The prognostik value of estradiol level on the exogenous hCG day in asisted reproductive technology cycles

Abstract

SUMMARY: The prognostik value of estradiol level on the exogenous hCG day in assisted reproductive technology cycles Objective To study the efficacy of the measurement of E2 levels, at the time of exogenous hCG administration, for follow up in cases receiving assisted reproductive technical treatment. Materials and Methods: Seventy-three patients who applied to Zeynep Kamil Women and Children's Diseases Education and Research Hospital, Assisted Reproductive Technologies Clinic, were studied. Treatment consisted of a long protocol with GnRH analogue, followed by controlled ovarian hyper Stimulation with rFSH. The relationships between E2 levels on the exogenous hCG administration day and the number of oocytes retrieved, fertilization and pregnancy rates were evaluated. Results: The mean age of the study group was 32.3±4.6 years, duration of infertility was 8.4±4.3 years, Day 3 FSH was 6.8±3.9 mIU/ml, LH was 4.5±3.1 mlU/ml, E2 was 50.2±43.4 pg/ml, and E2 on the day of hCG was 1723.7±1115.6 pg/ml. The mean number of oocytes retrieved was 8.3+5.1, number of fertilized oocytes was 4.5±3.5. It was found that E2 levels on the day of hCG was correlated with the number oocytes retrieved (r=0.587, p

Keywords

• Chorionic Gonadotropin,Prognosis,Fertilization,Estradiol

Yardımcı üreme tekniklerinde eksojen hCG uygulama günü E2 düzeyinin prognostik değeri

Öz

Amaç: Yardımcı üreme teknikleri ile tedavi programına alınan olguların takibi ve tedavinin yönlendirilmesinde eksojen hCG uygulama günü E2 düzeyinin tedavi beklentileri konusunda etkinliğinin araştırılması. Materyel Metod: Çalışma Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, Yardımcı Üreme Teknikleri Merkezi'nde tedaviye alınan 73 hastayı içermektedir. Tedavi protokolü olarak uzun protokol GnRH analogu, ardından rFSH ile kontrollü över hiperstimülasyonu uygulandı. Eksojen hCG uygulama günü E2 düzeyinin toplanan oosit, fertilizasyon ve gebelik ile ilişkisi araştırıldı. Bulgular: Çalışma grubumuzun yaş ortalaması 32.3 ± 4.6, infertilité süresi 8.4 ± 4.3 yıl, 3. gün FSH 6.8 ± 3.9 mIU/ml, LH 4.5 ± 3.1 mlU/ml, E2 50.2 ± 43.4 pg/ml, hCG günü E2 1723.7 ± 1115.6 pg/ml olarak bulundu. Toplanan oosit sayısı 8.3 ±5.1, fertilize oosit sayısı 4.5 ±3.5 idi. HCG günü E2 düzeyinin toplanan oosit ( r: 0.587) ve fertilize olan oosit sayısı (r: 0.423 ) ile korele olduğu ( p< 0.01), fertilizasyon olan grupta hCG günü E2 düzeyinin istatistiksel anlamda yüksek olduğu ( 1858 ± 1121 / 781 ± 404 pg/ml ) bulundu. Sonuç: hCG uygulama gününde ölçülen E2 düzeyinin toplanan ve fertilize olan oosit sayısı ile korele olması ve fertilizasyon olan olgularda E2'nin anlamlı düzeyde yüksek olması uygun düzeyde E2 mevcudiyetinin tedavinin başarısı açısından gerekli olduğunu göstermektedir. Yeterli düzey ve sürede yapılacak gonadotropin ile kontrollü över hiperstimülasyona cevaben ulaşılan E2 düzeyi hem tedavi protokolünün etkinliğini hem de sonuç ve başarı için beklentileri değerlendirmekte yararlı olacaktır.

Anahtar Kelimeler

• Koryonik gonadotropin,Seyir,Fertilizasyon,Östradiol

Kaynakça

1. 1. Scott RT, Hofmann GE, Oehninger S, Muasher SJ: Inter cycle variability of day 3 follicle stimulating hormone levels and its effect on stimulation quality in in vitro fertilization . Fertil Steril, 1990; 53: 297-302
2. 2. Klein NA, Battaglia DE, Clifton DK, Bremner WJ, Soules MR: The gonadotropin secretion pattern in normal women of advenced reproductive age in relation to the monotropic FSH rise . J SocGynecol Invest, 1996;3: 27-32
3. .3. Navot D, Rosewaks S, Marglioth EJ: Prognostic assesment of female fecundity ': Lancet,.1987; 2: 645-7
4. 4. Phelps JY, Levine AS, Hickman 77V: Day 4 estradiol levels predict pregnancy success in women undergoing controlled ovarian hyper stimulation for ivf. Fertil Steril, 1998; 69:1015-9
5. 5. Buyalos RP, Daneshniand S, Brzechffa PR: Basal estradiol and follicle stimulating hormone predict fecundity in women ojt advenced age undergoing ovulation induction therapy. Ferti\ Steril, 1997; 68: 272-7. 6. Seifer DB, Lambert-Messerlian G, Hogan J: Day 3 serum inhibin B is predictive of assisted reproductive technologies outcome. Fertil Steril, 1997; 67:110-4
6. 7. Thomas C, Nuojua-Huttunen S, Martikainen H: Pretreatment transvaginal ultrasound examination predicts ovarian responsiveness to gonadotrophins in in vitro fertilization
7. Hum Reprod, 1997;12: 220-3
8. 8. Engmann L, Sladkevicius P, Agrawal R: The value oj ovarian stromal blood flow velocity measurement after pituitary suppression in the prediction of ovarian responsiveness and outcome of IVF treatment ( Summary no 282 ) Elsevier Science Inc. 1998: 105-6

9. 9. Bloechle E, Schreiner TH, Kuchler I: Color Doppler assesment of assendent uterine artery perfusion in an in vitro fertilization — embryo transfer program after pituitary desensization and ovarian stimulation with human recombinanl follicle stimulating hormone. Hum Reprod, 1997;12: 1772-7
10. 10. Johannes LH, Peronneke S, Jolande AL: Elevated levels of basal estradiol-17B predict poor response in patients with normal basal levels of follicle stimulating hormone undergoing in vitro fertilization. Fertil Steril ,1998; 69: 1010-4
11. 11. Sharma V, Riddle A, Mason BA: An analys of facton influencing the establishment of a clinical pregnancy in ar, ultrasound based ambulatory in vitro fertilization program Fertil Steril, 1998; 49: 468-78
12. 12. Scott RT, Toner JP, Muasher SJ: Follicle stimulating hormone levels on cycle day 3, are predictive of in vitrc fertilization outcome. Fertil Steril, 1989; 51: 651-4
13. 13. Toner JP, Philput C, Jornes GS: Basal follicle stimulatin\ hormone level is better predictor of in vitro fertilization performance than age. Fertil Steril, 1991 ;55: 784-91
14. 14. Dimitris L, Peter D, Kostantinos K: Oocyte morpholog, correlates with embryo quality and pregnancy rate aft e intracytoplasmic sperm injection. Fertil Steril , 1999;72: 240-4,