The decline in serum estradiol on the second day after oocyte retrieval affects the outcome of IVF/ICSI-ET treatment in high ovarian responders

Effect of estradiol supplementation on luteal support following a significant reduction in serum estradiol levels after hCG triggering: a prospective randomized controlled trial

OBJECTIVE

This study aimed to evaluate the impact of adding 4 mg estradiol valerate to progesterone for luteal support on pregnancy rates in IVF cycles following a long protocol with reduced luteal serum estradiol levels post-hCG triggering.

DESIGN, SETTING, AND PARTICIPANTS

The prospective randomized controlled trial was conducted at a public tertiary hospital reproductive center with 241 patients who experienced a significant decrease in serum estrogen levels post-oocyte retrieval.

INTERVENTIONS

Participants received either a daily 4 mg dose of estradiol valerate in addition to standard progesterone or standard progesterone alone for luteal support.

RESULTS

The ongoing pregnancy rate did not show a significant difference between the E2 group and the control group (56.6% vs. 52.2%, with an absolute rate difference (RD) of 4.4%, 95% CI -0.087 to 0.179, P = 0.262). Similarly, the live birth rate, implantation rate, clinical pregnancy rate, early abortion rate, and severe OHSS rate were comparable between the two groups. Notably, the E2 group had no biochemical miscarriages, contrasting significantly with the control group (0.0% vs. 10.7%, RD -10.7%, 95% CI -0.178 to -0.041, P = 0.000). In the blastocyst stage category, the clinical pregnancy rate was notably higher in the E2 group compared to the control group (75.6% vs. 60.8%, RD 14.9%, 95% CI 0.012 to 0.294, P = 0.016).

CONCLUSION

Adding 4 mg estradiol valerate to progesterone for luteal support does not affect the ongoing pregnancy rate in embryo transfer cycles using a long protocol with a significant decrease in serum estradiol levels after hCG triggering. However, it may reduce biochemical miscarriages and positively impact clinical pregnancy rates in blastocyst embryo transfer cycles.

TRIAL REGISTRATION

ChiCTR1800020342.

Effect of reduced needle versus standard needle on pain experience during oocyte retrieval procedure: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The aim of this study was to compare reduced needle versus standard needle regarding pain experience among women undergoing oocyte retrieval procedures.

METHODS

A systematic search was done in Cochrane Library, PubMed, ISI web of science, and Scopus during April 2021. We selected randomized clinical trials (RCTs) compared reduced needle versus standard needle among women undergoing ultrasound-guided oocyte retrieval procedures. Revman software was utilized for performing our meta-analysis. Our primary outcomes were pain scores evaluated by the Visual Analog Scale (VAS) during the procedure, directly post-procedure, and 30 min post-procedure. Our secondary outcomes were the request for more analgesia, clinical pregnancy rate, and rate of vaginal bleeding less than expected.

RESULTS

Six RCTs met our inclusion criteria with a total number of 1063 patients. We found reduced needle was linked to a significant reduction in VAS pain score during and directly after the procedure, respectively (MD= -1.54, 95% CI [-2.38, -0.70], p = .003 and MD= -1.14, 95% CI [-1.38, -0.91], p < .001). After removal of the reported heterogeneity, the reduced needle had significantly reduced the pain score 30 min post-procedure and request for more analgesia in comparison with standard needle (p < .001). No significant difference was found between both groups regarding clinical pregnancy rate (p = .17). More patients in reduced needle group were reported to vaginally bleed less than expected compared to standard needle group (RR = 1.91, 95% CI [1.35, 2.70], p = .003).

CONCLUSIONS

Patient perceived pain, analgesic requirement, and vaginal bleeding are decreased with reduced needle administration versus standard needle without affecting the clinical pregnancy rate in oocyte retrieval procedure.

Establishment of predictive model for analyzing clinical pregnancy outcome based on IVF-ET and ICSI assisted reproductive technology

In order to explore the predictive model for analyzing clinical pregnancy outcomes based on IVF-ET (in vitro fertilization and embryo transfer) and ICSI (Intracytoplasmic sperm injection) assisted reproductive technology (ART). Methods: this study selected the embryo transfer (fresh) patients who received IVF-ET or ICSI treatment in the First Affiliated Hospital of Guangxi Medical University as the subjects. Moreover, the controlled ovarian stimulation (COS) and follow-up were conducted to collect relevant data for analysis, and finally a prediction model was established. Results: The results showed that the patients were divided into different ovarian response groups at first. The age, bFSH and bFSH/bLH were the highest in the poor ovarian response group (POR), followed by the normal ovarian response group (NOR) and the lowest in the high ovarian response group (HOR). The area under the ROC curve was 0.669 according to the predictive model of pregnancy-related factors. The confidence interval of 94% was 0.629–0.697, with statistical significance (P = 0.000, P < 0.01). Conclusion: it can be concluded that in clinical pregnancy, for many related factors, regression equation can be used to establish a prediction model to diagnose the success rate of pregnancy. In conclusion, a prediction model can be built based on the relevant experimental results, to provide experimental reference ideas for increasing the success rate of ART in late clinical pregnancy, which is of great research significance.

The importance of estradiol measurement in patients undergoing in vitro fertilization

Successful outcomes of in vitro fertilization (IVF) are dependent in part on successful oocyte maturation and retrieval during a controlled ovarian stimulation process, which is guided by serial ultrasound and estradiol measurements. Yet, laboratory analysis of estradiol poses challenges due to the need for accuracy and specificity across concentrations that span multiple orders of magnitude. The Endocrine Society released a 2013 position statement that called for improvements in methods to analyze estradiol, and while some progress has been made in standardization and assay specificity, further work is needed to meet the needs of patients in both the IVF setting and in other clinical contexts. This review highlights the capabilities and challenges of current laboratory methods for the analysis of estradiol in the IVF setting, including automated immunoassays and liquid chromatography-tandem mass spectrometry, and discusses current efforts to improve the analytical sensitivity and standardization of estradiol assays. Clinical laboratorians should be aware of the limitations of current estradiol assays and select appropriate methods for the measurement of estradiol in their patient population.