The Duration Of Luteal Estradiol Pretreatment Affects The IVF/ICSI Outcomes Of Poor Ovarian Responders

Objective: This study aims to verify if luteal estradiol pretreatment improves IVF/ICSIoutcomes in GnRH antagonist protocol as compared with standard GnRH antagonistprotocol in poor responding patients through a self-control test. Besides, it aims tofigure out if the duration of luteal estradiol pretreatment affects the IVF/ICSI outcomesof poor ovarian responders, and find out the more ideal duration of luteal estradiolpretreatment.Methods: This study enrolled a total of57poor ovarian responders who met with theinclusion criterion and subjected to IVF/ICSI cycle between March and November2012.The selected women were assigned to receive oral estradiol valerate4mg/d (2mg BidPO) which initiated on mid-luteal phase and either stopped at the day of mense onset(Group A, n=38) or the first day of controlled ovarian hyperstimulation (Group B, n=19).Compared all the parameters of basic endocrine state, the initial dosage ofgonadotrophin, the duration of ovarian stimulation, the total dosage of gonadotrophin,the level of serum hormone (E2, LH, P) and the endometrium on HCG day and thenumber of retrieved oocytes,2PN, high quality embryo et al. in standard GnRHantagonist protocol with that in luteal estradiol pretreatment and GnRH antagonistprotocol in Group A and Group B respectively. Besides, compared all of the parametersof the patients’ characteristics, the process of the controlled ovarian hyperstimulationand the outcomes in Group A with that in Group B.Results: In the luteal estradiol pretreatment and GnRH antagonist protocol the basiclevel of serum FSH was lower, the mean diameter of the maximum antral Follicle wassmaller, the level of serum E2on HCG day was higher, the endometrium on HCG day was thicker, and the number of retrieved oocytes,2PN, high quality embryo were morecompared with standard GnRH antagonist protocol, besides, it has a high pregnancy rate.Moreover, compared with Group A, the rate of high quality embryo was high in GroupB (A VS. B,43.75%VS.61.9%, P=0.049).Conclusion: This study demonstrated that the use of estradiol during a preceding lutealphase in a GnRH antagonist protocol can provide a better IVF/ICSI outcomes, such asthe low level basic serum of FSH, the synchronization of follicular growth, the moreretrieved oocytes,2PN, high quality embryos, and higher pregnancy rate. Moreover, theproper prolongation of luteal estradiol pretreatment can provide a better IVF/ICSIoutcome, such as the higher rate of high quality embryo. But, there is the biggestlimitation of the study which is the small sample. It needs a bigger sample to providemore reliable evidences.