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The impact of supraphysiologic serum estradiol levels on peri-implantation embryo development and early pregnancy outcome following in vitro fertilization cycles

  • Assisted Reproduction Technologies
  • Published:
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Abstract

Purpose

To determine the impact of elevated serum estradiol levels (EE2-defined as levels > 90th percentile) on the day of hCG administration during IVF on oocyte fertilization, embryo development, implantation, clinical pregnancy and miscarriage rates.

Methods

A total of 2,995 consecutive IVF cycles in 1,889 patients with non-donor oocyte retrieval resulting in fresh embryo transfer between 1/1/2005 and 12/31/2011 were analyzed. Cycles were stratified by serum E2 level on the day of hCG administration into those with levels >90th percentile and ≤ 90th percentile. Rates of normal fertilization, embryo development, positive pregnancy test, implantation, clinical pregnancy and spontaneous miscarriage were compared.

Results

Serum estradiol above the 90th percentile on the day of hCG administration was associated with a significantly lower rate of normal fertilization (68.6 ± 20 vs. 71.6 ± 21, p = 0.02) when compared with patients with a lower serum estradiol threshold. The proportion of embryos that progressed from 2PN to 6–8 cell on day 3 was not different between the two groups. Although rates of positive pregnancy test (55.2 % vs. 57 %), implantation (26.4 % vs. 28.5 %) and clinical pregnancy (45.5 % vs. 49.4 %) were lower in patients with a higher estradiol threshold, these differences were not statistically significant. Similarly, there was no difference in the spontaneous miscarriage rates between the two groups (8.4 % vs. 7.1 %).

Conclusions

Serum estradiol levels above the 90th percentile on the day of hCG administration is associated with lower oocyte fertilization rate; however, such levels do not impact embryo development, implantation, clinical pregnancy or spontaneous miscarriage rates.

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Author information

Authors and Affiliations

  1. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Florida Morsani School of Medicine, Tampa, FL, USA

    Anthony N. Imudia

  2. Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    Randi H. Goldman, Diane L. Wright, Aaron K. Styer & Thomas L. Toth

  3. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA

    Awoniyi O. Awonuga

  4. Massachusetts General Hospital Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    Diane L. Wright, Aaron K. Styer & Thomas L. Toth

  5. University of South Florida, 2 Tampa General Circle, Suite 6022, Tampa, FL, 33606, USA

    Anthony N. Imudia

Authors
  1. Anthony N. Imudia
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  2. Randi H. Goldman
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  3. Awoniyi O. Awonuga
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  4. Diane L. Wright
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  5. Aaron K. Styer
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  6. Thomas L. Toth
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Correspondence to Anthony N. Imudia.

Additional information

Capsule Elevated estradiol levels on the day of hCG trigger is associated with lower oocyte fertilization during IVF

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Imudia, A.N., Goldman, R.H., Awonuga, A.O. et al. The impact of supraphysiologic serum estradiol levels on peri-implantation embryo development and early pregnancy outcome following in vitro fertilization cycles. J Assist Reprod Genet 31, 65–71 (2014). https://doi.org/10.1007/s10815-013-0117-8

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  • DOI: https://doi.org/10.1007/s10815-013-0117-8

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