High estrogen exposure may not be detrimental on endometrial receptivity in women with PCOS

Abstract

The study aimed to assess the effect of high estrogen exposure and coasting on cycle outcome in women at risk for developing ovarian hyperstimulation syndrome (OHSS). Retrospective case–control study was conducted to figure out the outcomes of GnRH antagonist cycles in which women were at risk to develop OHSS. Women who underwent coasting (n = 100) were compared with a control group of women who did not undergo coasting (n = 287). Effect of endometrial estrogen exposure was determined by calculating area under curve of temporal estrogen measurements (AUCEM) through the cycle. Among 387 women with PCOS, 100 cases were required to undergo coasting to avoid OHSS. All participants reached to embryo transfer stage and clinical pregnancy rate was 44% in group with coasting whereas 39% in group without coasting (p > .05). AUCEM was a significant predictor for the cases who required coasting to avoid OHSS (AUC = 0.754, p < .001). Optimal cut off value was calculated to be 6762 with 71% sensitivity and 67% specificity. ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women with coasting (AUC = 0.496, p > .05). Consistently, ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women without coasting (AUC = 0.494, p > .05). In conclusion, neither coasting nor the high endometrial estrogen exposure was found to have detrimental effect on endometrial receptivity and cycle outcome in PCOS.

Chinese abstract

研究目的是评估高雌激素暴露的影响和卵巢过度刺激综合征(OHSS)的发生风险。采用回顾性病例对照研究的方法, 估算在使用拮抗剂方案的患者中发生OHSS的风险。试验组100例（采用了coasting方案）, 对照组287例（未采用coasting方案）。内膜雌激素暴露效应是通过治疗周期中时间-雌激素曲线下面积测量计算得来的。387名PCOS患者中, 100例为coasting法避免OHSS, 该组所有患者都进入胚胎移植期, 临床受孕率为44%, 对照组为39%(p>.05)。AUCEM 是一个重要的避免OHSS的预测因子(AUC=0.754, p<.001)。最佳的cut off 值是6762（敏感度71% 特异度67%）。ROC分析显示AUCEM对于试验组的临床妊娠没有预测价值(AUC=0.496, p>.05)。同样的, ROC分析显示AUCEM对于对照组的临床妊娠也没有预测价值(AUC=0.494, p>.05)。总之, 无论是coasting 还是高雌激素暴露都对PCOS患者的子宫内膜容受性和周期妊娠结局没有影响。

Keywords:

• Ovarian hyperstimulation syndrome
• polycystic ovaries
• estrogen exposure
• endometrial receptivity
• premature progesterone rise

Disclosure statement

The authors report no conflicts of interest.