CLINICAL-EVIDENCE FOR A DETRIMENTAL EFFECT ON UTERINE RECEPTIVITY OF HIGH SERUM ESTRADIOL CONCENTRATIONS IN HIGH AND NORMAL RESPONDER PATIENTS

This study was undertaken to investigate an empirical observation that 'high responder patients have poorer in-vitro fertilization (IVF) out come than normal responder patients', The aim of our study was to anal yse the effect of high serum oestradiol and progesterone concentration s at the day of human chorionic gonadotrophin (HCG) administration on endometrial receptivity and oocyte-embryo quality in high and normal r esponder patients, The IVF patients were divided into two groups: 59 h igh responder patients who voluntarily donated some of their oocytes, and a control group consisting of 105 normal responder patients, Both groups were compared in terms of the number and quality of oocytes ret rieved, embryos transferred, fertilization, implantation and gestation rates, serum oestradiol and progesterone concentrations and the oestr adiol:progesterone ratio on the day of HCG injection, To ascertain ooc yte-embryo quality, a second control group of 96 women undergoing oocy te donation (receiving oocytes from high responder patients) was consi dered. To assess the impact of steroid concentrations on endometrial r eceptivity, high responder patients were divided into two subgroups ac cording to oestradiol concentration, above or below the minimal oestra diol and progesterone concentrations (mean - SD) in this group, The no rmal responder patients were divided into two subgroups according to o estradiol concentration, above or below the maximal oestradiol and pro gesterone concentrations (mean + SD) in this group, To assess further the relevance of oestradiol concentration on endometrial receptivity, patients were divided into different subgroups according to increasing oestradiol concentration, regardless of whether they were high or nor mal responders, High responder patients had significantly decreased im plantation and pregnancy rates per cycle compared with normal responde r patients (33.3 versus 16.3 and 11.1 versus 5.4% respectively; P < 0. 05), The results of 108 embryo transfers in 91 recipients who received oocytes from the high responder group showed normal embryo quality, I mplantation rates and pregnancies per cycle mere significantly lower i n high responder patients with serum oestradiol concentrations > 1700 pg/ml compared with those having oestradiol concentrations less than o r equal to 1700 pg/ml, as well as in normal responder patients with se rum oestradiol concentrations > 2200 pg/ml compared with those having oestradiol concentrations less than or equal to 2200 pg/ml, Considerin g all the patients together, significant decreases in pregnancy and im plantation rates were observed when oestradiol concentrations were > 2 500 pg/ml compared with patients having lower oestradiol concentration s, Our clinical results demonstrate that high serum oestradiol concent rations on the day of HCG injection in high and normal responder patie nts, regardless of the number of oocytes retrieved and the serum proge sterone concentration, are detrimental to uterine receptivity without affecting embryo quality.