EJMS

Abstract

Background: Exposing embryos and endometrium to supra-physiological estradiol (E2) and progesterone (P) during the GnRH-agonist cycles could influence pregnancy outcomes. The harmful effect of low E2 and the beneficial effect of high P are controversial, raising attention for further exploration of their roles. This study evaluated the relationship between serum estradiol and progesterone on hCG injection day and the pregnancy outcome in GnRH-agonist-induced ICSI cycles.
Methods: This retrospective study included 292 patients in EL-Sahel Teaching Hospital between June 2009 and May 2012. An estradiol cut-off value of 5.21 pg/ml was used as it exceeded the 75th percentile of serum concentration. Receiver Operating Characteristic (ROC) Curve was used to identify the cut-off value of progesterone effect on clinical pregnancy outcomes. Patients were divided into 4 groups according to P and E2 concentrations; Group A: P < 1.04 ng/ml and E2 < 5.20 pg/ml, Group B: P < 1.04 ng/ml, and E2 ≥ 5.20 pg/ml, Group C: P ≥ 1.04 ng/ml and E2 < 5.20 pg/ml, Group D: P ≥1.04 ng/ml, and E2 ≥ 5.20 pg/ml.
Result: Retrieved oocytes count was significantly higher in groups B (15.7±5.2) and D (14.4± 6.3), compared to groups A (10.0±4.5) and C (9.2±4.0). Implantation rates were significantly higher in groups A (19.4%) and B (18.7%) than in groups C (12.9%) and D (11.9%). The clinical pregnancy rate was significantly higher in groups A (31.7%) and B (29.0%) than in groups C (22.1%) and D (20.6%). The ectopic pregnancy and live birth rates in group D were significantly higher than in the other three groups.
Conclusion: Higher progesterone levels on hCG injection day in GnRH-agonist-induced ICSI cycles critically affect pregnancy outcomes by reducing endometrial receptivity and implantation window. Estradiol concentration alone was not associated with pregnancy outcome; however, high E2 combined with earlier P elevation negatively affected pregnancy outcomes.