Impact of peak/mid luteal estradiol on pregnancy outcome after intracytoplasmic sperm injection

Objective: To compare peak to mid estradiol ratio with the probability of successful conception after intracytoplasmic sperm injection. Method: The quasi-experimental study was conducted in an infertility clinic at Islamabad from June 2010 till August 2011, and comprised couples subjected to intra-cytoplasmic sperm injection. Down-regulation of ovaries was followed by calculated stimulation, ovulation induction, oocytes retrieval, intra cytoplasmic sperm injection, in vitro maturation of embryos and finally blastocysts transfer. Serum estradiol was measured by enzyme-linked immunosorbent assay on ovulation induction day and the day of embryo transfer. Failure of procedure was detected by beta human chorionic gonadotropin5-25mIU/ml (Group I; non-pregnant).Females with beta human chorionic gonadotropin>25mIU/ml and no cardiac activity after 4 weeks of transfer were placed in Group II (pre-clinical abortion), and confirmation of foetal heart in the latter comprised Group III (clinical pregnancy). Data was analysed using SPSS 15. Results: Of the 323 couples initially enrolled, embryo transfer was carried out in 282(87.3%) females. Clinical pregnancy was achieved in 101(36%) of the cases, while 61(21.63%) had pre-clinical abortion, and 120(42%) remained non-pregnant. The peak/mid-luteal estradiolratio was low (2.3) in patients who had high oocyte maturity (p=0.001) and fertilisation rate (p=0.003) compared to non-pregnant patients with high peak/mid-luteal estradiolratio (2.56). Conclusion: High peak estradiol with maintenance of optimal levels in mid-luteal phase is required for implantation of fertilised ovum and accomplishment of clinical pregnancy.