[Influence of the high peak serum estradiol on the outcome of in vitro fertilization cycles]. / Influencia de las concentraciones séricas de estradiol en el resultado de ciclos de reproducción asistida in vitro.

BACKGROUND: For the use of assisted reproductive technologies of high complexity (IVF-ET and ICSI) is essential to proper ovarian stimulation with recombinant FSH drugs menotropins, as well as the use of GnRH analogues. OBJECTIVE: To correlate serum estradiol level on day 10th with the outcome of in vitro fertilization cycles. MATERIAL AND METHOD: Retrospective study of 523 IVF cycles, selected and analyzed from 2005 to 2009. Patients underwent individualized stimulation protocols with gonadotropins and agonist (late luteal phase). The patients were divided into three groups according with the serum level of estradiol on day 10th of stimulation: Group I, patients with serum level of Estradiol below 1,000 pg/mL; Group II, with levels between 1,000-4,000 pg/mL; and Group III, with levels above 4,000 pg/mL. Peak serum estradiol levels, oocyte number, fertilization rates, implantation rates, and pregnancy rates were compared among groups. RESULTS: The fertilization rate was 62.8 in Group I; 60.6% in Group II, and 54.2% in Group III. The pregnancy rate in Group I was 29.8%; in Group II, 37.3%; and 24% for Group III. The implantation rates were 14, 22 and 14% for each group respectively (I, II and III). CONCLUSIONS: There is an inverse relationship between high peak serum estradiol levels and pregnancy rate; the implantation rate seems affected by the extreme levels of serum estradiol. The percent of total mature oocytes and fertilization rate improve with serum levels of estradiol at physiologic values.

[Comparison of the results of an assisted-reproduction program related with the day of follicular aspiration]. / Comparación de los resultados de un programa de reproducción asistida relacionados con el día de aspiración folicular.

UNLABELLED: The proper time for the oocyte retrieval allow us to obtain good quality oocytes In assisted reproduction techniques, improving fertilization and pregnancy rates. The follicular aspiration has been done by vaginal ultrasounds when we can see at least 3 follicles > or = 16 mm diameter. OBJECTIVE: To compare oocyte quality, fertilization and pregnancy rate-according to the day of the follicular aspiration. MATERIAL AND METHODS: 438 cycles were studied in the Instituto para el Estudio de la Concepción Humana in Monterrey Mexico, comparing oocyte quality, fertilization and pregnancy rate. RESULTS: If egg retrieval was done on day 12 of the cycle, we obtained a mean of 7.61 good quality oocytes, 51% of them fertilized and the pregnancy rate was 36.8%, when the aspiration was performed on day 13 of the cycle, we obtained a mean of 7 good quality oocytes, 59% of them fertilized and the pregnancy rate was 34%, and if the oocyte retrieval was on day 14 of the cycle, we obtained a mean of 6.42 good quality oocytes, 57% of the fertilized and the pregnancy rate was 31.7%. DISCUSSION: The oocyte quality, fertilization and pregnancy rate were slightly better if the oocyte retrieval was performed on day 12 or 13 of the cycle, rather than day 14. However this was no statistical significative.

[Prognostic values of oestradiol/oocyte rate in ICSI patients]. / Pronóstico del indice estradiol-ovulo en la inyección intracitoplasmática de espermatozoides (ICSI).

OBJECTIVES: To analyze the pregnancy rate in women who underwent Intracytoplasmic Sperm Injection (ICSI) program depending of the oestradiol/oocyte index. STUDY DESIGN: Retrospective, comparative. MATERIAL AND METHODS: 332 patients were included. There were divided in three groups depending on the oestradiol/oocyte index: Group A:(100 pg/mL, group B: 101-250 pg/mL and group C: > 250 pg/mL). Therapeutic protocol. Down regulation with leuprolide acetate in late luteal phase protocol, COH with rec-FSH and / or HMG, ultrasonographic and estradiol blood levels were monitored; hCG application when > 3 follicles > 18 mm, oocyte retrieval performed 34 hours later. We analyzed: patient age, male age, number of follicles, estradiol serum levels at the day of hCG application, number of mature oocytes, oestradiol/oocyte index, fertilization rate, transferred embryos, transfer quality, catheter type and luteal support. Statistical analysis (SPSS 11) with chi square, ANOVA and Kruskall-Wallis was used. RESULTS: On having analyzed the number of metaphase II oocytes retrieval, oocytes fertilized and number of transferred embryos among three groups, the best results were obtained in group B. The differences among these variables were significant. (P = 0.014, p = 0.005 and p = 0.003, respectively). When the oestradiol/oocyte index was analyzed and the PR among groups (21.83, 36.62 and 17.80 %) we observed a significant difference (p = 0.003). CONCLUSION: It is convenient to monitor the oestradiol blood levels to offer schemes of COH less aggressive to improve the oocyte quality. The oestradiol/oocyte index is a parameter adapted as a predictive value of pregnancy.

[High concentrations of serum estradiol in assisted reproduction]. / Altas concentraciones de estradiol sérico en reproducci6ón asistida.

OBJECTIVES: To analyze the influence of the levels of estradiol on the day of HCG in the pregnancy rate (PR) of ICSI and oocyte donation. STUDY DESIGN: Retrospective, comparative. MATERIAL AND METHODS: 333 patients underwent ICSI and 66 in oocyte donation were included dividing them according to the level of estradiol: a) < 1,000 pg/mL, b) 1,001-3,000 pg/mL and c) > 3,000 pg/mL. Therapeutic protocol: Down regulation with acetate leuprolide in late luteal phase, COH with FSHr and/or HMG, ultrasonographic monitoring and estradiol blood levels, HCG application with > 3 follicles > 18 mm, oocyte retrieval 34 hours later. We analyzed: PR, age (including receptors), FSH and LH. Number, mature grade and fertilized oocytes; luteal support, transfer quality and type of catheter. Statistical analysis (SPSS 11) with chi square, ANOVA and Kruskall-Wallis. RESULTS: ICSI: Older patients in group A (p < 0.001), but without difference between B and C groups (p = 0.08). Statistical difference in number of follicles, number of oocytes, fertilized oocytes and transferred embryos being less in the A group (p < 0.001). Statistical difference in PR 21.7, 35.6 and 25.7% in A, B and C groups respectively (p = 0.032). Oocyte donation: Group A has younger patients (p = 0.005), FSH and LH were similiar among groups. Major number of follicles were observed to increase estradiol levels, but major quantity of metaphase II and fertilized oocytes were observed in group B (p = 0.05). PR without significant differences: 50, 51.5 and 52.3% in groups A, B and C (p = 0.977). Without statistical difference in the age of receptors; transferred embryos, type of catheter and quality on ICSI and oocyte donation groups. CONCLUSION: High estradiol levels at the day of HCG application affect the PR in patients submitted to ICSI. The best results were obtained with estradiol levels between 1,000 and 3,000 pg/mL. In oocyte donation the high concentrations of estradiol do not affect the PR of the receptors.