Elevated Serum Estradiol Levels Have Different Effects on Pregnancy Outcomes Depending on Whether Cleavage-stage or Blastocyst-stage Embryo Transfer Is Performed During Artificial Frozen Embryo Transfer Cycles
Objective: The aim of this study was to evaluate the association between serum estradiol (E2) and pregnancy outcomes of cleavage- or blastocyst-stage frozen embryo transfer (FET) cycles using hormone replacement therapy.Methods: A total of 776 FET cycles (669 couples) performed from January 2016 to December 2019 were included in the present retrospective cohort study. The impact of progesterone-initiation-day serum E2 levels on the ongoing pregnancy/live birth (OP/LB) rates was determined, and
... as determined, and cleavage-stage embryo transfers and blastocyst-stage embryo transfers were analyzed separately. Results: Regarding cleavage-stage embryo transfer cycles, serum E2 levels on progesterone initiation day were significantly lower in the OP/LB group than in the non-OP/LB group (214.75 ± 173.47 vs. 253.20 ± 203.30 pg/ml; P = 0.023). In addition, there were downward trends in implantation, clinical pregnancy and OP/LB rates with increasing E2 levels. However, in blastocyst-stage embryo transfer cycles, such trends were not observed, and there was no significant difference between the OP/LB group and the non-OP/LB group. Logistic regression analysis revealed that E2 levels on progesterone initiation day in cleavage-stage embryo transfer cycles were independently associated with OP/LB (odds ratio = 1.000, 95% confidence interval: 1.000-1.001, P = 0.008). The areas under the receiver operating characteristic curve were 0.55 in cleavage-stage embryo transfer cycles and 0.53 in blastocyst-stage embryo transfer cycles.Conclusions: The association of low OP/LB rates with elevated E2 levels on the progesterone initiation day in cleavage-stage embryo transfer cycles suggests that E2 levels should be monitored during artificial cleavage-stage embryo transfer cycles. However, it is not necessary to monitor serum E2 levels when transferring blastocysts in artificial FET cycles.