Estradiol Decline Before hCG Administration in COH Has a Negative Effect on IVF Outcomes in Patients Without OC Pretreatment

Figures & data

Figure 1 Illustration of E2 change during controlled ovarian hyperstimulation in control and E2 decline group.

Note: This image describes the different trends of E2 change in our test and control groups during controlled ovarian hyperstimulation.

Table 1 Demographics and Cycle Parameters of the E2 Decline Group and Control Group

	E2 Decline Group	Control Group	P
No. of cases	333	333
Infertility indications, n (%)			0.315
Female tubal factor	198 (59.5%)	195 (58.6%)
Male factor	113 (33.9%)	124 (37.2%)
Unexplained	22 (6.6%)	14 (4.2%)
Treatment protocol, n (%)			0.800
Ultrashort protocol	41 (12.3%)	35 (10.5%)
Short protocol	75 (22.5%)	84 (25.2%)
Long protocol	105 (31.5%)	103 (30.9%)
Antagonist protocol	112 (33.6%)	111 (33.3%)
Female age (year)^a	29.6±4.0	29.5±4.1	0.665
BMI (kg/m^2)^a	21.0±2.6	21.5±2.6	0.021*
Basal FSH (IU/L)^a	7.0±2.0	6.7±1.8	0.041*
AMH (ng/mL)^a	3.2±3.2	3.4±3.2	0.559
Estradiol peak (pmol/L)^a	11,065.1±8292.1	13,048.9±7883.1	0.002*
Estradiol on HCG day (pmol/L)^a	9614.0±7457.3	13,048.9±7883.1	0.000*
LH on HCG day (IU/L)^a	1.7±1.9	2.8±2.3	0.000*
FSH on HCG day (IU/L)^a	11.0±3.7	11.6±3.6	0.018*
Progesterone on HCG day (ng/mL)^a	0.85±1.5	0.91±0.5	0.493
Total dosage of HCG used (IU)^a	5049.5±2851.7	4825.8±2563.0	0.287
Total dosage of Gn used (IU)^a	1516.5±490.5	1513.4±433.8	0.932
No. of follicles on hCG day^a	11.1±6.2	12.1±5.9	0.038*
No. of retrieved oocytes^a	12.1±8.1	13.0±6.8	0.134
No. of normally fertilized zygotes^a	7.5±5.3	8.3±4.8	0.047*
No. of high-quality embryos^a	4.1±3.7	4.2±3.3	0.634

Notes: ^aMEAN±SD. *the difference were considered statistically significant when the p-value was less than 0.05 between the two groups.

Table 2 IVF and Clinical Outcomes of the E2 Decline Group and Control Group

	E2 Decline Group	Control Group	P
Retrieved oocyte rate^a	120.6%(4032/3342)	107.2%(4321/4030)	0.000*
Fertilization rate^a	62.2%(2507/4032)	64.0%(2767/4321)	0.079
High-quality embryo rate^a	45.1%(1352/2999)	43.6%(1395/3203)	0.226
Implantation rate^a	43.1%(331/768)	46.2%(356/771)	0.225
Pregnancy rate^a	56.0%(261/466)	61.6%(277/450)	0.088
Miscarriage rate^a	12.3%(32/261)	10.4%(29/277)	0.503
Live birth rate^a	48.7%(227/466)	55.1%(248/450)	0.033*

Notes: ^aPercent. *the difference were considered statistically significant when the p-value was less than 0.05 between the two groups.

Table 3 Demographics and Cycle Parameters of the E2 Decline Group and Control Group Without Pretreatment of Oral Contraceptive (OC) and with Pretreatment of Oral Contraceptive (OC)

