Abstract
Purpose : To investigate the estradiol (E2) level in the mid-follicular phase during controlled ovarian hyperstimulation (COH) and evaluate it as a predictor of a high risk for ovarian hyperresponse.
Methods : From January 1996 to October 2001, the records of a total of 146 patients undergoing 164 COH cycles were retrospectively reviewed. All patients received the long protocol of GnRH agonists from the previous mid-luteal phase and then hMG or FSH from day 3 of the menstrual cycle. The E2 level was evaluated on day 9. Ovarian hyperresponse was defined as 1) an E2 level on the day of hCG injection was >4000 pg/mL, or 2) the necessity for coasting during COH to decrease the risk of ovarian hyperstimulation syndrome (OHSS).
Results : Of the 52 cycles in which day 9 E2 level was >800 pg/mL, 29 (55.8%) fulfilled the criteria for ovarian hyperresponse. None of patients whose day 9 E2 level was <300 pg/mL met the criteria for hyperresponse. The pregnancy rate in the groups with day 9 E2 level <300 pg/mL was 42.9%; for an E2 level = 300–800 pg/mL, 49.2%; and for an E2 level >800 pg/mL, 32.7%. The corresponding implantation rates were 18.8, 28.0, and 17.0%. The E2 level on day 9 did not correlate with clinical pregnancy rates or implantation rates.
Conclusions : A high E2 level in the mid-follicular phase was predictive of patients with a high ovarian response. An E2 level on day 9 of menstrual cycle of >800 pg/mL suggests an increased risk for ovarian hyperresponse, and appropriate management should be instituted to decrease the risk of OHSS.
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Ho, HY., Lee, R.KK., Lin, MH. et al. Estradiol Level on Day 9 as a Predictor of Risk for Ovarian Hyperresponse During Controlled Ovarian Hyperstimulation. J Assist Reprod Genet 20, 222–226 (2003). https://doi.org/10.1023/A:1024155411444
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DOI: https://doi.org/10.1023/A:1024155411444