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Does the decrease in E2 levels between the trigger of ovulation and embryo transfer affect the reproductive outcome

Nefise Nazlı Yenigül1, Runa Özelci2, Emre Başer3

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Summary

A significant drop in estradiol (E2) levels after hCG injection in women undergoing assisted reproductive technology (ART) is linked to lower live birth rates and higher miscarriage rates, particularly in high responders. This E2 decline impacts ART success.

Keywords:
E2 declinehigh ovarian responselive birth ratelow ovarian reservemiscarriage rate

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Area of Science:

  • Reproductive Endocrinology
  • Infertility Research
  • Assisted Reproductive Technology (ART)

Background:

  • Serum estradiol (E2) levels fluctuate during assisted reproductive technology (ART) cycles.
  • The rate of E2 decline between human chorionic gonadotropin (hCG) administration and embryo transfer (ET) may influence ART outcomes.
  • Understanding these dynamics is crucial for optimizing infertility treatments.

Purpose of the Study:

  • To evaluate the impact of serum estradiol (E2) level decline rate on ART success.
  • To investigate this effect across different infertility etiologies and ovarian response groups.
  • To identify specific E2 decline thresholds associated with implantation and live birth rates.

Main Methods:

  • A cohort of 1,928 women aged 20-45 undergoing fresh ET were categorized by ovarian response (low, high, normal).
  • Patients were subgrouped based on E2 level decrease (<20%, 20-40%, 41-60%, >60%) between hCG injection and ET.
  • Implantation rate, live birth rate (LBR), and miscarriage rate (MCR) were primary and secondary outcome measures.

Main Results:

  • A >60% decrease in E2 levels post-hCG was associated with lower LBR and higher MCR in high responders.
  • In normoresponder women, a >60% E2 decline significantly increased MCR but not LBR.
  • The rate of E2 decline demonstrated a differential impact on ART success based on ovarian response.

Conclusions:

  • A substantial E2 decline (>60%) after hCG in fresh ET cycles negatively affects LBR in high responders.
  • For normoresponders, significant E2 decline primarily impacts miscarriage rates.
  • Monitoring E2 kinetics is important for predicting and potentially improving ART outcomes.