Serum estradiol level on trigger day impacts clinical pregnancy rate in modified natural frozen embryo transfer cycles

Abstract

Objective To examine the predictive value of serum estradiol and progesterone on the day of human chorionic gonadotropin (hCG) administration and embryo transfer for clinical pregnancy rate in modified natural‐cycle frozen embryo transfer (NC‐FET). Methods In a longitudinal prospective study, all eligible women who underwent NC‐FET cycles with hCG triggering in Royan Institute, Tehran, Iran, from June 1, 2015, to December 31, 2016, were evaluated. Serum estradiol and progesterone levels were measured at menstrual cycle initiation, on day of trigger with hCG, on day of embryo transfer, and in pregnant women every 7 days until the observation of a gestational sac with embryonic heartbeat. Results In total, 101 modified natural FET cycles were assessed, and the clinical pregnancy and live birth rates achieved were 34 (33.6%) and 32 (31.6%), respectively. The changes in estradiol level during early pregnancy showed an increase by an average of 200 pg/mL per week. Multivariable logistic regression analysis showed that only the estradiol level on the hCG day was a significant predictive variable for clinical pregnancy following NC‐FET (P=0.04). Conclusion Estradiol level on the day of hCG trigger predicted the clinical pregnancy rates after modified NC‐FET; this likely mirrored the developmental competence of the corpus luteum and an appropriate luteal structure‐function.

Serum progesterone levels greater than 32.5 ng/ml on the day of embryo transfer are associated with lower live birth rate after artificial endometrial preparation: a prospective study

“…Hull et al in a classical study showed that a lower threshold of 9.4 ng/ml was optimal for fertility in natural cycles [ 22 ]. Regarding FET cycles, Ramezanali et al [ 23 ] found that there was no significant difference in P 4 levels on the day of ET between pregnant and non-pregnant women (8.7 ± 0.5 versus 8.2 ± 0.5 ng/ml) in a longitudinal study of 101 modified natural FET cycles. In artificial cycles, current evidence suggests that P 4 levels of > 5 ng/ml provide an acceptably primed endometrium, resulting in endometrial luteinization and receptivity, which did not differ from that achieved by very higher levels [ 24 , 25 ].…”

Roles of estradiol levels on the day of human chorionic gonadotrophin administration in the live birth of patients with frozen embryo transfer

“…Our results founded that serum E 2 level on the day of HCG administration was an independent predictor of live‐birth achievement, and high serum E 2 level on HCG day was associated with decreased live‐birth rates in patients with FET. The impaired oocyte maturation and the decreased pregnancy achievement caused by elevated E 2 levels have been mentioned 34,35 . Clinical studies suggested that high E 2 levels could adversely affect perinatal outcomes.…”

“…The impaired oocyte maturation and the decreased pregnancy achievement caused by elevated E 2 levels have been mentioned. 34,35 Clinical studies suggested that high E 2 levels could adversely affect perinatal outcomes. The occurrence of complications associated with abnormal placenta was significantly increased when serum E 2 level was at >10 000 pmol/L.…”

Effect of the ratios of estradiol increase on the outcome of in vitro fertilization-embryo transfer with antagonist regimens: a single center retrospective cohort study

“…However, Blazar et al [ 26 – 28 ] discovered that higher E 2 levels on hCG days predicted a greater number of oocytes, and any adverse impact on endometrial can be conquered in IVF-ET. Only the estradiol level on the hCG day was a significant predictive variable for clinical pregnancy [ 29 , 30 ]. Additionally, according to percentile curves, Papageorgiou et al [ 31 ] did not identify any deleterious effects of high E 2 levels.…”