Estradiol (E2) Reduction Adversely Affect the Embryo Quality and Clinical Outcomes of In Vitro Fertilization and Embryo transfer (IVF-ET)

Objective. The purpose of this study was to explore the influence of decreased serum estradiol (E-2) levels during controlled ovarian hyperstimulation (COH) on in vitro fertilization and embryo transfer (IVF). Methods. The clinical data of 300 IVF-ET cycles with patients were analyzed retrospectively. According to the presence of falling E-2 level during the COH, we divided all subjects into two groups: the E-2 levels fall group (n = 120, group A) and the control group (n = 180, group B). In group A, there were 57 patients with falling E-2 with drug dosage reduction. The other 63 patients experienced the decreased E-2 level spontaneously. The clinical and laboratory variables in the groups were compared. Receiver operator characteristic (ROC) curve analyses were carried out in order to evaluate the predict value of E-2 level on the day of human chorionic gonadotropin (hCG) administration on IVF outcomes. Results. Duration and total dosage of gonadotropin (Gn) used were statistically more in group A than in group B (P < 0.001). The high-quality embryo rate was significantly lower in group A (P = 0.048). Women in group A had lower clinical pregnancy rate (P = 0.029), live birth rate (P < 0.001), ongoing pregnancy rate (P = 0.001), and higher early abortion rates (P = 0.008) than group B. Women with spontaneously falling E-2 group had a higher BMI index than those in the drug dosage reduction group (P = 0.001). More dosage and longer duration of Gn in spontaneously falling E-2 group than in the drug dosage reduction group (P < 0.01). There were no differences in clinical outcomes between the two types of E-2 decreased groups. Results from ROC showed an E-2 level < 1987.5 pg/ml on the hCG day might predict early abortion in this study. The sensitivity was 58.4% and the specificity was 78.9%. In addition, an E-2 level > 2020 pg/ml on the hCG day might be an index to predict live birth. The sensitivity was 57.0% and the specificity was 61.7%. Conclusions. Reduction of E-2 during COH might adversely affect the clinical pregnancy, early abortion, and ongoing pregnancy of IVF-ET.