Journal of Assisted Reproduction and Genetics

, Volume 36, Issue 11, pp 2333–2344 | Cite as

The impact of peak estradiol during controlled ovarian stimulation on the cumulative live birth rate of IVF/ICSI in non-PCOS patients

  • Wanlin Zhang
  • Ying Tian
  • Duo Xie
  • Ye Miao
  • Jin Liu
  • Xiaohong WangEmail author
Assisted Reproduction Technologies



The study aimed to investigate the impact of the peak E2 level during controlled ovarian hyperstimulation (COS) on the cumulative live birth rate (cLBR) in non-PCOS women with normal ovarian reserve.

Materials and methods

Women between 20 and 39 years were included. Donor cycles and patients who never experienced embryo transfer were excluded. Multivariable regression and smooth curve fitting were applied for statistical analysis.


A total of 1141 patients were included. The mean age, basal AFC, peak E2 level, and number of retrieved oocyte were 30.0 ± 3.7 years old, 16.8 ± 6.7, 3911.0 ± 1302.9 pg/ml, and 13.6 ± 5.5, respectively. In the overall population of the cohort, cLBR, miscarriage rate, and preterm birth rate were 66.9%, 7.4%, and 13.7%, respectively. The results of multivariable regression analysis failed to show the impact of peak E2 on the cLBR [OR (95%CI) 0.995 (0.982, 1.009), P = 0.486]. However, the result of smooth curve fitting indicated that when the peak E2 was lower than 2185 pg/ml, the cLBR increased about 12% with 100 pg/ml increasing of the peak E2. When the peak E2 was higher than 6136 pg/ml, the cLBR decreased about 10% with 100 pg/ml increasing of the peak E2.


We concluded that the peak E2 level on hCG trigger day is associated with the cLBR in a segmental pattern. There should be an appropriate range of the peak E2 level during COS to achieve a relative best cLBR in non-PCOS patients using stimulating protocol mainly based on GnRH agonist; however, the cutoff value must vary in different centers.


In vitro fertilization Cumulative live birth rate Peak estradiol Retrospective cohort study 


Funding information

This work was funded by grants from the National Natural Science Foundation of China (NSFC, Grant/Award No. 81671463) and the Key Project and Development Plan-fund of Shaanxi province (Grant/Award No. 2017ZDCXL-SF-02-03).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

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Supplementary Fig. S1

(PNG 323 kb)

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ESM 1 (TIFF 408 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Reproductive Medical Center, Department of Obstetrics and Gynecology, Tangdu HospitalAir Force Military Medical UniversityXi’anChina
  2. 2.Department of GynecologyTraditional Chinese Medicine Hospital of Shaanxi ProvinceXi’anChina
  3. 3.Department of Obstetrics and Gynecology986 Hospital of Air ForceXi’anChina

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