A paradigm of higher success rate of intracytoplasmic sperm injection – preovulatory human chorionic gonadotropin-day serum oestradiol

INTRODUCTION: The aim of the study is to evaluate the correlation between the level of serum oestradiol (E(2)) on the day of human chorionic gonadotropin (hCG-day) administration and successful intracytoplasmic sperm injection (ICSI) outcome. MATERIAL AND METHODS: This prospective study was performed during the period from January 2019 to September 2021, at Zagazig Obstetrics and Gynecology Department, and Al-Azhar Obstetrics and Gynecology Department, and private ART centers. One hundred and fifty women attending the infertility clinic for ICSI cycles. All women were divided into 5 groups according to the serum E(2) level on the day of hCG administration: Group A – serum E(2) < 1000 pg/ml; Group B – serum E(2) 1000 to < 2000 pg/ml; Group C – serum E(2) 2000 to < 3000 pg/ml;Group D – serum E(2) 3000 to < 4000 pg/ml; Group E – serum E(2) ≥ 4000 pg/ml. RESULTS: The highest fertilization rate (58.1%) was among women with E(2) ≥ 4000 pg/ml, while the lowest (37%) was in women with E(2) 1000 to < 2000 pg/ml. Also, the highest pregnancy rate (21.5%) was among women with E(2) > 4000 pg/ml, while the lowest (5.3%) was in women with E(2) < 1000 pg/ml. In the current study the median serum E(2) level on the day of hCG administration was highly significant in women who became pregnant when compared to women who did not. The best cut-off value of serum E(2) at hCG administration was ≥ 3682.3 pg/ml. CONCLUSIONS: this study suggests that the optimal range of E(2) level for achieving a successful pregnancy is > 4000 pg/ml.