title: Spuriously elevated serum estradiol concentrations measured by an automated immunoassay rarely cause unnecessary cancellation of in vitro fertilization cycles.
abstract: OBJECTIVE
  To report a case of a patient in whom serum E2, as measured by an automated E2 assay, remained elevated at levels corresponding to the periovulatory phase (>380 pg/mL), despite 3 weeks of treatment by a GnRH agonist (GnRH-a).
  
  
  METHODS
  Case report.
  
  
  METHODS
  Tertiary-care academic center.
  
  
  METHODS
  A 39-year-old patient accepted for IVF treatment. In view of controlled ovarian hyperstimulation, down-regulation by a GnRH-a was monitored by serum E2 measurement.
  
  
  METHODS
  Obvious causes for high serum E2 levels (pregnancy, E2-producing ovarian cysts, and noncompliance of the patient) were excluded. The IVF cycle was canceled.
  
  
  METHODS
  Serum samples were analyzed retrospectively by radioimmunoassay (RIA), and ether extraction of the samples was performed before measurement by the automated E2 assay.
  
  
  RESULTS
  Radioimmunoassay revealed adequately suppressed serum E2 levels under GnRH-a treatment (<15 pg/mL). Ether extraction revealed an interfering component that was soluble in the aqueous phase.
  
  
  CONCLUSIONS
  If a patient on a long controlled ovarian hyperstimulation IVF protocol still has high serum E2 levels after 2 to 3 weeks of down-regulation, and obvious reasons for this (pregnancy, E2 producing ovarian cysts, noncompliance of the patient) are excluded, E2 immunoassay interference should be excluded to avoid unnecessary cancellation of the IVF cycle.
authors: Center for Reproductive Medicine, Akademisch Ziekenhuis Vrije Universiteit Brussel, Brussels, Belgium. ellen.anckaert@az.vub.ac.be
authors: Ellen
authors: E
authors: Anckaert
authors: Peter
authors: P
authors: Platteau
authors: Johan
authors: J
authors: Schiettecatte
authors: Paul
authors: P
authors: Devroey
authors: Andre
authors: A
authors: Van Steirteghem
authors: Johan
authors: J
authors: Smitz