title: Estradiol progesterone ratio on ovulation induction day: a determinant of successful pregnancy outcome after intra cytoplasmic sperm injection.
abstract: BACKGROUND
  Intracytoplasmic sperm injection (ICSI) is an advanced technique employed in assisted reproductive clinics for treatment of infertile couples. The reproductive endocrinologists try their level best to identify factors that enhance success rate after ICSI.
  
  
  OBJECTIVE
  To compare estradiol progesterone ratio on ovulation induction day amongst pregnancy outcome groups following ICSI.
  
  
  METHODS
  A cross sectional study was conducted on 323 couples of Assisted Reproductive Clinic in Islamabad from June 2010 till August 2011. Down regulation of females aged 18-40 years with gonadotrophin releasing hormone agonist was followed by calculated stimulation with gonadotrophin injections (COS). Oocytes pickup was done 36 hours after ovulation induction by 16G adapter and double lumen oocyte aspiration needle under general anesthesia. Oocytes were fertilized in vitro, graded and only blastocysts were transferred seven days after ovulation induction. Serum estradiol and progesterone were measured by enzyme linked immuno sorbent assay on ovulation induction day, ratio was compared in three groups of females; no conception with βhCG 5-25 mIU/ml, preclinical abortion with βhCG >25 mIU/ml and no cardiac activity on transvaginal scan and clinical pregnancy with βhCG >25mIU/ml and cardiac activity on transvaginal scan.
  
  
  RESULTS
  Females having high estradiol/ progesterone ratio were able to achieve clinical pregnancy shown by a positive βhCG and cardiac activity on transvaginal scan. These females also had significantly high number of oocytes, endometrial thickness and implantation rate.
  
  
  CONCLUSIONS
  A high estradiol/progesterone ratio on the day of ovulation induction predicts the success of intra cytoplasmic sperm injection.
authors.affiliation: Bahria University Medical and Dental College, Karachi, Pakistan.
authors.forename: Rehana
authors.initials: R
authors.lastname: Rehman
authors.affiliation: Department of Biological and Biomedical Sciences, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan.
authors.forename: Rakhshaan
authors.initials: R
authors.lastname: Khan
authors.affiliation: Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, KSA.
authors.forename: Mukhtiar
authors.initials: M
authors.lastname: Baig
authors.affiliation: Research Development, Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Mehwish
authors.initials: M
authors.lastname: Hussain
authors.affiliation: Department of Biological and Biomedical Sciences, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan.
authors.forename: Syeda Sadia
authors.initials: SS
authors.lastname: Fatima
keywords: Implantaion; Intracytoplasmic sperm injection; Ovulation induction; Pregnancy outcome