Elevated levels of basal estradiol-17beta predict poor response in patients with normal basal levels of follicle-stimulating hormone undergoing in vitro fertilization.

OBJECTIVE

To evaluate whether the predictive ability of a normal FSH level on cycle day 3 can be enhanced by levels of estradiol-17beta (E2) on cycle day 3.

DESIGN

Prospective cohort study.

SETTING

University hospital-based, tertiary care infertility center.

PATIENT(S): Two hundred thirty-one consecutively seen patients who attended the center for their first IVF attempt.

INTERVENTION(S): Blood samples were collected on day 3 of the cycle preceding IVF; IVF was performed in all patients.

MAIN OUTCOME MEASURE(S): Patient's age, number of ampules of hMG, cancellation rate, number of oocytes, fertilization rate, and clinical pregnancy rate.

RESULT(S): In patients with elevated FSH levels on cycle day 3, a low oocyte yield was achieved (7 versus 11) and a high number of ampules of hMG was necessary (56 versus 33). Their cancellation rate was high (67% versus 16%). In patients with normal basal FSH levels, high E2 levels predicted a high cancellation rate (56%, versus 13% in patients with low E2 levels) and a low oocyte yield (9, versus 11 in patients with low E2 levels). Patients with both normal FSH levels and low E2 levels on cycle day 3 fared best.

CONCLUSION(S): The basal E2 level on cycle day 3 is a useful prognosticator of response to stimulation in IVF patients with normal basal FSH levels.