Tags

Type your tag names separated by a space and hit enter

Cycle day, estrogen level, and lead follicle size: analysis of 27,790 in vitro fertilization cycles to determine optimal start criteria for gonadotropin-releasing hormone antagonist.
Fertil Steril. 2018 04; 109(4):633-637.FS

Abstract

OBJECTIVE

To determine the optimal criteria at which to start GnRH antagonists during controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF).

DESIGN

Retrospective clinical cohort.

SETTING

IVF clinics.

PATIENT(S)

Women undergoing fresh autologous IVF using GnRH antagonist for ovulation suppression during COH.

INTERVENTION(S)

Measurement of lead follicle size, E2 level, and cycle day of stimulation on day of antagonist initiation.

MAIN OUTCOME MEASURE(S)

Clinical pregnancy rate (PR).

RESULT(S)

The highest clinical PR was achieved when the antagonist was started when a lead follicle reached 14-15.9 mm in size (mean clinical PR 21.3; 95% confidence interval [CI] 19.3, 23.6) on cycle day 6 (mean clinical PR 22.2; 95% CI 17, 28.4), or when the E2 level was between 500 and 599 pg/mL (mean clinical PR 25.4; 95% CI 19.5, 32.4). Starting antagonists when the E2 level was <300 or >1,100 pg/mL reduced the odds of clinical pregnancy by 40% (odds ratio 0.60, 95% CI 0.5, 0.7).

CONCLUSION(S)

Cycle day, E2 level, and follicle size at time of antagonist start are all independent predictors of a clinical pregnancy after IVF. Initiating antagonists when the E2 level is extremely low (<300 pg/mL) or extremely high (>1,100 pg/mL) significantly reduces the odds of pregnancy.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina. Electronic address: blyttle@med.unc.edu.Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29605403

Citation

Lyttle Schumacher, Brianna M., et al. "Cycle Day, Estrogen Level, and Lead Follicle Size: Analysis of 27,790 in Vitro Fertilization Cycles to Determine Optimal Start Criteria for Gonadotropin-releasing Hormone Antagonist." Fertility and Sterility, vol. 109, no. 4, 2018, pp. 633-637.
Lyttle Schumacher BM, Mersereau JE, Steiner AZ. Cycle day, estrogen level, and lead follicle size: analysis of 27,790 in vitro fertilization cycles to determine optimal start criteria for gonadotropin-releasing hormone antagonist. Fertil Steril. 2018;109(4):633-637.
Lyttle Schumacher, B. M., Mersereau, J. E., & Steiner, A. Z. (2018). Cycle day, estrogen level, and lead follicle size: analysis of 27,790 in vitro fertilization cycles to determine optimal start criteria for gonadotropin-releasing hormone antagonist. Fertility and Sterility, 109(4), 633-637. https://doi.org/10.1016/j.fertnstert.2017.12.021
Lyttle Schumacher BM, Mersereau JE, Steiner AZ. Cycle Day, Estrogen Level, and Lead Follicle Size: Analysis of 27,790 in Vitro Fertilization Cycles to Determine Optimal Start Criteria for Gonadotropin-releasing Hormone Antagonist. Fertil Steril. 2018;109(4):633-637. PubMed PMID: 29605403.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cycle day, estrogen level, and lead follicle size: analysis of 27,790 in vitro fertilization cycles to determine optimal start criteria for gonadotropin-releasing hormone antagonist. AU - Lyttle Schumacher,Brianna M, AU - Mersereau,Jennifer E, AU - Steiner,Anne Z, Y1 - 2018/03/28/ PY - 2017/09/18/received PY - 2017/11/20/revised PY - 2017/12/18/accepted PY - 2018/4/2/pubmed PY - 2018/12/12/medline PY - 2018/4/2/entrez KW - GnRH antagonist KW - in vitro fertilization KW - pregnancy outcomes SP - 633 EP - 637 JF - Fertility and sterility JO - Fertil. Steril. VL - 109 IS - 4 N2 - OBJECTIVE: To determine the optimal criteria at which to start GnRH antagonists during controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF). DESIGN: Retrospective clinical cohort. SETTING: IVF clinics. PATIENT(S): Women undergoing fresh autologous IVF using GnRH antagonist for ovulation suppression during COH. INTERVENTION(S): Measurement of lead follicle size, E2 level, and cycle day of stimulation on day of antagonist initiation. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate (PR). RESULT(S): The highest clinical PR was achieved when the antagonist was started when a lead follicle reached 14-15.9 mm in size (mean clinical PR 21.3; 95% confidence interval [CI] 19.3, 23.6) on cycle day 6 (mean clinical PR 22.2; 95% CI 17, 28.4), or when the E2 level was between 500 and 599 pg/mL (mean clinical PR 25.4; 95% CI 19.5, 32.4). Starting antagonists when the E2 level was <300 or >1,100 pg/mL reduced the odds of clinical pregnancy by 40% (odds ratio 0.60, 95% CI 0.5, 0.7). CONCLUSION(S): Cycle day, E2 level, and follicle size at time of antagonist start are all independent predictors of a clinical pregnancy after IVF. Initiating antagonists when the E2 level is extremely low (<300 pg/mL) or extremely high (>1,100 pg/mL) significantly reduces the odds of pregnancy. SN - 1556-5653 UR - https://www.unboundmedicine.com/medline/citation/29605403/Cycle_day_estrogen_level_and_lead_follicle_size:_analysis_of_27790_in_vitro_fertilization_cycles_to_determine_optimal_start_criteria_for_gonadotropin_releasing_hormone_antagonist_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0015-0282(17)32162-3 DB - PRIME DP - Unbound Medicine ER -