[Results' analysis of estradiol and progesterone supplementation in luteal phase vs progesterone alone in an assisted reproduction program]

Abstract

Objective: To correlate estradiol and progesterone concentrations in luteal phase with pregnancy rates, and to determine the real value of estradiol administration during luteal phase support.

Patients and methods: In a prospective and comparative study, 69 patients who underwent IVF-ET program were divided in two groups: group 1 (n = 32) received luteal phase support only with progesterone and group 2, (n = 37) luteal phase support with estradiol and progesterone. Ovarian stimulation was made with recombinant FSH and GnRH analogues (agonists or antagonists) and 24 hours after oocyte retrieval we began luteal phase support: group 1 progesterone (in oily solution) 100 mg/day IM, and group 2 same progesterone doses plus 2 mg of estradiol valerianate. Statistical analysis was performed using students' t- test and ROC curves.

Results: No statistical differences were observed in age, preovulatory estradiol levels, oocytes retrieved, fertilization rates, number of embryos transferred, or difficulty of embryo transfer among groups. The overall pregnancy rate was of 34.78% per cycle, no significant differences were observed among groups (37.5 vs 32.43%). We observed greater incidence of miscarriage in group 2 (4.35 vs 0%), without statistical significance. When comparing estradiol levels and pregnancy outcomes, higher levels were observed in the pregnancy group (403.3 vs 221.85 pg/mL) on day 7 post-transfer. Same results were reported for progesterone levels (107.04 vs 240.76). We determined that estradiol levels on day 7, higher than 244 pg/mL, could predict pregnancy with sensitivity of 58% and specificity of 70%, whereas progesterone levels greater than 108.6 ng/mL had specificity and sensitivity of 50 and 70%, respectively.

Conclusions: We couldn't determine any advantage with estradiol supplementation during luteal phase support; however, measurement on day 7 of estradiol and progesterone allowed a greater predictive accuracy of pregnancy outcome.