Predicting the ovarian response in ART cycles using rate of increase in serum estradiol on day six of controlled ovarian hyperstimulation

Objective: Although, earlier studies have evaluated the significance of various estradiol patterns during controlled ovarian hyperstimulation (COH), their prognostic significance remains unclear. The objective of this study is to investigate the rate of increase in estradiol (ROI-E2) during COH and evaluate it as a predictor of ovarian response. Materials and Methods: In this retrospective study, 130 patients undergoing COH for IVF/ICSI cycles were reviewed. The E2 level during COH was evaluated on day 1, 5, 6, 7 & 8 and the ROI-E2 was determined. Age, basal FSH, number of mature follicles, number and maturity of oocytes, and incidence of ovarian hyperstimulation syndrome (OHSS) were recorded and their relationship with ROI-EZ was determined. Results: Patients with elevated basal FSH have shown poor ROI-E2 on day six and a significant negative correlation was observed. Similarly, patients with advanced age group demonstrated poor ROI-E2 on day six. The average ROI-E2 on day six was significantly higher in patients who developed OHSS than non-OHSS group. The number of follicles, oocytes and maturity of the oocytes were maximum among the patients with higher ROI-E2 on day six. Discussion: In a COH cycle, there is significant predictive association between ROI-E2 on day six and good ovarian response and hyper-response.