	E2 Decline Group Without OC	Control group Without OC	P	E2 Decline Group with OC	Control group with OC	P
No. of cases	141	136		192	197
Infertility indications, n (%)			0.469			0.493
Female tubal factor	87 (61.7%)	86 (63.2%)		111 (57.8%)	109 (55.3%)
Male factor	47 (33.3%)	47 (34.6%)		66 (34.4%)	77 (39.1%)
Unexplained	7 (5.0%)	3 (2.2%)		15 (7.8%)	11 (5.6%)
Treatment protocol, n (%)			0.432			0.917
Ultrashort protocol	18 (12.8%)	10 (7.4%)		23 (12.0%)	25 (12.7%)
Short protocol	19 (13.5%)	23 (16.9%)		56 (29.2%)	61 (31.0%)
Long protocol	71 (50.4%)	73 (53.7%)		34 (17.7%)	30 (15.2%)
Antagonist protocol	33 (23.4%)	30 (22.1%)		79 (41.1%)	81 (41.1%)
Female age (year)^a	29.1±3.8	29.2±4.0	0.770	30.0±4.1	29.7±4.1	0.516
BMI (kg/m^2)^a	20.8±2.4	21.3±2.6	0.031*	21.2±2.9	21.6±2.7	0.125
Basal FSH (IU/L)^a	6.8±2.3	6.8±1.6	0.807	7.2±1.7	6.9±1.9	0.010*
AMH (ng/mL)^a	2.9±3.0	3.0±2.9	0.815	3.5±3.4	3.6±3.4	0.619
Estradiol peak (pmol/L)^a	11,752.1±7824.1	13,150.3±7837.7	0.130	10,555.7±8600.6	12,973.5±7929.8	0.004*
Estradiol on HCG day (pmol/L)^a	10,330.7±7204.2	13,150.3±7837.7	0.002*	9082.9±7609.7	12,973.5±7929.8	0.000*
LH on HCG day (IU/L)^a	1.5±1.4	2.6±2.0	0.000*	1.9±2.3	2.9±2.4	0.000*
FSH on HCG day (IU/L)^a	11.5±3.8	12.3±3.7	0.086	10.6±3.6	11.2±3.5	0.085
Progesterone on HCG day (ng/mL)^a	1.1±2.3	1.0±0.6	0.710	0.70±0.37	0.87±0.44	0.000*
Total dosage of HCG used (IU)^a	5390.1±2533.4	5110.3±2399.6	0.347	4799.5±3046.8	4629.4±2658.2	0.558
Total dosage of Gn used (IU)^a	1560.0±462.1	1645.1±463.4	0.127	1484.5±509.1	1422.5±387.8	0.177
No. of follicles on hCG day^a	12.1±6.2	12.8±5.8	0.338	10.4±6.1	11.6±5.9	0.047*
No. of retrieved oocytes^a	13.5±7.9	13.8±7.1	0.724	11.1±8.1	12.4±6.5	0.081
No. of normally fertilized zygotes^a	8.0±5.3	8.7±4.7	0.269	7.1±5.2	8.0±4.9	0.087
No. of high-quality embryos^a	4.0±3.5	4.4±3.4	0.422	4.1±3.9	4.1±3.2	0.973

Notes: ^aMEAN±SD. *the difference were considered statistically significant when the p-value was less than 0.05 between paired groups.

Table 4 IVF and Clinical Outcomes of the E₂ Decline Group and Control Group Without Pretreatment of Oral Contraceptive (OC) and with Pretreatment of Oral Contraceptive (OC)

	E2 Decline Group without OC	Control Group without OC	P	E2 Decline Group with OC	Control Group with OC	P
Retrieved oocyte rate^a	121.5%(1899/1563)	107.8%(1875/1740)	0.000*	119.9%(2133/1779)	106.8%(2446/2290)	0.000*
Fertilization rate^a	59.8%(1135/1899)	63.3%(1186/1875)	0.028*	64.3%(1372/2133)	64.6%(1581/2446)	0.825
High-quality embryo rate^a	41.5%(570/1373)	42.2%(595/1410)	0.715	48.1%(782/1626)	44.6%(800/1793)	0.042*
Implantation rate^a	43.3%(142/328)	49.7%(154/310)	0.106	43.0%(189/440)	43.8%(202/461)	0.794
Pregnancy rate^a	56.3%(111/197)	68.0%(123/181)	0.020*	55.8%(150/269)	57.2%(154/269)	0.728
Miscarriage rate^a	9.0%(10/111)	6.5%(8/123)	0.460	14.7%(22/150)	13.6%(21/154)	0.797
Live birth rate^a	50.8%(100/197)	63.5%(115/181)	0.003*	47.2%(127/269)	49.4%(133/269)	0.664

Notes: ^aPercent. *the difference were considered statistically significant when the p-value was less than 0.05 between paired groups.