Fluctuations between estradiol level and cumulus oocyte complex (COC) count: Does it predict the outcomes of ART cycles

Background: The success of in vitro fertilization (IVF) depends on controlled ovarian hyperstimulation (COH) resulting in multi-follicular response. The follicles contain granulosa cells which secrete hormone estradiol (E2). E2 is required for follicular development and play an important role in embryo implantation.Objective: The aim was to assess the impact of total serum E2 on the day of human chronic gonadotropin (hCG) administration and the serum E2 per oocyte ratio in the outcomes of assisted reproductive technology (ART) cycles.Materials and Methods: A total of 205 women were categorized into 3 groups according to the serum E2 levels: 1: <1500 pg/ml; 2: 1500-3000 pg/ml; 3: > 3000 pg/ml. Another categorization includes 3 groups according to E2/oocyte ratio: A: <150 pg/ml per oocyte; B: 150-200 pg/ml per oocyte; and C: > 200 pg/ml per oocyte. The outcome compared between groups include laboratory and clinical characteristics. One-way analysis of variance (ANOVA), Chi-square and Kruskal-Wallis tests were performed wherever appropriate. differences were considered significant at p<0.05.Results: There was a significant difference between the groups based on the E2 levels with respect to laboratory parameters. In group 3, the rates of chemical pregnancy (50%), clinical pregnancy (54.1%) and live birth (45.8%) were significantly higher when compared to the other groups (p=0.004, p<0.0001; p<0.0001, respectively). Moreover, according to E2/oocyte ratio, the chemical pregnancy rate was higher in group A (46.6%, p=0.002); and the clinical pregnancy (40.5%) and delivery (29.7%) rates were higher in group C (p<0.001).Conclusion: Supraphysiological levels of E2 resulting had no adverse effects on the quality of the embryos in IVF cycles. Therefore, the E2/oocyte ratio data can be a useful adjunct in predicting success rates of IVF cycles. It is confirmed that both pregnancy and live birth rates were elevated with E2/oocyte ratio > 200 pg/mL.

Keywords:

E2 , oocyte ratio , Estradiol level , IVF , Live birth rate