DAY 3 ESTRADIOL SERUM CONCENTRATIONS AS PROGNOSTICATORS OF OVARIAN STIMULATION RESPONSE AND PREGNANCY OUTCOME IN PATIENTS UNDERGOING IN-VITRO FERTILIZATION

Objective: To test the hypothesis that elevated E(2) levels on day 3 of IVF cycles without GnRH agonist (GnRH-a) are associated with reduced oocyte numbers and pregnancy rates (PRs). Design: Day 3 levels of E(2) and FSH were obtained from patients undergoing controlled ovarian hyperstimulation without GnRH analogue for IVF. Patients: Five hundred ninety-two consecutive IVF cycles. Results: Patients were grouped according to their day 3 E(2) levels (<30, 31 to 45, 46 to 60, 61 to 75, and >75 pg/mL [conversion factor to SI unit, 3.671]). The ongoing PR per retrieval for patients with E(2) levels < 30 pg/mL was significantly higher than for patients with Ea levels 31 to 75 pg/mL. There were no pregnancies if the E(2) level was >75 pg/mL. The mean number of oocytes per retrieval was significantly lower in patients from the E(2) groups with E(2) > 60 pg/mL compared with patients in groups with E(2) < 60 pg/mL. Day 3 FSH and E(2) levels also were evaluated simultaneously. In patients with the lowest levels of FSH and E(2), the PR was the highest. No pregnancies occurred if the FSH level was >17 mIU/mL (conversion factor to SI unit, 1.00) and E(2) level was >45 pg/mL on day 3. Conclusions: For patients undergoing IVF without GnRH analogue, oocyte numbers and PRs decrease with increasing levels of day 3 E(2). Combining day 3 FSH and E(2) improved the prognostic ability of either of these hormones used alone.