Journal of Assisted Reproduction and Genetics

Published in:

11-04-2024 | Estradiol | Assisted Reproduction Technologies

High estradiol levels in fresh embryo transfer cycles are not associated with detrimental impact on birth outcomes

Authors: Ivy L. Lersten, Laura Grau, Samad Jahandideh, Kate Devine, Laura Zalles, Shayne M. Plosker, Anthony N. Imudia, Luis R. Hoyos, Meike L. Uhler, Michael Homer, Cassandra Roeca, Mary D. Sammel, Alex J. Polotsky

Published in: Journal of Assisted Reproduction and Genetics | Issue 4/2024

Abstract

Purpose

There is an unclear relationship between estradiol levels and fresh embryo transfer (ET) outcomes. We determined the relationship between estradiol on the day of trigger, in fresh ET cycles without premature progesterone elevation, and good birth outcomes (GBO).

Methods

We identified autologous fresh ET cycles from 2015 to 2021 at multiple clinics in the USA. Patients with recurrent pregnancy loss, uterine factor, and elevated progesterone on the day of trigger (progesterone > 2 ng/mL or 3-day area under the curve > 4.5 ng/mL) were excluded. The primary outcome was GBO (singleton, term, live birth with appropriate weight). Log-binomial generalized estimating equations determined the likelihood of outcomes.

Results

Of 17,608 fresh ET cycles, 5025 (29%) yielded GBO. Cycles with estradiol \(\ge\) 4000 pg/mL had a greater likelihood of GBO compared to cycles < 1000 pg/mL (aRR = 1.32, 95% CI 1.13–1.54). Pairwise comparisons of estradiol between < 1000 pg/mL versus 1000–1999 pg/mL and 1000–1999 pg/mL versus 2000–2999 pg/mL revealed a higher likelihood of GBO with higher estradiol (aRR 0.83, 95% CI 0.73–0.95; aRR 0.91, 95% CI 0.85–0.97, respectively). Comparisons amongst more elevated estradiol levels revealed that the likelihood of GBO remained similar between groups (2000–2999 pg/mL versus 3000–3999 pg/mL, aRR 1.04, 95% CI 0.97–1.11; 3000–3999 pg/mL versus \(\ge\) 4000 pg/mL, aRR 0.96, 95% CI 0.9–1.04).

Conclusion

In fresh ET cycles, higher estradiol levels were associated with an increased prevalence of GBO until estradiol 2000–2999 pg/mL, thereafter plateauing. In fresh ET candidates, elevated estradiol levels should not preclude eligibility though premature progesterone rise, and risk of ovarian hyperstimulation syndrome must still be considered.

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Title: High estradiol levels in fresh embryo transfer cycles are not associated with detrimental impact on birth outcomes
Authors: Ivy L. Lersten
Laura Grau
Samad Jahandideh
Kate Devine
Laura Zalles
Shayne M. Plosker
Anthony N. Imudia
Luis R. Hoyos
Meike L. Uhler
Michael Homer
Cassandra Roeca
Mary D. Sammel
Alex J. Polotsky
Publication date: 11-04-2024
Publisher: Springer US
Keywords: Estradiol
Progesterone
Ovarian Hyperstimulation Syndrome
Published in: Journal of Assisted Reproduction and Genetics / Issue 4/2024
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-024-03062-4

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High estradiol levels in fresh embryo transfer cycles are not associated with detrimental impact on birth outcomes

Abstract

Purpose

Methods

Results

Conclusion

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