Skip to main content
Top
Published in: Reproductive Biology and Endocrinology 1/2015

Open Access 01-12-2015 | Research

The association of serum estradiol level with outcomes of clomiphene citrate/human menopausal gonadotropin ovarian stimulation for in vitro fertilization and embryo transfer

Authors: Xiao-Jin Zhang, Su-Ying Liu, Wei Fu, Xiao-Xi Sun

Published in: Reproductive Biology and Endocrinology | Issue 1/2015

Login to get access

Abstract

Background

The purpose of this study was to test the hypothesis that estradiol (E2) level on day 3 may be associated with in vitro fertilization (IVF) outcomes.

Methods

The records of patients who received clomiphene citrate 100 mg/day plus human menopausal gonadotropin 150 IU/day from day 3 and received frozen-thawed embryo transfers were reviewed. Patients were divided into three groups: group A (E2 ≤30 pg/ml), group B (30< E2 ≤50 pg/ml), and group C (E2 >50 pg/ml). A total of 1080 cycles from 941 patients were included.

Results

The number of eggs and MII oocytes were less in group C than group A (both, P = 0.001). The embryo implantation (P = 0.006) and clinical pregnancy rates (P = 0.036) were lower in group C than group B, and the rates were similar between group A and B.

Conclusion

Maintaining the serum E2 level from 30 to 50 pg/ml may result in a higher clinical pregnancy rate in IVF cycles.
Literature
1.
go back to reference Muasher SJ. Use of gonadotropin-releasing hormone agonists in controlled ovarian hyperstimulation for in vitro fertilization. Clin Ther. 1992;14:74–86.PubMed Muasher SJ. Use of gonadotropin-releasing hormone agonists in controlled ovarian hyperstimulation for in vitro fertilization. Clin Ther. 1992;14:74–86.PubMed
2.
go back to reference Teramoto S, Kato O. Minimal ovarian stimulation with clomiphene citrate: a large-scale retrospective study. Reprod Biomed Online. 2007;15:134–8.CrossRefPubMed Teramoto S, Kato O. Minimal ovarian stimulation with clomiphene citrate: a large-scale retrospective study. Reprod Biomed Online. 2007;15:134–8.CrossRefPubMed
3.
go back to reference Verberg MF, Eijkemans MJ, Macklon NS, Heijnen EM, Baart EB, Hohmann FP, et al. The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis. Hum Reprod Update. 2009;15:5–12.CrossRefPubMed Verberg MF, Eijkemans MJ, Macklon NS, Heijnen EM, Baart EB, Hohmann FP, et al. The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis. Hum Reprod Update. 2009;15:5–12.CrossRefPubMed
4.
go back to reference Baart EB, Martini E, Eijkemans MJ, Van Opstal D, Beckers NG, Verhoeff A, et al. Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in human preimplantation embryo: a randomized controlled trial. Hum Reprod. 2007;22:980–8.CrossRefPubMed Baart EB, Martini E, Eijkemans MJ, Van Opstal D, Beckers NG, Verhoeff A, et al. Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in human preimplantation embryo: a randomized controlled trial. Hum Reprod. 2007;22:980–8.CrossRefPubMed
5.
go back to reference Grochowski D, Wołczyński S, Kuczyński W, Domitrz J, Szamatowicz J, Szamatowicz M. Good results of milder form of ovarian stimulation in an in vitro fertilization/intracytoplasmic sperm injection program. Gynecol Endocrinol. 1999;13:297–304.CrossRefPubMed Grochowski D, Wołczyński S, Kuczyński W, Domitrz J, Szamatowicz J, Szamatowicz M. Good results of milder form of ovarian stimulation in an in vitro fertilization/intracytoplasmic sperm injection program. Gynecol Endocrinol. 1999;13:297–304.CrossRefPubMed
6.
