A Higher Estradiol Rise After Dual Trigger in Progestin-Primed Ovarian Stimulation Is Associated With a Lower Oocyte and Mature Oocyte Yield in Normal Responders

Abstract

Background: Prior studies have shown that patients with a >10% estradiol (E2) rise after trigger had more oocytes retrieved than plateauing or decreasing E2 responders. However, multiple follicles develop at different stages of maturation during controlled ovarian stimulation (COS) and may exhibit different responses to trigger. The association between the magnitude of E2 increase and oocyte retrieval outcomes is still unclear.Methods: This was a retrospective cohort study of 2,898 women undergoing their first COS cycles with normal response from January 2014 to December 2017 at a tertiary-care academic medical center. Patients were categorized into five groups according to the percentage increase in E2 levels before and after dual trigger: <10.0%, 10.0–19.9%, 20.0–29.9%, 30.0–39.9%, and ≥40.0%. Univariable and multivariable linear regression analysis were performed to explore the association between E2 increase and oocyte/mature oocyte yield, while logistic regression was used to assess its effect on low oocyte/mature oocyte yield (<10th percentile).Results: The post-trigger E2 increase was negatively associated with both oocyte yield (P-trend < 0.001, adjusted P-trend = 0.033) and mature oocyte yield (P-trend < 0.001, adjusted P-trend = 0.002). Compared with a <10.0% E2 increase after trigger, patients with a ≥40.0% rise had fewer mature oocyte yield [adjusted mean absolute difference [MD] = −5.2, 95% confidence interval [CI]: −8.2–−1.8] and higher risk of low mature oocyte yield (adjusted odds ratio [OR] = 1.64, 95% CI: 1.04–2.60), whereas no statistical significance was found in oocyte yield (adjusted MD = −2.7, 95% CI: −6.1–0.8) and low oocyte yield (adjusted OR = 1.48, 95% CI: 0.96–2.28). In addition, the rates of implantation, positive pregnancy test, clinical pregnancy, ongoing pregnancy, pregnancy loss, and live birth were comparable among the 1,942 frozen embryo transfer cycles with embryos originating from different groups of E2 increase (all P > 0.05).Conclusions: A higher E2 rise after dual trigger is independently associated with a lower oocyte and mature oocyte yield in normal responders. Further studies are needed to explore the efficacy of individualized time interval from trigger to oocyte retrieval based on the magnitude of E2 increase after trigger.

Effect of Dual Trigger with Follicle Stimulating Hormone and Chorionic Gonadotropin Hormone on Ovulation Rate in Infertile Women received Aromatase Inhibitor Superovulation in Kirkuk City, Iraq

“…The majority of study participants in all groups were between the ages of 25 and 34 years, were overweight, and had been experiencing infertility for less than five years at the time of enrollment. These findings were close to that reported by Decleer, et al, 7 in a study done earlier showed that, covariates, age, body mass index (BMI), basal hormonal level, the number of days of stimulation as well as the cycle ranking did not demonstrate any differences between the groups compared. In another study, Lamb et al 3 discovered that the mean age of women undergoing ART therapy was 30.36 years, and that the mean BMI was 25.9 kilograms per square meter.…”

“…When properly indicated, intrauterine insemination (IUI) is a less invasive and more affordable alternative to other methods of conception. [5][6][7] The aim of the study was to determine whether dual trigger (FSH and hCG) can improve the ovulation and pregnancy rate (Figure 1).…”

Does the decrease in E2 levels between the trigger of ovulation and embryo transfer affect the reproductive outcome in IVF-ICSI cycles?

“…The results of early studies of IVF cycles showed that E2 values measured 24 h after hCG administration are not predictive of reproductive outcome ( 15 , 16 ) . Ozdegirmenci et al ( 15 ) reported a 38% CPR in women with a 30% E2 decline, but in Huang’s study ( 16 ) , the number of women with a 30% decrease was too small to allow a statistical comparison.…”

The comparison between fixed versus degressive doses of medroxyprogesterone acetate combined with letrozole in patients of progestin-primed ovarian stimulation protocol: a propensity score-matched study

“…Most importantly, it significantly reduces the occurrence of ovarian hyperstimulation syndrome (OHSS), a severe complication associated with other COH protocols. Due to these benefits, the PPOS protocol is considered suitable for women with various ovarian responses, including those with poor ovarian response (3)(4)(5)(6), normal responders (7,8), and even high responders (7,9) in IVF/ICSI cycles.…”