Estradiol production during controlled ovarian hyperstimulation correlates with treatment outcome in women undergoing in vitro fertilization-embryo transfer

Objective: To study the value of E-2 production during controlled ovarian hyperstimulation (COH) in predicting IVF-ET outcome. Design: Historical cohort. Setting: Academic infertility center. Patient(s): A cohort of 270 patients who completed 324 consecutive IVF-ET treatment cycles. Intervention(s): None. Main Outcome Measure(s): Area under the curve for E-2 levels (AUC-E-2) from the first day of COH until the day of hCG administration was calculated and cycles grouped into low, average, and high AUC-E-2 groups. Clinical pregnancy rates per cycle were compared among the three groups, and correlation with AUC-E-2 values were calculated for all patients and after sub-grouping according to age, COH protocol and infertility diagnosis. Result(s): Cycles with low and high AUC-E-2 values had significantly lower pregnancy rates particularly in patients 35 years or older. There was a positive correlation between AUC-E-2 and pregnancy rates up to a certain AUC-E-2 level above with a negative correlation was found. The turning point between positive and negative correlation occurred at a significantly lower AUC-E-2 level in patients 35 years or older. Conclusions: Estradiol production during OCH correlates with IVF-ET outcome. Women > 35 years of age seem more vulnerable to high E-2 levels.