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      The Serum Concentration of Estradiol after Embryo Transfer and the Decline from Preovulatory Levels May Influence the Success of IVF Treatment

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          Aim: To establish the influence that serum estradiol concentrations prior to oocyte retrieval and 3 days after embryo transfer have on the establishment of in vitro fertilization (IVF) pregnancy. Method: Preovulatory (day-0) and luteal-phase (day-6) estradiol concentrations were retrospectively analyzed in 310 infertile patients, undertaking 1st-cycle conventional IVF or intracytoplasmic sperm injection. Results: The IVF treatment success is significantly reduced in patients with an estradiol level <600 pg/ml and also when a rapid decline in luteal-phase estradiol concentrations from preovulatory concentrations (day 0:day 6 ratio) was exhibited. Conclusion: A day 0:day 6 estradiol ratio >5 and a serum estradiol concentration <600 pg/ml may adversely impact on the establishment of pregnancy in IVF.

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          Increasing uterine receptivity by decreasing estradiol levels during the preimplantation period in high responders with the use of a follicle-stimulating hormone step-down regimen.

          To analyze the effect on uterine receptivity of a decrease in E2 levels during the preimplantation period with the use of a step-down regimen in high responders undergoing IVF. Prospective controlled clinical study. The Instituto Valenciano de Infertilidad. High responders in whom at least one previous IVF attempt failed in which 3-4 good-quality embryos were transferred and E2 levels were >3,000 pg/mL on the day of hCG administration. Gonadotropins were administered according to two different protocols. Blood samples were collected and IVF was performed. Serum E2 levels and reproductive outcome of IVF. Estradiol levels on the day of hCG administration and throughout the preimplantation period and the number of oocytes collected were significantly lower with the use of the step-down regimen than during the previous failed cycle in which the standard protocol was used. The fertilization rate was similar and the number of good-quality embryos transferred was comparable. However, the implantation and pregnancy rates were significantly improved in patients who underwent the step-down regimen compared with those who received the standard protocol. With the use of a step-down regimen with FSH in high responders, our clinical results demonstrate that uterine receptivity can be improved when E2 levels are decreased during the preimplantation period.

            Author and article information

            Horm Res Paediatr
            Hormone Research in Paediatrics
            S. Karger AG
            20 February 2003
            : 59
            : 2
            : 95-99
            aSchool of Health Science, Griffith University, Gold Coast Campus, Bundall, and bMonash IVF Gold Coast Fertility Centre, Allamanda Private Hospital, Southport, Australia
            68578 Horm Res 2003;59:95–99
            © 2003 S. Karger AG, Basel

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            Figures: 2, Tables: 1, References: 9, Pages: 5
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