go back to reference Vargyas JM, Morente C, Shangold G, Marrs RP. The effect of different methods of ovarian stimulation for human in vitro fertilization and embryo replacement. Fertil Steril. 1984;42:745–9.PubMed Vargyas JM, Morente C, Shangold G, Marrs RP. The effect of different methods of ovarian stimulation for human in vitro fertilization and embryo replacement. Fertil Steril. 1984;42:745–9.PubMed
7.
go back to reference Tummon IS, Daniel SAJ, Kaplan BR, Nisker JA, Yuzpe AA. Randomized, prospective comparison of luteal leuprolide acetate and gonadotropins versus clomiphene citrate and gonadotropins in 408 first cycles of in vitro fertilization. Fertil Steril. 1992;58:563–8.PubMed Tummon IS, Daniel SAJ, Kaplan BR, Nisker JA, Yuzpe AA. Randomized, prospective comparison of luteal leuprolide acetate and gonadotropins versus clomiphene citrate and gonadotropins in 408 first cycles of in vitro fertilization. Fertil Steril. 1992;58:563–8.PubMed
8.
go back to reference Claudio AB, Owen D, Isaac K, Liu HC, Rosenwaks Z. Clomiphene citrate and hMG: an alternative stimulation protocol for selected failed in vitro fertilization patients. J Assist Reprod Genet. 1995;12:8–12.CrossRef Claudio AB, Owen D, Isaac K, Liu HC, Rosenwaks Z. Clomiphene citrate and hMG: an alternative stimulation protocol for selected failed in vitro fertilization patients. J Assist Reprod Genet. 1995;12:8–12.CrossRef
9.
go back to reference Gysler M, March CM, Mishell Jr DR, Bailey EJ. A decades experience with an individualized clomiphene treatment regimen including its effect on the post coital test. Fertil Steril. 1982;37:161–7.PubMed Gysler M, March CM, Mishell Jr DR, Bailey EJ. A decades experience with an individualized clomiphene treatment regimen including its effect on the post coital test. Fertil Steril. 1982;37:161–7.PubMed
10.
go back to reference Weigert M, Krischker U, Pöhl M, Poschalko G, Kindermann C, Feichtinger W. Comparison of stimulation with clomiphene citrate in combination with recombinant follicle-stimulating hormone and recombinant luteinizing hormone to stimulation with a gonadotropin-releasing hormone agonist protocol: a prospective, randomized study. Fertil Steril. 2002;78:34–9.CrossRefPubMed Weigert M, Krischker U, Pöhl M, Poschalko G, Kindermann C, Feichtinger W. Comparison of stimulation with clomiphene citrate in combination with recombinant follicle-stimulating hormone and recombinant luteinizing hormone to stimulation with a gonadotropin-releasing hormone agonist protocol: a prospective, randomized study. Fertil Steril. 2002;78:34–9.CrossRefPubMed
11.
go back to reference Revelli A, Chiadò A, Dalmasso P, Stabile V, Evangelista F, Basso G, et al. “Mild” vs. “long” protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial. J Assist Reprod Genet. 2014;31:809–15.PubMedCentralCrossRefPubMed Revelli A, Chiadò A, Dalmasso P, Stabile V, Evangelista F, Basso G, et al. “Mild” vs. “long” protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial. J Assist Reprod Genet. 2014;31:809–15.PubMedCentralCrossRefPubMed
12.
go back to reference Young SL, Opashi MS, Fritz MA. Serum concentration of euclomiphene and zuclomiphene across consecutive cycles of clomiphene citrate therapy in anovulatory infertile women. Fertil Steril. 1999;71:639–44.CrossRefPubMed Young SL, Opashi MS, Fritz MA. Serum concentration of euclomiphene and zuclomiphene across consecutive cycles of clomiphene citrate therapy in anovulatory infertile women. Fertil Steril. 1999;71:639–44.CrossRefPubMed
13.
go back to reference Phelps JY, Levine AS, Hickman TN, Zacur HA, Wallach EE, Hinton EL. Day 4 estradiol levels predict pregnancy success in women undergoing controlled ovarian hyperstimulation for IVF. Fertil Steril. 1998;69:1015–9.CrossRefPubMed Phelps JY, Levine AS, Hickman TN, Zacur HA, Wallach EE, Hinton EL. Day 4 estradiol levels predict pregnancy success in women undergoing controlled ovarian hyperstimulation for IVF. Fertil Steril. 1998;69:1015–9.CrossRefPubMed
