A Comparative Study to Assess the Efficacy of Two Different Estradiol Formulations during In Vitro Fertilization

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization (IVF)
• Hormone Replacement Therapy (HRT)

Background:

• Assisted reproductive technology (ART) advancements necessitate optimized hormone replacement therapy (HRT) protocols for embryo transfer.
• Endometrial thickness is crucial for successful implantation, regulated by precise hormonal control, particularly estrogen levels.
• Estradiol valerate is commonly used to achieve optimal endometrial lining (>7 mm) in HRT, but clinical outcome differences among estrogen formulations remain under-researched.

Purpose of the Study:

• To compare the efficacy of oral estradiol hemihydrate versus estradiol valerate in HRT cycles for in vitro fertilization (IVF).
• To evaluate the impact of different oral estrogen formulations on endometrial thickness and key reproductive outcomes.

Main Methods:

• Retrospective study involving 2,529 Indian women undergoing HRT for IVF between January 2017 and May 2019.
• Comparison of implantation rates, endometrial thickness, clinical pregnancy rates, abortion rates, ectopic pregnancy, and live birth rates between estradiol valerate and estradiol hemihydrate groups.

Main Results:

• No significant difference in implantation rates (47.42% vs. 49.07%, P=0.284) between estradiol valerate and estradiol hemihydrate.
• Estradiol hemihydrate resulted in significantly greater endometrial thickness (9.57 ± 0.058 mm vs. 9.25 ± 0.038 mm, P<0.001).
• Secondary outcomes including clinical pregnancy, abortion, ectopic pregnancy, and live birth rates showed no significant variations between the groups.

Conclusions:

• Oral estradiol hemihydrate and estradiol valerate are therapeutically equivalent for HRT in IVF settings.
• Both formulations provide similar clinical outcomes, including live birth rates, despite minor differences in endometrial thickness.
• The choice between oral estradiol hemihydrate and estradiol valerate may not significantly impact overall IVF success rates.