Elevated levels of basal estradiol-17β predict poor response in patients with normal basal levels of follicle-stimulating hormone undergoing in vitro fertilization

Objective: To evaluate whether the predictive ability of a normal FSH level on cycle day 3 can be enhanced by levels of estradiol-17 beta (E-2) on cycle day 3. Design: Prospective cohort study. Setting: University hospital-based, tertiary care infertility center. Patient(s): Two hundred thirty-one consecutively seen patients who attended the center for their first IVF attempt. Intervention(s): Blood samples were collected on day 3 of the cycle preceding IVF; IVF was performed in all patients. Main Outcome Measure(s): Patient's age, number of ampules of hMG, cancellation rate, number of oocytes, fertilization rate, and clinical pregnancy rate. Result(s): In patients with elevated FSH levels on cycle day 3, a low oocyte yield was achieved (7 versus 11) and a high number of ampules of hMG was necessary (56 versus 33). Their cancellation rate was high (67% versus 16%). In patients with normal basal FSH levels, high E-2 levels predicted a high cancellation rate (56%, versus 13% in patients with low E-2 levels) and a low oocyte yield (9, versus 11 in patients with low E-2 levels). Patients with both normal FSH levels and low E-2 levels on cycle day 3 fared best. Conclusion(s): The basal E-2 level on cycle day 3 is a useful prognosticator of response to stimulation in IVF patients with normal basal FSH levels. (C) 1998 by American Society for Reproductive Medicine.