14.
go back to reference Prasad S, Kumar Y, Singhal M, Sharma S. Estradiol level on day 2 and day of trigger: a potential predictor of the IVF-ET success. J Obstet Gynaecol India. 2014;64:202–7.PubMedCentralCrossRefPubMed Prasad S, Kumar Y, Singhal M, Sharma S. Estradiol level on day 2 and day of trigger: a potential predictor of the IVF-ET success. J Obstet Gynaecol India. 2014;64:202–7.PubMedCentralCrossRefPubMed
15.
go back to reference Scott Jr RT, Hofmann GE, Veeck LL, Jones Jr HW, Muasher SJ. Embryo quality and pregnancy rates in patients attempting pregnancy through in vitro fertilization. Fertil Steril. 1991;55:426–8.PubMed Scott Jr RT, Hofmann GE, Veeck LL, Jones Jr HW, Muasher SJ. Embryo quality and pregnancy rates in patients attempting pregnancy through in vitro fertilization. Fertil Steril. 1991;55:426–8.PubMed
17.
go back to reference Wilding MG, Capobianco C, Montanaro N, Kabili G, Di Matteo L, Fusco E, et al. Human cleavage-stage embryo vitrification is comparable to slow-rate cryopreservation in cycles of assisted reproduction. J Assist Reprod Genet. 2010;27:549–54.PubMedCentralCrossRefPubMed Wilding MG, Capobianco C, Montanaro N, Kabili G, Di Matteo L, Fusco E, et al. Human cleavage-stage embryo vitrification is comparable to slow-rate cryopreservation in cycles of assisted reproduction. J Assist Reprod Genet. 2010;27:549–54.PubMedCentralCrossRefPubMed
18.
go back to reference Karimzadeh MA, Ahmadi S, Oskouian H, Rahmani E. Comparison of mild stimulation and conventional stimulation in ART outcome. Arch Gynecol Obstet. 2010;281:741–6.CrossRefPubMed Karimzadeh MA, Ahmadi S, Oskouian H, Rahmani E. Comparison of mild stimulation and conventional stimulation in ART outcome. Arch Gynecol Obstet. 2010;281:741–6.CrossRefPubMed
19.
go back to reference Zhang J, Chang L, Sone Y, Silber S. Minimal ovarian stimulation (mini-IVF) for IVF utilizing vitrification and cryopreserved embryo transfer. Reprod Biomed Online. 2010;1:485.CrossRef Zhang J, Chang L, Sone Y, Silber S. Minimal ovarian stimulation (mini-IVF) for IVF utilizing vitrification and cryopreserved embryo transfer. Reprod Biomed Online. 2010;1:485.CrossRef
20.
go back to reference Kato K, Takehara Y, Segawa T, Kawachiya S, Okuno T, Kobayashi T, et al. Minimal ovarian stimulation combined with elective single embryo transfer policy: age-specific results of a large, single-centre, Japanese cohort. Reprod Biol Endocrinol. 2012;10:35.PubMedCentralCrossRefPubMed Kato K, Takehara Y, Segawa T, Kawachiya S, Okuno T, Kobayashi T, et al. Minimal ovarian stimulation combined with elective single embryo transfer policy: age-specific results of a large, single-centre, Japanese cohort. Reprod Biol Endocrinol. 2012;10:35.PubMedCentralCrossRefPubMed
21.
go back to reference Hesham A, Hamdy Z, Waleed EK, Nada A, El-Khattan E, Abou-Setta AM. The effectiveness of clomiphene citrate in LH surge suppression in women undergoing IUI: a randomized controlled trial. Fertil Steril. 2010;94:2167–71.CrossRef Hesham A, Hamdy Z, Waleed EK, Nada A, El-Khattan E, Abou-Setta AM. The effectiveness of clomiphene citrate in LH surge suppression in women undergoing IUI: a randomized controlled trial. Fertil Steril. 2010;94:2167–71.CrossRef
22.
