Euploid Programmed Frozen Embryo Transfer Cycles Are Associated with a Higher Live Birth Rate when Estradiol Levels More Closely Mimic Physiology.
Academic Article
Overview
abstract
OBJECTIVE: To determine whether peak estradiol (E2) levels above the usual physiologic range (300-500 pg/mL) will impact programmed frozen embryo transfer (FET) outcomes in an ideal study population of those using good-quality single euploid blastocysts. DESIGN: Retrospective cohort study SUBJECTS: Single euploid programmed FET done at a single academic institution from January 2016 to December 2019. The population was divided into three groups based on peak serum E2 levels during endometrial preparation: group A (E2 <300 pg/mL), group B (300-500 pg/mL), and group C (>500 pg/mL). Group B was used as the reference range for statistical analysis. MAIN OUTCOME: The primary outcome was live birth rate. Secondary outcomes included implantation, biochemical, ectopic, and miscarriage rates. RESULTS: 750 FET cycles were included in this study. Poisson regression analysis showed a negative impact on higher peak E2 on live birth rate (p=0.03). A decrease in live birth rate was noted between group C and referent group B (50.2% vs 63.4%, RR 0.79 [0.68-0.91], p<0.01) and group A and referent group B (42.5% vs 63.4%, RR 0.67 [0.46-0.98], p=0.04). Secondary outcomes were notable for a lower implantation rate when groups A and C were compared to group B, and a higher biochemical rate between group C and group B. There was no notable difference between groups in ectopic or miscarriage rate. CONCLUSION: Limiting peak serum E2 levels to 300-500 pg/mL during programmed FET cycles is associated with improved live birth rates compared to cycles with peak E2 levels were <300 pg/mL or >500 pg/mL in an ideal study population.
