Estradiol progesterone ratio on ovulation induction day: a determinant of successful pregnancy outcome after intra cytoplasmic sperm injection

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Abstract

Background: Intracytoplasmic sperm injection (ICSI) is an advanced technique employed in assisted reproductive clinics for treatment of infertile couples. The reproductive endocrinologists try their level best to identify factors that enhance success rate after ICSI.

Objective: To compare estradiol progesterone ratio on ovulation induction day amongst pregnancy outcome groups following ICSI.

Materials and Methods: A cross sectional study was conducted on 323 couples of Assisted Reproductive Clinic in Islamabad from June 2010 till August 2011. Down regulation of females aged 18-40 years with gonadotrophin releasing hormone agonist was followed by calculated stimulation with gonadotrophin injections (COS). Oocytes pickup was done 36 hours after ovulation induction by 16G adapter and double lumen oocyte aspiration needle under general anesthesia. Oocytes were fertilized in vitro, graded and only blastocysts were transferred seven days after ovulation induction. Serum estradiol and progesterone were measured by enzyme linked immuno sorbent assay on ovulation induction day, ratio was compared in three groups of females; no conception with βhCG 5-25 mIU/ml, preclinical abortion with βhCG >25 mIU/ml and no cardiac activity on transvaginal scan and clinical pregnancy with βhCG >25mIU/ml and cardiac activity on transvaginal scan.

Results: Females having high estradiol/ progesterone ratio were able to achieve clinical pregnancy shown by a positive βhCG and cardiac activity on transvaginal scan. These females also had significantly high number of oocytes, endometrial thickness and implantation rate.

Conclusion: A high estradiol/progesterone ratio on the day of ovulation induction predicts the success of intra cytoplasmic sperm injection.

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Most cited references 35

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Comparative aspects of implantation.

Fuller Bazer, Robert Burghardt, Thomas E. Spencer … (2009)

Uterine receptivity to implantation of blastocysts in mammals includes hatching from zona pellucida, precontact with uterine luminal (LE) and superficial glandular (sGE) epithelia and orientation of blastocyst, apposition between trophectoderm and uterine LE and sGE, adhesion of trophectoderm to uterine LE/sGE, and, in some species, limited or extensive invasion into the endometrial stroma and induction of decidualization of stromal cells. These peri-implantation events are prerequisites for pregnancy recognition signaling, implantation, and placentation required for fetal-placental growth and development through the remainder of pregnancy. Although there is a range of strategies for implantation in mammals, a common feature is the requirement for progesterone (P(4)) to downregulate expression of its receptors in uterine epithelia and P(4) prior to implantation events. P(4) then mediates its effects via growth factors expressed by stromal cells in most species; however, uterine luminal epithelium may express a growth factor in response to P(4) and/or estrogens in species with a true epitheliochorial placenta. There is also compelling evidence that uterine receptivity to implantation involves temporal and cell-specific expression of interferon (IFN)-stimulated genes that may be induced directly by an IFN or induced by P(4) and stimulated by an IFN. These genes have many roles including nutrient transport, cellular remodeling, angiogenesis and relaxation of vascular tissues, cell proliferation and migration, establishment of an antiviral state, and protection of conceptus tissues from challenges by the maternal immune cells.

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Effect of obesity on oocyte and embryo quality in women undergoing in vitro fertilization.

Katharine F. Berry, E Ginsburg, K Shah … (2011)

To estimate the effect of body mass index (BMI) on oocyte and embryo parameters and cycle outcomes in women undergoing in vitro fertilization (IVF). We evaluated a retrospective cohort of 1,721 women undergoing a first IVF cycle with fresh, autologous embryos between 2007 and 2010 in an academic infertility practice. Main outcome measures included number of mature and normally fertilized oocytes, embryo morphology, estradiol on the day of human chorionic gonadotropin administration, clinical pregnancy, spontaneous abortion, and live birth. We performed multivariable analyses, adjusting for potential confounders, including age at cycle start, infertility diagnosis, type of stimulation, total gonadotropin dose, use of intracytoplasmic sperm injection, and number of embryos transferred. Compared with women of normal BMI, women with class II (BMI 35-39.9) and III (BMI 40 or higher) obesity had fewer normally fertilized oocytes (9.3 compared with 7.6 and 7.7, P<.03) and lower estradiol levels (2,047 pg/mL compared with 1,498 and 1,361, P<.001) adjusting for age and despite similar numbers of mature oocytes. Odds of clinical pregnancy (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.31-0.82) and live birth (OR 0.51, 95% CI 0.29-0.87) were 50% lower in women with class III obesity as compared with women of normal BMI. Obesity was associated with fewer normally fertilized oocytes, lower estradiol levels, and lower pregnancy and live birth rates. Infertile women requiring IVF should be encouraged to maintain a normal weight during treatment.

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Serum estradiol levels during controlled ovarian hyperstimulation influence the pregnancy outcome of in vitro fertilization in a concentration-dependent manner.

Bo Sun Joo, Sea Hee Park, Byeong Min An … (2010)

To determine an optimal serum E(2) level on the day of hCG administration in controlled ovarian hyperstimulation (COH) during IVF-ET without compromising pregnancy outcome. Retrospective study. Large urban medical center. Data of 455 cycles of fresh IVF-ET with COH. Serum E(2) levels on the day of hCG administration were categorized into five groups: group A ( 4000 pg/mL). Serum E(2) levels, number of oocytes retrieved, pregnancy outcomes. Of 455 cycles, 148 (32.5%) cycles resulted in clinical pregnancy. The implantation rate was 12.2%, and the delivery rate was 18.7%. The number of oocytes obtained increased with increasing serum E(2) levels. The pregnancy rate gradually increased from group A to D as E(2) levels increased but decreased in group E. In women /=38 years old, pregnancy and delivery rates were higher in group C than in other groups. These results show that serum E(2) levels have a concentration-dependent effect on the pregnancy outcome, suggesting an optimal range of E(2) level for achieving a successful pregnancy. This optimal range of serum E(2) level in women is age dependent: 3000-4000 pg/mL for women /=38 years. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Iran J Reprod Med

Journal ID (iso-abbrev): Iran J Reprod Med

Journal ID (publisher-id): IJRM

Title: Iranian Journal of Reproductive Medicine

Publisher: Research and Clinical Center for Infertility (Yazd, Iran )

ISSN (Print): 1680-6433

ISSN (Electronic): 2008-2177

Publication date (Print): September 2014

Volume: 12

Issue: 9

Pages: 633-640

Affiliations

[1 ] Bahria University Medical and Dental College, Karachi, Pakistan.

[2 ] Department of Biological and Biomedical Sciences, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan.

[3 ] Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, KSA.

[4 ] Research Development, Dow University of Health Sciences, Karachi, Pakistan

Author notes

Corresponding Author: Rakhshaan Khan, H. # 10, St # 46, F-7/1, Islamabad, Pakistan. Email: drrakhshaan@gmail.com, Tel: 03235218211

Article

Publisher ID: ijrm-12-633

PMC ID: 4248148

PubMed ID: 25469136

SO-VID: cc5b8bd3-642c-459e-acdc-b8b2fbb164e0

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Estradiol progesterone ratio on ovulation induction day: a determinant of successful pregnancy outcome after intra cytoplasmic sperm injection

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Abstract

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HLA-G and immune tolerance in pregnancy

Most cited references 35

Comparative aspects of implantation.

Effect of obesity on oocyte and embryo quality in women undergoing in vitro fertilization.

Serum estradiol levels during controlled ovarian hyperstimulation influence the pregnancy outcome of in vitro fertilization in a concentration-dependent manner.

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