go back to reference Ye H, Huang GN, Zeng PH, Pei L. IVF/ICSI outcomes between cycles with luteal estradiol (E2) pre-treatment before GnRH antagonist protocol and standard long GnRH agonist protocol: a prospective and randomized study. J Assist Reprod Genet. 2009;26:105–11.PubMedCentralCrossRefPubMed Ye H, Huang GN, Zeng PH, Pei L. IVF/ICSI outcomes between cycles with luteal estradiol (E2) pre-treatment before GnRH antagonist protocol and standard long GnRH agonist protocol: a prospective and randomized study. J Assist Reprod Genet. 2009;26:105–11.PubMedCentralCrossRefPubMed
23.
go back to reference Thum MY, Kalu E, Abdalla H. Elevated basal FSH and embryo quality: lessons from extended culture embryos: raised FSH and blastocyst quality. J Assist Reprod Genet. 2009;26:313–8.PubMedCentralCrossRefPubMed Thum MY, Kalu E, Abdalla H. Elevated basal FSH and embryo quality: lessons from extended culture embryos: raised FSH and blastocyst quality. J Assist Reprod Genet. 2009;26:313–8.PubMedCentralCrossRefPubMed
24.
go back to reference Calhoun KC, Fritz MA, Steiner AZ. Examining the relationship between ovarian reserve, as measured by basal FSH levels, and the risk of poor obstetric outcome in singleton IVF gestations. Hum Reprod. 2011;26:3424–30.CrossRefPubMed Calhoun KC, Fritz MA, Steiner AZ. Examining the relationship between ovarian reserve, as measured by basal FSH levels, and the risk of poor obstetric outcome in singleton IVF gestations. Hum Reprod. 2011;26:3424–30.CrossRefPubMed
25.
go back to reference DiMattina M, Gordon JD, Botes A, Celia G, Payson M, Graves-Herring J. Follicular and estradiol parameters that improve success with natural cycle in vitro fertilization. J Reprod Med. 2014;59:267–73.PubMed DiMattina M, Gordon JD, Botes A, Celia G, Payson M, Graves-Herring J. Follicular and estradiol parameters that improve success with natural cycle in vitro fertilization. J Reprod Med. 2014;59:267–73.PubMed
26.
go back to reference Imudia AN, Goldman RH, Awonuga AO, Wright DL, Styer AK, Toth TL. The impact of supraphysiologic serum estradiol levels on peri-implantation embryo development and early pregnancy outcome following in vitro fertilization cycles. J Assist Reprod Genet. 2014;31:65–71.PubMedCentralCrossRefPubMed Imudia AN, Goldman RH, Awonuga AO, Wright DL, Styer AK, Toth TL. The impact of supraphysiologic serum estradiol levels on peri-implantation embryo development and early pregnancy outcome following in vitro fertilization cycles. J Assist Reprod Genet. 2014;31:65–71.PubMedCentralCrossRefPubMed
27.
go back to reference Kondapalli LA, Molinaro TA, Sammel MD, Dokras A. A decrease in serum estradiol levels after human chorionic gonadotrophin administration predicts significantly lower clinical pregnancy and live birth rates in in vitro fertilization cycles. Hum Reprod. 2012;27:2690–7.PubMedCentralCrossRefPubMed Kondapalli LA, Molinaro TA, Sammel MD, Dokras A. A decrease in serum estradiol levels after human chorionic gonadotrophin administration predicts significantly lower clinical pregnancy and live birth rates in in vitro fertilization cycles. Hum Reprod. 2012;27:2690–7.PubMedCentralCrossRefPubMed
28.
go back to reference Prapas Y, Petousis S, Dagklis T, Panagiotidis Y, Papatheodorou A, Assunta I, et al. GnRH antagonist versus long GnRH agonist protocol in poor IVF responders: a randomized clinical trial. Eur J Obstet Gynecol Reprod Biol. 2013;166:43–6.CrossRefPubMed Prapas Y, Petousis S, Dagklis T, Panagiotidis Y, Papatheodorou A, Assunta I, et al. GnRH antagonist versus long GnRH agonist protocol in poor IVF responders: a randomized clinical trial. Eur J Obstet Gynecol Reprod Biol. 2013;166:43–6.CrossRefPubMed
29.
go back to reference Vuk DK, Michael M, Rogerio A. Does the addition of clomiphene citrate or letrazole to gonadotropin treatment enhance the oocyte yield in poor responders undergoing IVF? J Assist Reprod Genet. 2011;28:1067–72.CrossRef Vuk DK, Michael M, Rogerio A. Does the addition of clomiphene citrate or letrazole to gonadotropin treatment enhance the oocyte yield in poor responders undergoing IVF? J Assist Reprod Genet. 2011;28:1067–72.CrossRef
