Serum estradiol/progesterone ratio on day of embryo transfer may predict reproductive outcome following controlled ovarian hyperstimulation and in vitro fertilization

  • Irmhild Gruber
  • Alexander Just
  • Monika Birner
  • Alexander Lösch
Open Access



To determine whether estradiol-to-progesterone (E2/P) ratios at the time of embryo transfer (ET) have an effect on implantation and pregnancy in IVF cycles.


239 women consecutively treated by IVF or ICSI were retrospectively analyzed and early luteal serum E2 and P were measured on the day of ET. Transfer occurred after a variable in vitro culture period ranging from 4–7 days after ovulation induction (OI). Following ET, serum E2/P ratios were calculated for clinical pregnancies, preclinical abortions and non-coneption cycles.


Receiver-operator curve analysis demonstrated that the E2/P ratio could differentiate between clinical pregnancies and non-pregnant cycles (area under the curve on OI +4 days = 0.70; 95% CI = 0.60–0.80; p = 0.003, on OI +5 days = 0.76; 95% CI = 0.64–0.88; p = 0.001, OI +7 days = 0.85; 95% CI = 0.75–0.96; p < 0.0001).


These retrospective data may hold prognostic value regarding endometrial receptivity as reflected by E2/P measurements and may help improve IVF treatment outcome. Further prospective studies should be undertaken to confirm these obersveration.





