Low serum estradiol concentrations after five days of controlled ovarian hyperstimulation for in vitro fertilization are associated with poor outcome

Objective: To evaluate the prognostic significance of low serum E-2 concentrations in controlled ovarian hyperstimulation (COH) cycles for IVF. Design: Retrospective study. Setting: Assisted conception unit of a university hospital. Patient(s): One thousand four hundred and forty patients undergoing COH for IVF. Intervention(s): COH, serum E-2 measurement, ultrasonographic scanning of ovarian follicles, oocyte retrieval, and ET. Main Outcome Measure(s): Cancellation and pregnancy rates. Result(s): Patients were classified into four groups according to serum E-2 levels on the sixth day of COH: group A (E-2 level < 50 pg/mL [114 cycles]), group B (E-2 level 51-100 pg/mL [189 cycles]), group C (E-2 level 101-200 pg/mL [320 cycles]), and group D (E-2 level >200 pg/mL [817 cycles]). Group A experienced the highest cancellation rates (65.1%) and lowest pregnancy rates (7.8%) despite requiring significantly more hMG ampules (47.8 +/- 1.7). The cancellation rate was higher (75.1%) and no pregnancy occurred in a subset of group A in whom COH was initiated with greater than or equal to 3 ampules (225 IU) of gonadotropins. Conclusion(s): In COH cycles using luteal phase buserelin, low initial serum E-2 concentrations are associated with poor outcome. (Fertil Steril(R) 2000;74:63-6. (C) 2000 by American Society for Reproductive Medicine).