Supraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles.

BACKGROUND The study aim was to determine whether supraphysiological estradiol (E(2)) levels reduce oocyte/embryo quality in oocyte donation cycles. METHODS A retrospective analysis of 330 consecutive fresh oocyte donation cycles was performed in an assisted reproductive treatment programme between January 1996 and December 2000. Throughout the study period, oocyte donors and recipients followed a standard synchronization regimen that did not vary. A serum E(2) level (peak E(2)) was obtained from all oocyte donors on the morning of HCG administration. Peak E(2) values were grouped by 33rd percentile (group I, <1500 pg/ml; group II, 1500-3000 pg/ml; and group III, >3000 pg/ml). All embryo transfers were performed on day 3 after oocyte recovery. RESULTS Comparisons between groups revealed no significant differences in the quality of oocytes retrieved, and in fertilization rates. Higher peak E(2) levels were directly correlated with a greater number of oocytes retrieved, embryos available for transfer and cryopreservation, and higher average embryo quality scores (P < 0.005). Compared with group I, group III had significantly higher embryo implantation rates (P < 0.05). CONCLUSIONS Sustained supraphysiological E(2) levels do not adversely affect the quality of developing oocytes and embryos. On the contrary, elevated E(2) levels are associated with a larger number of oocytes and embryos and high-grade embryos for transfer/cryopreservation and, consequently, improved implantation rates.

[1]  E. Rudak,et al.  Periovulatory 17β-estradiol changes and embryo morphologic features in conception and nonconceptional cycles after human in vitro fertilization , 1986 .

[2]  R. Frydman,et al.  Evidence for an adverse effect of elevated serum estradiol concentrations on embryo implantation , 1988 .

[3]  R. Powers,et al.  A multifactorial analysis of the pregnancy outcome in a successful embryo cryopreservation program. , 1993, Fertility and sterility.

[4]  M. Sauer,et al.  Very high serum estradiol levels are not detrimental to clinical outcome of in vitro fertilization , 1990, Fertility and sterility.

[5]  R. Lobo,et al.  Embryo implantation after human in vitro fertilization: importance of endometrial receptivity. , 1990, Fertility and sterility.

[6]  E. Ng.  What is the threshold value for serum estradiol levels associated with adverse IVF outcomes? , 2000, Fertility and sterility.

[7]  M. Seif,et al.  Endometrial structure after superovulation: a prospective controlled study. , 1994, Fertility and sterility.

[8]  D. Valbuena,et al.  Lower implantation rates in high responders: evidence for an altered endocrine milieu during the preimplantation period. , 1996, Fertility and sterility.

[9]  R. Paulson,et al.  The luteal phase of cycles utilizing controlled ovarian hyperstimulation and the possible impact of this hyperstimulation on embryo implantation. , 1997, American journal of obstetrics and gynecology.

[10]  P. Ho,et al.  High serum oestradiol concentrations in fresh IVF cycles do not impair implantation and pregnancy rates in subsequent frozen-thawed embryo transfer cycles. , 2000, Human reproduction.

[11]  C. Benadiva,et al.  Superovulation with human menopausal gonadotropins is associated with endometrial gland-stroma dyssynchrony. , 1994, Fertility and sterility.

[12]  M. Paglierani,et al.  Hormonal patterns, steroid receptors and morphological pictures of endometrium in hyperstimulated IVF cycles. , 1997, European journal of obstetrics, gynecology, and reproductive biology.

[13]  H. Jones,et al.  Advanced endometrial maturation after ovulation induction with human menopausal gonadotropin/human chorionic gonadotropin for in vitro fertilization. , 1984, Fertility and sterility.

[14]  Sharara Fi.  Low and high responders--at what levels of serum estradiol do things start to get fuzzy? , 1999 .

[15]  L. Veeck,et al.  The importance of the follicular phase to success and failure in in vitro fertilization. , 1983, Fertility and sterility.

[16]  L. Veeck,et al.  Combined impact of the number of pre-ovulatory oocytes and cryopreservation on IVF outcome. , 1991, Human reproduction.

[17]  R. McClelland,et al.  Ovulation induction and endometrial steroid receptors. , 1994, Human reproduction.

[18]  M. Sauer,et al.  Establishment of a nonanonymous donor oocyte program: preliminary experience at the University of Southern California , 1989 .

[19]  E. Cittadini,et al.  The Endometrium in Human Assisted Reproduction , 1991, Annals of the New York Academy of Sciences.

[20]  R. Paulson,et al.  Ultrastructural characteristics of the luteal phaseendometrium in patients undergoing controlled ovarian hyperstimulation , 1997, Fertility and sterility.

[21]  F. Bonilla-musoles,et al.  Is the retrieval of high numbers of oocytes desirable in patients treated with gonadotrophin-releasing hormone analogues (GnRHa) and gonadotrophins? , 1989, Human reproduction.

[22]  H. Bohnet,et al.  Morphometric analysis of the endometrium of infertile patients in relation to peripheral hormone levels. , 1990, Fertility and sterility.

[23]  F. Sharara,et al.  High estradiol levels and high oocyte yield are not detrimental to in vitro fertilization outcome. , 1999, Fertility and sterility.

[24]  D. Valbuena,et al.  Increasing uterine receptivity by decreasing estradiol levels during the preimplantation period in high responders with the use of a follicle-stimulating hormone step-down regimen. , 1998, Fertility and sterility.

[25]  M. Sauer,et al.  Reversing the natural decline in human fertility: An extended clinical trial of oocyte donation to women of advanced reproductive age , 1992, JAMA.

[26]  D. Valbuena,et al.  Clinical evidence for a detrimental effect on uterine receptivity of high serum oestradiol concentrations in high and normal responder patients. , 1995, Human reproduction.