconception cycles. Occurrence of conception did not correlate with the absolute E(2) level or with percent E(2) decline in good and high responders. Early spontaneous abortion occurred more frequently in high responders with >98% E(2) decline; however, the difference did not reach statistical significance.
  
  
  CONCLUSIONS
  Multifactorial analysis refutes the negative role of supraphysiologic levels of E(2) on the day of hCG administration or its dramatic decline at the midluteal phase on the success rate after embryo transfer. A possibly increased rate of early spontaneous abortion in the high-response group warrants further verification.
authors.affiliation: IVF and Infertility Unit, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel-Aviv University, Zerifin, Israel. ivfunitdoc@asaf.health.govil
authors.forename: Shevach
authors.initials: S
authors.lastname: Friedler
authors.forename: Ariel
authors.initials: A
authors.lastname: Zimerman
authors.forename: Mori
authors.initials: M
authors.lastname: Schachter
authors.forename: Arieh
authors.initials: A
authors.lastname: Raziel
authors.forename: Deborah
authors.initials: D
authors.lastname: Strassburger
authors.forename: Raphael
authors.initials: R
authors.lastname: Ron El
mesh_terms: D006063:Chorionic Gonadotropin / Q000494:pharmacology; D010064:Embryo Implantation; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D008183:Luteal Phase / Q000097:blood*; D012189:Retrospective Studies
chemical_list: D006063:Chorionic Gonadotropin; D004958:Estradiol