The Association Between Serum Estradiol Levels on hCG Trigger Day and Live Birth Rates in Non-PCOS Patients: A Retrospective Cohort Study

Abstract

ObjectiveTo retrospectively analyze the association of serum estradiol (E2) levels on human chorionic gonadotropin (hCG) trigger day and live birth rates (LBRs) in women undergoing fresh embryo transfer and not exhibiting polycystic ovary syndrome.DesignRetrospective cohort study.MethodsAnalysis of 13,950 patients who had fresh embryo transfer between December 2013 and December 2019. The main outcome measurement was LBRs. Multivariable regression analysis was performed to investigate associations between E2 levels on the hCG trigger day and LBRs. Stratification analysis was performed to test for effect modification in subgroups. Furthermore, a two-piecewise linear regression model was established to find nonlinear relationships.ResultsMultivariable regression analysis showed a significant association between serum E2 levels on the hCG trigger day and LBRs, adjusting for covariates [relative risk (RR) 1.027, 95% confidence interval (CI) 1.007, 1.049]. Stratification analysis showed that the LBRs were positively associated (RR 1.052, 95% CI 1.004, 1.102) with every 1 ng/ml increase of serum E2 on the hCG trigger day for the subgroup with low antral follicle counts on the trigger day. Specifically, a two-piecewise linear regression model showed that there was a positive association (RR 1.188, 95% CI 1.057, 1.334) between serum E2 and LBR for every increase of 1 ng/ml E2 when the concentration of serum E2 was lower than 2.1 ng/ml. However, there was no significant association (RR 1.002, 95% CI 0.971, 1.032) between E2 levels and LBRs when the concentration of E2 was higher than the 2.1ng/ml inflection point.ConclusionsSerum E2 levels on the hCG trigger day were segmentally connected with LBRs.

Nonlinear relationship between gonadotropin total dose applied and live birth rates in non-PCOS patients: a retrospective cohort study

“…The ovarian stimulation protocol has been introduced previously 25 . In brief, ovarian stimulation in fresh cycles was achieved with combination of gonadotropin-releasing hormone agonist, antagonist and recombinant follicle-stimulating hormone.…”

The association between systemic immune-inflammation index and in vitro fertilization outcomes in women with polycystic ovary syndrome: a cohort study

“…If the non-linear correlation was observed, a two-piecewise linear regression model was performed to calculate the threshold effect of the SII on clinical and laboratory outcomes in terms of the smoothing plot. When the ratio between SII on clinical and laboratory outcomes appears obvious in smoothed curve, recursive method calculates automatically the inflection point, where the maximum model likelihood will be used [ 27 ]. P < 0.05 was used for statistical significance.…”

Effect of the ratios of estradiol increase on the outcome of in vitro fertilization-embryo transfer with antagonist regimens: a single center retrospective cohort study

“…However, Blazar et al [ 26 – 28 ] discovered that higher E 2 levels on hCG days predicted a greater number of oocytes, and any adverse impact on endometrial can be conquered in IVF-ET. Only the estradiol level on the hCG day was a significant predictive variable for clinical pregnancy [ 29 , 30 ]. Additionally, according to percentile curves, Papageorgiou et al [ 31 ] did not identify any deleterious effects of high E 2 levels.…”