Relationship of progesterone/estradiol ratio on day of hCG administration and pregnancy outcomes in high responders undergoing in vitro fertilization
Received 3 February 2008; received in revised form 9 July 2008; accepted 7 August 2008. published online 01 October 2008.
Objective
To evaluate the predictive value of a serum P/E2 ratio measured on the day of hCG administration regarding pregnancy outcomes in high responders undergoing IVF.
Design
Retrospective study.
Setting
Teaching hospital.
Patient(s)
Two hundred twenty-three infertile women classified as high responders in IVF-ET cycles.
Intervention(s)
Eligible infertile women undergoing IVF were assigned to four groups according to serum P levels on the day of hCG administration: group 1, P≤0.9 ng/mL; group 2, 0.9 < P≤1.4 ng/mL; group 3, 1.4 < P≤2.0 ng/mL; group 4, P>2.0 ng/mL. The relationship of E2 level and P/E2 ratio on the day of hCG administration and pregnancy outcomes was analyzed.
Main Outcome Measure(s)
Implantation and pregnancy rate.
Result(s)
Patients in group 4 had highest E2 level and P/E2 ratio, as well as lowest implantation and pregnancy rates. Using P for grouping, the sensitivity/positive predictive values (%/%) of P/E2 ratio in the four groups were 15/66, 30/65, 30/60, and 25/41, respectively.
Conclusion(s)
Using the level of a single sex hormone on hCG day to predict pregnancy outcome in high responders undergoing IVF is confounding, whereas using a P/E2 ratio on hCG day is theoretically reasonable. However, the low sensitivity and positive predictive value make the use of P/E2 clinically unfeasible.
aDepartment of Obstetrics and Gynecology, Cathay General Hospital, HsinChu Branch, HsinChu, Taiwan
bDepartment of Medical Laboratory Science and Biotechnology, Yuanpei University, Hsin Chu, Taiwan
cFu Jen Catholic University School of Medicine, Taipei, Taiwan
dDepartment of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
Reprint requests: Dr. Shang-Gwo Horng, M.D., Department of Obstetrics and Gynecology, Cathay General Hospital, HsinChu Branch, HsinChu, Taiwan, No 678, Section 2, Junghua Rd., HsinChu City, Taiwan (FAX: 886-3-5263199).
F.-K.L. has nothing to disclose. T.-H.L. has nothing to disclose. T.-K.L. has nothing to disclose. S.-G.H. has nothing to disclose. S.-C.C. has nothing to disclose.
ABSTRACT