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Purpose <p>To investigate whether the magnitude of estradiol (E<sub>2</sub>) decline from hCG trigger day to post-retrieval day 2 impacts clinical outcomes of fresh embryo transfers in high responders undergoing GnRH antagonist ovarian stimulation cycles.</p> Methods <p>This retrospective cohort study analyzed 1859 fresh embryo transfer cycles (high responders, January 2018–December 2021) under antagonist protocols. Final oocyte maturation was triggered with GnRHa, hCG, or dual trigger. Serum E<sub>2</sub> was measured on trigger day and 48&#xa0;h post-retrieval. Patients were stratified by E<sub>2</sub> ratio (post-retrieval day 2/hCG day): low (≤ 0.2, <i>n</i> = 202) vs. high (&gt; 0.2, <i>n</i> = 1657). Multivariate logistic regression compared clinical pregnancy rates (CPR) and live birth rates (LBR) between groups. Given the substantial sample size imbalance between groups (1:8 ratio), we implemented bootstrap adjustment with 1000 replicates to address potential estimation bias.</p> Results <p>Mean patient age was 31.0&#xa0;years; 82.0% involved day 3 transfers. Overall CPR and LBR were 56.2% and 45.2%, respectively. The low E<sub>2</sub> ratio group (≤ 0.2) showed significantly reduced CPR (46.5% vs. 57.3%; aOR = 1.38, 95% BCa CI = (0.04, 0.67), bootstrap “<i>p</i>” = 0.031) and LBR (35.6% vs. 46.3%; aOR = 1.42, 95% BCa CI = (0.04, 0.64), bootstrap “<i>p</i>” = 0.028) compared to the high-ratio group (&gt; 0.2).</p> Conclusion <p>A post-retrieval E<sub>2</sub> ratio ≤ 0.2 predicts significantly decreased CPR and LBR in fresh embryo transfers under GnRH antagonist protocols. This ratio may serve as a clinical criterion for outcome prediction.</p>

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Magnitude of Post-Retrieval Estradiol Decline Directly Compromises Clinical Pregnancy and Live Birth Rates in High Responders Undergoing IVF/ICSI cycles with antagonist protocols

  • 期刊论文

  • 发表日期：

    2025年11月11日

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  • Qianqian Chen,
  • Yanbo Du,
  • Xu Han,
  • Mei Sun

摘要

Purpose

To investigate whether the magnitude of estradiol (E2) decline from hCG trigger day to post-retrieval day 2 impacts clinical outcomes of fresh embryo transfers in high responders undergoing GnRH antagonist ovarian stimulation cycles.

Methods

This retrospective cohort study analyzed 1859 fresh embryo transfer cycles (high responders, January 2018–December 2021) under antagonist protocols. Final oocyte maturation was triggered with GnRHa, hCG, or dual trigger. Serum E2 was measured on trigger day and 48 h post-retrieval. Patients were stratified by E2 ratio (post-retrieval day 2/hCG day): low (≤ 0.2, n = 202) vs. high (> 0.2, n = 1657). Multivariate logistic regression compared clinical pregnancy rates (CPR) and live birth rates (LBR) between groups. Given the substantial sample size imbalance between groups (1:8 ratio), we implemented bootstrap adjustment with 1000 replicates to address potential estimation bias.

Results

Mean patient age was 31.0 years; 82.0% involved day 3 transfers. Overall CPR and LBR were 56.2% and 45.2%, respectively. The low E2 ratio group (≤ 0.2) showed significantly reduced CPR (46.5% vs. 57.3%; aOR = 1.38, 95% BCa CI = (0.04, 0.67), bootstrap “p” = 0.031) and LBR (35.6% vs. 46.3%; aOR = 1.42, 95% BCa CI = (0.04, 0.64), bootstrap “p” = 0.028) compared to the high-ratio group (> 0.2).

Conclusion

A post-retrieval E2 ratio ≤ 0.2 predicts significantly decreased CPR and LBR in fresh embryo transfers under GnRH antagonist protocols. This ratio may serve as a clinical criterion for outcome prediction.