Estradiol (E(2)) Reduction Adversely Affect the Embryo Quality and Clinical Outcomes of In Vitro Fertilization and Embryo transfer (IVF-ET)

OBJECTIVE: The purpose of this study was to explore the influence of decreased serum estradiol (E(2)) levels during controlled ovarian hyperstimulation (COH) on in vitro fertilization and embryo transfer (IVF). METHODS: The clinical data of 300 IVF-ET cycles with patients were analyzed retrospectively. According to the presence of falling E(2) level during the COH, we divided all subjects into two groups: the E(2) levels fall group (n = 120, group A) and the control group (n = 180, group B). In group A, there were 57 patients with falling E(2) with drug dosage reduction. The other 63 patients experienced the decreased E(2) level spontaneously. The clinical and laboratory variables in the groups were compared. Receiver operator characteristic (ROC) curve analyses were carried out in order to evaluate the predict value of E(2) level on the day of human chorionic gonadotropin (hCG) administration on IVF outcomes. RESULTS: Duration and total dosage of gonadotropin (Gn) used were statistically more in group A than in group B (P < 0.001). The high-quality embryo rate was significantly lower in group A (P = 0.048). Women in group A had lower clinical pregnancy rate (P = 0.029), live birth rate (P < 0.001), ongoing pregnancy rate (P = 0.001), and higher early abortion rates (P = 0.008) than group B. Women with spontaneously falling E(2) group had a higher BMI index than those in the drug dosage reduction group (P = 0.001). More dosage and longer duration of Gn in spontaneously falling E(2) group than in the drug dosage reduction group (P < 0.01). There were no differences in clinical outcomes between the two types of E(2) decreased groups. Results from ROC showed an E(2) level <1987.5 pg/ml on the hCG day might predict early abortion in this study. The sensitivity was 58.4% and the specificity was 78.9%. In addition, an E(2) level >2020 pg/ml on the hCG day might be an index to predict live birth. The sensitivity was 57.0% and the specificity was 61.7%. CONCLUSIONS: Reduction of E(2) during COH might adversely affect the clinical pregnancy, early abortion, and ongoing pregnancy of IVF-ET.