How low is too low Cycle day 28 estradiol levels and pregnancy outcomes

Capsule:
A low estradiol level at the time of a first positive pregnancy test after in vitro fertilization is associated with poorer pregnancy outcomes but does not preclude the possibility of a live birth.

Authors:
Alexis P. Melnick, M.D., Nigel Pereira, M.D., Erin M. Murphy, M.D., Zev Rosenwaks, M.D., Steven D. Spandorfer, M.D.

Volume 105, Issue 4, Pages 905-909

Abstract:

Objective:
To determine the utility of cycle day 28 E2 levels in predicting pregnancy outcomes after IVF.

Design:
Retrospective, cohort study.

Setting:
Academic medical center.

Patient(s):
All IVF cycles resulting in a positive pregnancy test result at our center between January 2007 and December 2012 were included.

Intervention(s):
In vitro fertilization with fresh embryo transfer.

Main Outcome Measure(s):
A total of 5,471 IVF cycles were identified. Cycles were stratified by day-28 E2 level (pg/mL) into three groups: A: ≤50; B: 51–100; and C: >100. Outcomes measured were live birth, clinical pregnancy, biochemical, ectopic, and spontaneous abortion rates.

Result(s):
There were 806, 588, and 4,077 IVF pregnancies in groups A, B, and C, respectively. Live birth rates were lower in groups A (15.4%) and B (41.2%) compared with group C (77.4%), representing decreased odds of live birth in patients with E2 levels of ≤50 pg/mL (odd ratio 0.05, 95% confidence interval 0.04–0.07) and in patients with levels of 51–100 pg/mL (odds ratio 0.20, 95% confidence interval 0.17–0.25) compared with patients with levels >100 pg/mL. Rates of biochemical and ectopic pregnancies were higher in groups A (66.5%, 6.20%) and B (30.7%, 3.57%) compared with group C (7.31%, 0.66%). An hCG level <50 mIU/mL was associated with increased odds of a biochemical pregnancy and decreased odds of a live birth. Conclusion(s):
Low E2 levels early in IVF pregnancies are associated with poorer pregnancy outcomes. Estradiol can be used alone or in conjunction with hCG levels to predict the odds of a live birth.

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