Effect of Estradiol Prescribed during Luteal Phase of Art Cycles and Pregnancy Outcome

Implantation is one of the most important steps in ART cycles and it depends upon embryo and endometrial reception. Different protocols have been suggested for getting better endometrium. It seems estrogen increases the endometrial reception and pregnancy rate by inducing changes in the hormonal status. The aim of this study was to evaluate the effect of estradiol(E2) on luteal phase support and pregnancy rate in ART cycles. This prospective randomized study was done in Yazd at the IVF center from March until December, 2002. 68 patients who had undergone IVF or ICSI were enrolled in the study. Exclusion criteria was age>40, endometriosis and ovarian hyper stimulation syndrome. Induction ovulation protocol was long suppression with GnRH analogues.After embryo transfer, patients were divided in two groups randomly. Both groups received 100mg progesterone IM daily from the transfer day. Estradiol valerate 2 mg/day was added from the 7th transfer day to progesterone in Group I and continued if the BhCG became positive. Abortion and malformations were measured in all patients. Data analyzed with SPSS 11.0 and P value <0.05 considered statistically significant. Pregnancy rate in the 34 patients of estradiol group (group I) was 26.5%which was significantly higher than 11.8 %(4 cases) in the other group (Pvalue=0.034). Abortion rate was higher in estradiol group (3 cases), but there was no abortion in the progesterone group(P=0.119). 2 cases of major fetal malformations were observed in E2 supplementation group (P=0.246). E2 suplementation to progesterone in the luteal phase of ART cycles, especially in the long GnRH analogues causes higher endometrial receptivity and pregnancy rate.