Prediction of Assisted Reproductive Technology Outcome by Day 5 Estradiol (E2) Levels in Antagonist Cycles

Aim and background:Follicle monitoring and hormone levels, particularly those of estradiol (E2), progesterone (P4), follicle-stimulating hormone (FSH), and luteinizing hormone, are critical factors in determining the effectiveness of in vitro fertilization (IVF). Based on their day-5 E2 readings, patients are divided into three groups. Group I comprises values less than 400 pg/mL, group II ranges from 400 to 900 pg/mL, and group III exceeds 900 pg/mL. The study’s objectives were to construct a prediction formula for the total number of retrieved oocytes, analyze the mean number of mature and total oocytes, and determine the incidence of ovarian hyperstimulation syndrome (OHSS) in three groups. Materials and methods: The Department of Reproductive Medicine and Surgery at a tertiary care facility in coastal Karnataka carried out this retrospective observational research. The study included 140 patients who underwent IVF stimulation using the antagonist protocol between May 2022 and April 2023, a duration of 1 year. Simple linear regression techniques and receiver operating curve (ROC) curves are utilized in statistical analysis. Results: The average age, duration of infertility, BMI, antral follicle count (AFC), and anti-mullerian hormone (AMH) were in that order 31.51 years, 5.04 years, 24.44 kg/m², 17.67, and 3.63 ng/mL. Based on the day 5 E2 values and the difference between the day 5 and the trigger E2 values, the quantity and mature oocytes were predicted with statistical significance. The E2 threshold levels on day 5 and the day of trigger to day 5 E2 difference were 946 pg/mL and 2758 pg/mL, respectively, to forecast and prevent OHSS. Conclusion: The current study’s measurement of the day-5 E2 level is significant since it aids in the prediction of the number and maturity of oocytes as well as the risk of OHSS.