30.
go back to reference Kutlusoy F, Guler I, Erdem M, Erdem A, Bozkurt N, Biberoglu EH, et al. Luteal phase support with estrogen in addition to progesterone increases pregnancy rates in in vitro fertilization cycles with poor response to gonadotropins. Gynecol Endocrinol. 2014;30:363–6.CrossRefPubMed Kutlusoy F, Guler I, Erdem M, Erdem A, Bozkurt N, Biberoglu EH, et al. Luteal phase support with estrogen in addition to progesterone increases pregnancy rates in in vitro fertilization cycles with poor response to gonadotropins. Gynecol Endocrinol. 2014;30:363–6.CrossRefPubMed
31.
go back to reference Elassar A, Engmann L, Nulsen J, Benadiva C. Letrozole and gonadotropins versus luteal estradiol and gonadotropin-releasing hormone antagonist protocol in women with a prior low response to ovarian stimulation. Fertil Steril. 2011;95:2330–4.CrossRefPubMed Elassar A, Engmann L, Nulsen J, Benadiva C. Letrozole and gonadotropins versus luteal estradiol and gonadotropin-releasing hormone antagonist protocol in women with a prior low response to ovarian stimulation. Fertil Steril. 2011;95:2330–4.CrossRefPubMed
32.
go back to reference Van Hooff MH. The human menopausal gonadotropin (hMG) dose in in vitro fertilization (IVF): what is the optimal dose? J Assist Reprod Genet. 1995;12:233–5.CrossRefPubMed Van Hooff MH. The human menopausal gonadotropin (hMG) dose in in vitro fertilization (IVF): what is the optimal dose? J Assist Reprod Genet. 1995;12:233–5.CrossRefPubMed
33.
go back to reference Branigan EF, Estes MA. Minimal stimulation IVF using clomiphene citrate and oral contraceptive pill pretreatment for LH suppression. Fertil Steril. 2000;73:587–90.CrossRefPubMed Branigan EF, Estes MA. Minimal stimulation IVF using clomiphene citrate and oral contraceptive pill pretreatment for LH suppression. Fertil Steril. 2000;73:587–90.CrossRefPubMed
34.
go back to reference Brady PC, Kaser DJ, Ginsburg ES, Ashby RK, Missmer SA, Correia KF, et al. Serum progesterone concentration on day of embryo transfer in donor oocyte cycles. J Assist Reprod Genet. 2014;31:569–75.PubMedCentralCrossRefPubMed Brady PC, Kaser DJ, Ginsburg ES, Ashby RK, Missmer SA, Correia KF, et al. Serum progesterone concentration on day of embryo transfer in donor oocyte cycles. J Assist Reprod Genet. 2014;31:569–75.PubMedCentralCrossRefPubMed
35.
go back to reference Ficicioglu C, Cenksoy PO, Yildirim G, Kaspar C. Which cut-off value of serum anti-Müllerian hormone level can predict poor ovarian reserve, poor ovarian response to stimulation and in vitro fertilization success? A prospective data analysis. Gynecol Endocrinol. 2014;30:372–6.CrossRefPubMed Ficicioglu C, Cenksoy PO, Yildirim G, Kaspar C. Which cut-off value of serum anti-Müllerian hormone level can predict poor ovarian reserve, poor ovarian response to stimulation and in vitro fertilization success? A prospective data analysis. Gynecol Endocrinol. 2014;30:372–6.CrossRefPubMed
Metadata
Title
The association of serum estradiol level with outcomes of clomiphene citrate/human menopausal gonadotropin ovarian stimulation for in vitro fertilization and embryo transfer
Authors
Xiao-Jin Zhang
Su-Ying Liu
Wei Fu
Xiao-Xi Sun
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Reproductive Biology and Endocrinology / Issue 1/2015
Electronic ISSN: 1477-7827
DOI
https://doi.org/10.1186/s12958-015-0109-x

Other articles of this Issue 1/2015

Reproductive Biology and Endocrinology 1/2015 Go to the issue