Prediction of success in intracytoplasmic sperm injection (ICSI) by estimation of serum Estradiol/Progesterone ratio on the day of embryo transfer

Objective: To compare estradiol-to-progesterone ratio with pregnancy outcome in patients of intracytoplasmic sperm injection. Methods: The quasi-experimental study was conducted on 106 couples at an assisted reproductive clinic in Islamabad from June 2010 to August 2011. Down-regulation of females aged 18-41 with Gonadotrophin releasing hormone agonist was followed by calculated stimulation with Gonadotrophin injections (Puregon). Oocytes pickup was done 36 hours after ovulation induction by human chronic gonadotropin (hCG) (on Day 0), eggs fertilised in vitro were graded and only blastocysts were transferred on Day 5 (Ovulatoin induction+7 days). Serum estradiol and progesterone was measured by Enzyme-Linked Immunosorbent Assay on D0 and D5 and its values were compared in 3 groups of females; no conception beta hCG<5 mIU/ml; pre-clinical abortion with beta hCG>5 mIU/ml and no cardiac activity on trans-vaginal scan; and clinical pregnancy with beta hCG>5mIU/ml and cardiac activity on transvaginal scan. SPSS 15 was used for data analysis. Results: Out of the 106 females, 12 (11.32%) had to be excluded for various reasons at different stages. The final sample stood at 94 (88.67%). Of them, 33 (35.1%) achieved clinical pregnancy, 21 (22.3%) had non-viable pregnancy, and 40 (42.6%) failed to conceive. Females who had significantly high number of oocytes and thick endometrial lining at the day of hCG administration were found to have significant rise in estradiol-to-progresterone ratio on the day of embryo transfer which correlated with a positive pregnancy test and cardiac activity on trans-vaginal scan (p <0.05). Conclusion: The success of intracytoplasmic sperm injection could be predicted by good number of oocytes that secrete large amount of estradiol, increased thickness of endometrial lining, and a high estradiol-to-progresterone ratio on the day of embryo transfer.