Estradiol supplementation during the luteal phase in poor responder patients undergoing in vitro fertilization: a randomized clinical trial

Abstract

Purpose This study was designed to evaluate the effects of adding Estradiol (E2) supplementation to progesterone (P) on improvement of pregnancy outcomes in poor responder patients who underwent in vitro fertilization (IVF).Methods In a prospective randomized clinical trial, 118 poor responder patients, older than 38 years without contraindications of estradiol consumption from Infertility clinic of a university hospital were randomly divided (by computerized software) into two groups. Control group (59 patients) received only P and intervention group (59 patients) received P and E2 (4 mg/d). Supplementation was done with 4 mg E2 in the luteal phase. Fertilization rate, implantation rate, biochemical and clinical pregnancy rates, abortion rate, ongoing pregnancy, multiple pregnancy and ectopic pregnancy rates were documented for those who completed the study protocol in each group (per protocol analysis) and compared between groups. Result Fifty five patients in control group and 53 patients in intervention group successfully completed the study protocol. Treatment outcomes were not significantly different between two groups. Conclusion For poor responder women who underwent IVF, addition of E2 to P supplementation could not significantly improve pregnancy outcomes.

Effects of estradiol injection on outcome of in-vitro fertilization: a randomized, double-blind, placebo controlled trial

“…The authors found that the E2 supplementation was associated with sig- nificant decrease in E2 levels after hCG injection when compared to placebo. However the clinical pregnancy rate and number of retrieved oocytes were not affected by the E2 supplementation, which is consistent with previous studies [23,24]. The results showed that E2 serum levels in hCG administration day and the third and seventh day after ovum retrieval in these patients were noticeably decreased.…”

“…Histological data from endometrial biopsies of patients undergoing IVF on days 21 and 25 of cycles has shown that omitting the E2 injections from treatment cycles does not have any effects on unity of uterine endometrium, estrogen receptor numbers, and hormone profile of these patients. In these studies, it has been suggested that perhaps the high physiologic levels of progesterone compensates for loss of E2 during the midluteal phase and masks its effects on unity of endometrium, embryo implantation, and as a result the outcome of IVF [24]. In addition, it has been suggested that since the optimal dose of E2 administration during the luteal phase is still not determined and is of question, perhaps the reason for controversial results on this subject is due to ineffectiveness of E2 supporting doses during the luteal phase [5].…”

Plasmatic estradiol concentration in the mid-luteal phase is a good prognostic factor for clinical and ongoing pregnancies, during stimulated cycles of in vitro fertilization

“…The use of E 2 in daily doses of 4 to 6 mg/day to improve the luteal phase is a controversial topic. Fatemi et al (2007) , Ceyhan et al (2008) , Aghahosseini et al (2011) , Lin et al (2013) and Engmann et al (2008) in randomized studies, reported no benefit stemming from the administration of E 2 in a dose of 4 mg/day. Other authors ( Drakakis et al.…”

Estrogen supplementation in art (a review)

“…Aghahosseini и соавт. [37] первыми провели рандомизированное контролируемое исследование влияния приема препаратов эстрогенов (4 мг перо-рально) в лютеиновую фазу цикла ЭКО у 118 паци-енток старше 37 лет, у которых было получено 5 и менее ооцитов. Авторы не выявили различий в ча-стоте имплантации и частоте наступления беремен-ности между группами, которые в данной когорте пациенток оказались чрезвычайно низкими (9,5% против 8,2% и 13,2% против 10,9% соответственно).…”