  1. 1.
    Edwards RG, Steptoe PC, Purdy JM: Establishing full-term pregnancies using cleaving embryos grown in vitro. Br J Obstet Gynaecol. 1980, 87: 737-756.CrossRefGoogle Scholar
  2. 2.
    Smitz J, Devroey P, Camus M, Deschacht J, Khan I, Staessen C, Van Waesberghe L, Wisanto A, Van Steirteghem AC: The luteal phase and early pregnancy after combined GnRH-agonist/HMG treatment for superovulation in IVF or GIFT. Hum Reprod. 1988, 3: 585-590.CrossRefGoogle Scholar
  3. 3.
    Albano C, Grimbizis G, Smitz J, Riethmuller-Winzen H, Reissmann T, Van Steirteghem A, Devroey P: The luteal phase of nonsupplemented cycles after ovarian superovulation with human menopausal gonadotrophin-realising hormone antagonist Cetrorelix. Fertil Steril. 1998, 70: 357-359. 10.1016/S0015-0282(98)00135-6.CrossRefPubMedGoogle Scholar
  4. 4.
    Forman R, Fries N, Testart J, Belaisch-Allart J, Hazout A, Frydman R: Evidence for an adverse effect of elevated serum estradiol concentrations on embryo implantation. Fertil Steril. 1988, 49: 118-122.CrossRefGoogle Scholar
  5. 5.
    Sharara FI, McClamrock HD: Ratio of estradiol concentration on the day of human chorionic gonadotrophin administration to mid-luteal estradiol concentration is predictive of in-vitro fertilization outcome. Hum Reprod. 1999, 14: 2777-2782. 10.1093/humrep/14.11.2777.CrossRefPubMedGoogle Scholar
  6. 6.
    Ng Hung Yu E, Shu Biu Yeung W, Yee Lan Lau E, Wai Ki So W, Ho Chung P: A rapid decline in serum oestradiol concentrations around the mid-luteal phase had no adverse effect on outcome in 763 assisted reproduction cycles. Hum Reprod. 2000, 15: 1903-1908. 10.1093/humrep/15.9.1903.CrossRefGoogle Scholar
  7. 7.
    Csapo AI, Pulkkinen MO, Weist NG: Effects of luteectomy and progesterone replacement therapy in early pregnant patients. Am J Obstet Gynecol. 1973, 115: 759-765.CrossRefGoogle Scholar
  8. 8.
    Csapo A, Pulkkinen MO, Kaihola HL: The effect of estradiol replacement therapy on early pregnant luteectomized patients. Am J Obstet Gynecol. 1973, 115: 987-990.CrossRefGoogle Scholar
  9. 9.
    Weitlauf HM: Biology of implantation. The Physiology of Reproduction. 1994, New York: Raven Press, 233-277.Google Scholar
  10. 10.
    Devroey P, van Steirteghem A: A review of ten years experience of ICSI. Hum Reprod Update. 2004, 10: 19-28. 10.1093/humupd/dmh004.CrossRefPubMedGoogle Scholar
  11. 11.
    Zegers-Hochschild F, Nygren KG, Adamson D, de Mouzon J, Lancaster P, Mansour R, Sullivan E: The International Committee Monitoring Assisted Reproductive Technologies (ICMART) glossary on ART terminology. Fertil Steril. 2006, 86: 16-19. 10.1016/j.fertnstert.2006.04.018.CrossRefPubMedGoogle Scholar
  12. 12.
    Gore BZ, Cadwell BV, Speroff L: Estrogen-induced human luteolysis. J Clin Endocrinol Metab. 1973, 36: 615-617.CrossRefGoogle Scholar
  13. 13.
    Lessey BA, Killam AP, Metzger DA, Haney AF, Greene GL, McCarty KS: Immunohistochemical analysis of human uterine estrogen and progesterone receptors throughout the menstrual cycle. J Clin Endocrinol Metab. 1988, 67: 34-340.CrossRefGoogle Scholar
  14. 14.
    Garcia E, Bouchard P, De Brux J, Berdah J, Frydman R, Perrot-Applanat M: Use of immunocytochemistra of progesterone and estrogen receptors for endometrial dating. J Clin Endocrinol Metab. 1988, 67: 80-87.CrossRefGoogle Scholar
  15. 15.
    Paulson RJ, Sauer MV, Lobo RA: Embryo implantation after human in vitro fertilization: importance of endometrial receptivity. Fertil Steril. 1990, 53: 870-874.CrossRefGoogle Scholar
  16. 16.
    Gardner DK, Schoolcraft WB, Wagley L, Schlenker T, Stevens John , Hesla J: A prospective randomized trial of blastocyst culture and transfer in in-vitro fertilization. Hum Reprod. 1998, 13: 3434-3440. 10.1093/humrep/13.12.3434.CrossRefPubMedGoogle Scholar
  17. 17.
    Lopata A: Molecular aspects of implantation. Blastocyst-endometrial interaction: an appraisal of some old and new ideas. Mol Hum Reprod. 1996, 2: 519-525. 10.1093/molehr/2.7.519.CrossRefPubMedGoogle Scholar
  18. 18.
    Macklon NS, Fauser BC: Impact of ovarian hyperstimulation on the luteal phase. J Reprod Fertil. 2000, 101-108. Suppl 55Google Scholar
  19. 19.
    Beckers NG, Laven JS, Eijkemans MJ, Fauser BC: Folicular and luteal phase characteristics following early cessation of gonadotropin-releasing hormone agonist during ovarian stimulation for in-vitro fertilization. Hum Reprod. 2000, 15: 43-49. 10.1093/humrep/15.1.43.CrossRefPubMedGoogle Scholar
  20. 20.
    Clayton RN, Catt KJ: Regulation of pituitary gonadotropin-releasing hormone receptors by gonadal hormones. Endocrinology. 1981, 108: 887-895.CrossRefGoogle Scholar
  21. 21.
    Beckers NG, Macklon NS, Eijkemans MJ, Ludwig M, Felberbaum RE, Diedrich K, Bustion S, Loumaye E, Fauser BC: Nonsupplemented luteal phase characteristics after the administration of recombinant human chorionic gonadotropin, recombinant luteinizing hormone, or gonadotropin-releasing hormone (GnRH) agonist to induce final oocyte maturation in in vitro fertilization patients after ovarian stimulation with recombinant follicle-stimulating hormone and GnRH antagonist co treatment. J Clin Endocrinol Metab. 2003, 88: 4186-4192. 10.1210/jc.2002-021953.CrossRefPubMedGoogle Scholar
  22. 22.
    Papanikolaou EG, Bourgain C, Kolibianakis E, Tournaye H, Devroey P: Steroid recepter expression in late follicular phase endometrium in GnRH antagonist IVF cycles is already transformation in the absence of secretory changes. Hum Reprod. 2005, 20: 1541-1547. 10.1093/humrep/deh793.CrossRefPubMedGoogle Scholar
  23. 23.
    Friedler S, Gilboa S, Schachter M, Raziel A, Strassburger D, Ron ELR: Luteal phase characteristics following GnRH antagonist or agonist treatment – a comparative study. Reprod Biomed Online. 2006, 12: 27-32.CrossRefGoogle Scholar

Copyright information

© Gruber et al; licensee BioMed Central Ltd. 2007

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Authors and Affiliations

  • Irmhild Gruber
    • 1
  • Alexander Just
    • 1
  • Monika Birner
    • 1
  • Alexander Lösch
    • 1
  1. 1.Department of Gynecology and Obstetrics, IVF Outpatient DepartmentGeneral Hospital of St. PoeltenSt. PoeltenAustria

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