Can serum estradiol levels on the fourth day of IVF/ICSI cycle predict outcome in poor responder women?

Figures & data

Figure 1. The receiver operating characteristic (ROC) curve analysis of the relationship between the rise in serum E2 levels on stimulation day 4 and achieving clinical pregnancy(n = 5/88) (AUC = 0.68; p = 0.19; 95% CI 0.51–0.85).

Figure 2. The receiver operating characteristic (ROC) curve analysis of the relationship between the rise in serum E2 levels on stimulation day 4 and achieving embryo transfer (n = 42/88) (AUC: 0.74; p < 0.001; 95% CI 0.63–0.84).

Table 1. Clinical characteristics of the study group.

	N	Minimum	Maximum	Median
Age	88	25	48	37
BMI	88	15	36	25.5
IVF-ET treatment number	88	1	3	1
Day 3 E2	88	10.1	175.0	52
E2 level on stimulation day 4	88	11.0	865.0	76
E2 level on hCG day	88	17	2426	833
P level on hCG day	88	0.2	4.2	0.6
Day 3 FSH (IU/L)	88	3.6	19.0	9.9
Day 3 LH (IU/L)	88	1.1	12.1	4.8
AFC (antral follicle count)	88	1	10	4.5
Stimulation days	88	4	22	9
Total gonadotropins used (IU)	88	1575	9800	3825
Endometrial thickness on hCGday	88	1	13	9
>14 mm follicle number	88	0	7	2
Oocytes retrieved	88	0	4	2
M2 oocyte number	88	0	4	1
2PN number	88	0	3	0
Embryo number	88	0	3	0
Transferred embryo number	42	1	3	1

Whole study group: N = 88; BMI: body mass index; IVF-ET: in vitro fertilization- embryo transfer; E2: estradiol; P: progesterone; FSH: follicle stimulating hormone; LH: luteinising hormone; hCG: human chorionic gonadotropin; 2PN: two pronuclei.

Table 2. The comparison of poor responder patients according to the cycle characteristics and cycle outcomes based on clinical pregnancy achievement status as a result of the current IVF-ET treatment cycle.

Parameter	Clinical Pregnancy (+) (n = 5)	Clinical Pregnancy (−) (n = 83)	p Value
Age (years)	38 (34–42)	37 (25–48)	0.697
BMI (kg/m^2)	22 (21–27)	26 (15–36)	0.068
Cycle number	2 (1–2)	1 (1–3)	0.168
Day 3 FSH level (mIU/mL)	9.4 (4–16.5)	10 (3.6–19)	0.422
Day 3 LH level (mIU/mL)	5 (3.4–12.1)	4.7 (1.1–12)	0.460
Day 3 E2 level (pg/mL)	66 (46–120)	52 (10.1–175)	0.073
AFC (antral follicle count)	5 (4–7)	4 (1–10)	0.379
Stimulation days	9 (8–10)	9 (4–22)	0.757
E2 level on stimulation day 4 (pg/mL)	115 (74–422)	76 (11–865)	0.185
E2 level increment coefficient on stimulation day 4	1.7 (6–6.9)	1.7 (0.1–20)	0.850
Total gonadotropins used (IU)	4050 (2625–4500)	3825 (1575–9800)	0.843
Median follicle number >14 mm	2 (1–5)	2 (0–7)	0.905
E2 level on hCG day (pg/mL)	669 (321–1810)	838 (129–2426)	0.884
P level on hCG day (ng/mL)	0.5 (0.3–1.2)	0.6 (0.2–4.2)	0.527
Endometrial thickness on hCG day (mm)	9 (9–13)	9 (3–13)	0.118
Oocytes retrieved	2 (1–4)	2 (0–4)	0.466
M2 oocyte number	2 (1–4)	1 (0–4)	0.095
2PN number	1 (1–2)	0 (0–3)	0.029
Embryo number	1 (1–2)	0 (0–3)	0.049
Fertilization rate (%)	66.7 (50–100)	50 (0–100)	0.279
Transferred embryo number	1 (1–2)	1 (1–3)	0.792

N = 88; IVF-ET: in vitro fertilization- embryo transfer; BMI: body mass index; FSH: follicle stimulating hormone; LH: luteinising hormone; E2: estradiol; P: progesterone; hCG: human chorionic gonadotropin; 2PN: two pronuclei. p Values are calculated by using Mann Whitney U test of median (min-max values). The distribution of continous variables is tested by Kolmogorov Smirnov test. p Value significance is expressed as bold.