Super high estradiol response to gonadotropin stimulation in patients undergoing in vitro fertilization

Michael Peter Diamond, Tina Buchholz, Stephen P. Boyers, Gad Lavy, Bruce S. Shapiro, Alan H. DeCherney

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

The likelihood of establishment of a term pregnancy from in vitro fertilization (IVF) is related to the estradiol (E2) pattern and peak level. To examine the influence of super high E2 peak levels (>-2000 pg/ml), we reviewed the clinical outcomes of all IVF cycles with follicular phase E2 levels >2000 pg/ml from May 1982 through June 1987. Among 1651 IVF cycles initiated during this time, 102 cycles (6.2%) had super high E2 levels. Twenty-seven of these cycles occurred in 34 IVF attempts in 12 women. Stimulation was performed with human menopausal gonadotropin (hMG) in 96 cycles and follicle-stimulating hormone (FSH) in 6 cycles. A mean of 9.3±0.7 oocytes per cycle was recovered, of which 5.5±0.5 fertilized and underwent cleavage. In 11 cycles, with a mean of 6.8 oocytes recovered, none fertilized. Polyploid fertilization occurred in 23 of 90 cycles (25.6%), and 40 of 558 fertilized oocytes (7.2%). From these cycles, 10 clinical pregnancies (9.8%) have resulted: 6 pregnancies in 59 cycles with luteal-phase progesterone support (10.2%) and 4 pregnancies in 31 cycles without luteal-phase progesterone support (12.9%). Among the 1549 cycles with peak E2 levels <-2000 pg/ml, 143 (9.2%) resulted in clinical pregnancies. We conclude that there is a small subset of patients who will have super high E2 responses to gonadotropin stimulation and that there is a tendency to stimulate repetitively in this fashion. With regard to pregnancy outcome (1) pregnancy rates are not elevated in this sub-group of high E2 responses, and (2) there does not appear to be an advantage of luteal-phase progesterone support in these super high E2 cycles.

Original languageEnglish (US)
Pages (from-to)81-84
Number of pages4
JournalJournal of in Vitro Fertilization and Embryo Transfer
Volume6
Issue number2
DOIs
StatePublished - Apr 1 1989
Externally publishedYes

Keywords

  • estradiol
  • in vitro fertilization
  • super high response

ASJC Scopus subject areas

  • Embryology
  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Developmental Biology

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