title: High Peak Estradiol Predicts Higher Miscarriage and Lower Live Birth Rates in High Responders Triggered with a GnRH Agonist in IVF/ICSI Cycles.
abstract: OBJECTIVE
  To investigate parameters predictive of pregnancy outcomes in high responders undergoing fresh, autologous, GnRH antagonist IVF/ICSI cycles using a GnRH agonist trigger.
  
  
  METHODS
  Retrospective cohort study of all patients deemed high-risk for ovarian hyperstimulation syndrome who underwent fresh, autologous IVF/ICSI using a GnRH agonist trigger at an academic fertility center from 2010-2012.
  
  
  RESULTS
  A total of 71 first cycles were analyzed. Rates of clinical pregnancy, live birth (LB), and total (clinical plus biochemical) miscarriage (MC) were 52%, 38%, and 25%, respectively. Mean peak estradiol (E2) and the number of oocytes retrieved were 3,701 pg/mL and 15.2, respectively. Peak E2 was significantly higher in those cycles resulting in clinical MC (p = 0.003). After adjusting for age, basal follicle stimulating hormone, and the number of oocytes retrieved, elevated peak E2 remained associated with increased clinical MC (p = 0.029) and trended towards a relationship with higher total MC (p = 0.062). When peak E2 was treated as a binary variable based on the threshold value of > 5,000 pg/mL, peak E2 above this value was associated with a higher rate of clinical MC (OR = 16.14 with 95% CI 1.25-209.35, p = 0.033) and total MC (OR = 6.81 with 95% CI 1.12-41.54, p = 0.037), as well as a lower LB rate (OR = 0.095 with 95% CI 0.01-0.90, p = 0.041).
  
  
  CONCLUSIONS
  Clinicians should recognize most IVF/ICSI patients triggered with a GnRH agonist as inherently in danger of excessively high serum E2 and avoid peak levels > 5,000 pg/mL in order to avoid higher MC and lower LB rates.
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Steward
authors.forename: Cindy E
authors.initials: CE
authors.lastname: Zhang
authors.forename: Anish A
authors.initials: AA
authors.lastname: Shah
authors.forename: Jason S
authors.initials: JS
authors.lastname: Yeh
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
authors.forename: Yi-Ju
authors.initials: YJ
authors.lastname: Li
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Price
authors.forename: Suheil J
authors.initials: SJ
authors.lastname: Muasher
mesh_terms: D000022:Abortion, Spontaneous / Q000097:blood*; D000328:Adult; D015331:Cohort Studies; D004958:Estradiol / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006801:Humans; D050498:Live Birth; D011247:Pregnancy; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic
chemical_list: D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol