The Prognostic Importance of Estradiol and Progesterone Profile in IVF Cycles Treated with Adjunctive GnRH Agonist

Lee, N W; Song, J; Kim, T; Kim, S H; Koo, B S

Abstract

Although significant progress has been realized in the induction of follicular develpment,oocyte recovery,and the laboratory aspects of human in vitro fertilization (IVF),implantation rate and pregnancy rate after embryo transfer (ET) remain low. Among many variable factors related with implantation and early pregnancy maintenance, hormonal factor is thought to be important. Empirical hormonal therapy during periimplantation period was performed, but there is little information about the optimal hormonal environment during periimplantation period. To assess the prognostic importance of estradiol (E2) and progesterone (P4) levels on the day of hCG administration in IVF cycles treated with adjunctive GnRH agonist, we reviewed the 79 cycles underwent oocyte retieval for IVF after controlled ovarian hyperstimulation (COH) with GnRH-agonist and hMG/FSH exclusive of male factor and over 38 years old, from january 1995 to december 1995. Serum E2 and P4 levels were determined using radioimmunoassay (RIA) on the day of hCG administration (day 0). We analized IVF-ET outcome (number of oocytes,number of embryos transferable,fertilization rate,implantation rate and pregnancy rate/cycle) related to the serum E2 and P4 levels. The serum E2,P4 levels on the day 12 were measured to compare the luteal phase pattern of serum E2,P4 in conception and nonconception cycles. The followings are summarized results. 1. Absolute P4 level on the day 0 was related to the size of recruited follicular mass (FM) and number of embryos transferable (P < 0.0001, < 0.05) but not related to the fertilization rate (FR) and pregnancy rate (PR). 2. In lower corrected P4 level (day 0 P4/oocyte), FM was increased (P < 0.01). 3. Absolute E2 level on the day 0 was related to the size of FM and number of embryos transferable (P < 0.05, P < 0.01)and not related to the FR and PR, but implantation rate (IR) was increased in lower E2 group (P < 0.05). 4. Corrected E2 level (day 0 E2/oocyte) was not related to the FM and FR but IR and PR were increased in lower corrected E2 group (P < 0.05). 5. There was no significant differences in the absolute levels of P4 and E2 during the late luteal phase between the pregnant and nonpregnant cycles, but E2/P4 ratio in pregnant group was higher than that of nonpregnant group (P < 0.05). In conclusion, it is suggested that absolute level of steroids during late follicular phase has no impact on the PR in IVF cycles and high E2 level per oocyte may have adverse effects on the embyronic development as well as endometrial receptivity.