Peak serum estradiol level during controlled ovarian hyperstimulation is associated with increased risk of small for gestational age and preeclampsia in singleton pregnancies after in vitro fertilization

• Published in: Fertility and sterility Vol. 97; no. 6; pp. 1374 - 1379
• Main Authors: Imudia, Anthony N., M.D, Awonuga, Awoniyi O., M.D, Doyle, Joseph O., M.D, Kaimal, Anjali J., M.D, Wright, Diane L., Ph.D, Toth, Thomas L., M.D, Styer, Aaron K., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2012; Elsevier
• Subjects: abnormal placentation; Adult; animal ovaries; Biological and medical sciences; Birth control; blood serum; Chorionic Gonadotropin - administration & dosage; cohort studies; confidence interval; controlled ovarian hyperstimulation; Diseases of mother, fetus and pregnancy; Estradiol; Estradiol - blood; Female; Fertilization in Vitro - adverse effects; Fertilization in Vitro - statistics & numerical data; Gynecology. Andrology. Obstetrics; human chorionic gonadotropin; Humans; in vitro fertilization; Infant, Newborn; Infant, Small for Gestational Age; infants; Internal Medicine; IVF; Male; Medical sciences; Obstetrics and Gynecology; odds ratio; Ovulation Induction - adverse effects; Ovulation Induction - statistics & numerical data; patients; Placenta Diseases - blood; Placenta Diseases - epidemiology; pre-eclampsia; Pre-Eclampsia - blood; Pre-Eclampsia - epidemiology; preeclampsia; Pregnancy; Pregnancy. Fetus. Placenta; Premature Birth - blood; Premature Birth - epidemiology; preterm delivery; Prevalence; Reproductive Control Agents - administration & dosage; Retrospective Studies; risk; Risk Factors; small for gestational age; Sterility. Assisted procreation; small for gestational age; abnormal placentation; IVF; preeclampsia; controlled ovarian hyperstimulation; Estradiol; preterm delivery; Intrauterine growth retardation; Pregnancy disorders; Estrogen; Assisted procreation; Singleton pregnancy; Fetal diseases; Serum; Ovarian hyperstimulation; Gynecology; Low birth weight; Premature delivery; Obstetrics; Pregnancy toxemia; Female genital diseases; In vitro fertilization embryo transfer; Newborn diseases; Prematurity; Preeclampsia; Risk factor
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/j.fertnstert.2012.03.028

Objective To assess the impact of elevated peak serum E2 levels (EPE2 ; defined as levels >90th percentile) on the day of hCG administration during controlled ovarian hyperstimulation (COH) for IVF on the likelihood for small for gestational age (SGA), preeclampsia (PreE), and preterm delivery (PTD) in singleton pregnancies. Design Retrospective cohort study. Setting Tertiary-care academic medical center. Patient(s) Singleton live-birth pregnancies conceived after fresh IVF-ET. Intervention(s) None. Main Outcome Measure(s) The delivery rate of SGA infants and the development of PreE and PTD in patients with and without EPE2. Result(s) Patients with EPE2 during COH were more likely to deliver SGA infants (7 [26.9%] vs. 10 [3.8%]; odds ratio [OR], 95% confidence interval [CI] {9.40, 3.22–27.46}) and develop PreE (5 [18.5%] vs. 12 [4.5%]; adjusted OR, 95% CI {4.79, 1.55–14.84}). No association was found between EPE2 and the likelihood for delivery before 37 weeks, 35 weeks, or 32 weeks of gestation. Receiver operating characteristic analysis revealed that EPE2 level predicted adverse obstetrical outcome (SGA + PreE) with 38.5% and 91.7% sensitivity and specificity, respectively. Using a serum peak E2 cutoff value of 3,450 pg/mL (>90th percentile level), the positive predictive value was 37%, while the negative predictive value was 92%. Conclusion(s) EPE2 level (>3,450 pg/mL) on the day of hCG administration during COH is associated with greater odds of developing PreE and delivery of an SGA infant in singleton pregnancies resulting from IVF cycles.