Prognostic value of day 3 estradiol on in vitro fertilization outcome

Objective: To evaluate the prognostic value of day 3 E₂ levels, independent of day 3 FSH levels, on responses to ovulation induction and subsequent pregnancy rates (PRs) in IVF-ET patients. Design: Prospective, observational. Setting: University-based tertiary care and private reproductive endocrine-infertility units. Patients and Interventions: A total of 225 patients underwent 292 IVF cycles with luteal phase GnRH agonist suppression and hMG stimulation. Main Outcome Measures: We evaluated response and outcome data including age, day 3 FSH and E, levels from a menstrual cycle before IVF, ampules of hMG used, maximum E₂ level, cancellation rates, and clinical PR. Results: Despite similar age, number of ampules of hMG, and peak E₂ levels, patients with an elevated E₂ level (E₂ > 80 pg/mL) (conversion factor to SI unit, 3.671) on day 3 of a cycle before IVF-ET achieved a lower PR per initiated cycle (14.8% versus 37.0%) and had a higher cancellation rate (18.5% versus 0.4%) compared with those with E₂ levels < 80 pg/mL. Even when patients with elevated FSH levels (FSH ≥ 15 mIU/mL) (conversion factor to SI unit, 1.00) were excluded (leaving 279 cycles), those with an elevated day 3 E₂ still had a lower PR per initiated cycle (14.8% versus 38.9%) and maintained a higher cancellation rate (18.5% versus 0.4%). When the day 3 E₂ was >100 pg/mL there was a 33.3% cancellation rate and no pregnancies were achieved. Conclusion: Patients who presented with an elevated day 3 E₂ (≥80 pg/mL) in a cycle before IVF-ET had a higher cancellation rate and achieved a lower PR independent of FSH level. A day 3 E₂ level, in addition to a day 3 FSH level, appears very helpful in prospectively counseling patients regarding cancellation risk and ultimate IVF-ET success.