The effect of supraphysiological estradiol on pregnancy outcomes differs between women with PCOS and ovulatory women

Daimin Wei, Yunhai Yu, Mei Sun, Yuhua Shi, Yun Sun, Xiaohui Deng, Jing Li, Ze Wang, Shigang Zhao, Heping Zhang, Richard Legro, Zi Jiang Chen

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Context Supraphysiological estradiol exposure after ovarian stimulation may disrupt embryo implantation after fresh embryo transfer. Women with polycystic ovary syndrome (PCOS), who usually overrespond to ovarian stimulation, have a better live birth rate after frozen embryo transfer (FET) than after fresh embryo transfer; however, ovulatory women do not. Objective To evaluate whether the discrepancy in live birth rate after fresh embryo transfer vs FET between these two populations is due to the variation in ovarian response (i.e., peak estradiol level or oocyte number). Design, Setting, Patients, Intervention(s), and Main Outcome Measure(s) This was a secondary analysis of data from two multicenter randomized trials with similar study designs. A total of 1508 women with PCOS and 2157 ovulatory women were randomly assigned to undergo fresh or FET. The primary outcome was live birth. Results Compared with fresh embryo transfer, FET resulted in a higher live birth rate (51.9% vs 40.7%; OR, 1.57; 95% CI, 1.22 to 2.03) in PCOS women with peak estradiol level >3000pg/mL but not in those with estradiol level ≤3000 pg/mL. In women with PCOS who have ≥16 oocytes, FET yielded a higher live birth rate (54.8% vs 42.1%; OR, 1.67; 95% CI, 1.20 to 2.31), but this was not seen in those with <16 oocytes. In ovulatory women, pregnancy outcomes were similar after fresh embryo transfer and FET in all subgroups. Conclusions Supraphysiological estradiol after ovarian stimulation may adversely affect pregnancy outcomes in women with PCOS but not in ovulatory women.

Original languageEnglish (US)
Pages (from-to)2735-2742
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume103
Issue number7
DOIs
StatePublished - Jul 1 2018

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Polycystic Ovary Syndrome
Embryo Transfer
Pregnancy Outcome
Estradiol
Live Birth
Birth Rate
Ovulation Induction
Oocytes
Multicenter Studies
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Wei, Daimin ; Yu, Yunhai ; Sun, Mei ; Shi, Yuhua ; Sun, Yun ; Deng, Xiaohui ; Li, Jing ; Wang, Ze ; Zhao, Shigang ; Zhang, Heping ; Legro, Richard ; Chen, Zi Jiang. / The effect of supraphysiological estradiol on pregnancy outcomes differs between women with PCOS and ovulatory women. In: Journal of Clinical Endocrinology and Metabolism. 2018 ; Vol. 103, No. 7. pp. 2735-2742.
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title = "The effect of supraphysiological estradiol on pregnancy outcomes differs between women with PCOS and ovulatory women",
abstract = "Context Supraphysiological estradiol exposure after ovarian stimulation may disrupt embryo implantation after fresh embryo transfer. Women with polycystic ovary syndrome (PCOS), who usually overrespond to ovarian stimulation, have a better live birth rate after frozen embryo transfer (FET) than after fresh embryo transfer; however, ovulatory women do not. Objective To evaluate whether the discrepancy in live birth rate after fresh embryo transfer vs FET between these two populations is due to the variation in ovarian response (i.e., peak estradiol level or oocyte number). Design, Setting, Patients, Intervention(s), and Main Outcome Measure(s) This was a secondary analysis of data from two multicenter randomized trials with similar study designs. A total of 1508 women with PCOS and 2157 ovulatory women were randomly assigned to undergo fresh or FET. The primary outcome was live birth. Results Compared with fresh embryo transfer, FET resulted in a higher live birth rate (51.9{\%} vs 40.7{\%}; OR, 1.57; 95{\%} CI, 1.22 to 2.03) in PCOS women with peak estradiol level >3000pg/mL but not in those with estradiol level ≤3000 pg/mL. In women with PCOS who have ≥16 oocytes, FET yielded a higher live birth rate (54.8{\%} vs 42.1{\%}; OR, 1.67; 95{\%} CI, 1.20 to 2.31), but this was not seen in those with <16 oocytes. In ovulatory women, pregnancy outcomes were similar after fresh embryo transfer and FET in all subgroups. Conclusions Supraphysiological estradiol after ovarian stimulation may adversely affect pregnancy outcomes in women with PCOS but not in ovulatory women.",
author = "Daimin Wei and Yunhai Yu and Mei Sun and Yuhua Shi and Yun Sun and Xiaohui Deng and Jing Li and Ze Wang and Shigang Zhao and Heping Zhang and Richard Legro and Chen, {Zi Jiang}",
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The effect of supraphysiological estradiol on pregnancy outcomes differs between women with PCOS and ovulatory women. / Wei, Daimin; Yu, Yunhai; Sun, Mei; Shi, Yuhua; Sun, Yun; Deng, Xiaohui; Li, Jing; Wang, Ze; Zhao, Shigang; Zhang, Heping; Legro, Richard; Chen, Zi Jiang.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 103, No. 7, 01.07.2018, p. 2735-2742.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The effect of supraphysiological estradiol on pregnancy outcomes differs between women with PCOS and ovulatory women

AU - Wei, Daimin

AU - Yu, Yunhai

AU - Sun, Mei

AU - Shi, Yuhua

AU - Sun, Yun

AU - Deng, Xiaohui

AU - Li, Jing

AU - Wang, Ze

AU - Zhao, Shigang

AU - Zhang, Heping

AU - Legro, Richard

AU - Chen, Zi Jiang

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Context Supraphysiological estradiol exposure after ovarian stimulation may disrupt embryo implantation after fresh embryo transfer. Women with polycystic ovary syndrome (PCOS), who usually overrespond to ovarian stimulation, have a better live birth rate after frozen embryo transfer (FET) than after fresh embryo transfer; however, ovulatory women do not. Objective To evaluate whether the discrepancy in live birth rate after fresh embryo transfer vs FET between these two populations is due to the variation in ovarian response (i.e., peak estradiol level or oocyte number). Design, Setting, Patients, Intervention(s), and Main Outcome Measure(s) This was a secondary analysis of data from two multicenter randomized trials with similar study designs. A total of 1508 women with PCOS and 2157 ovulatory women were randomly assigned to undergo fresh or FET. The primary outcome was live birth. Results Compared with fresh embryo transfer, FET resulted in a higher live birth rate (51.9% vs 40.7%; OR, 1.57; 95% CI, 1.22 to 2.03) in PCOS women with peak estradiol level >3000pg/mL but not in those with estradiol level ≤3000 pg/mL. In women with PCOS who have ≥16 oocytes, FET yielded a higher live birth rate (54.8% vs 42.1%; OR, 1.67; 95% CI, 1.20 to 2.31), but this was not seen in those with <16 oocytes. In ovulatory women, pregnancy outcomes were similar after fresh embryo transfer and FET in all subgroups. Conclusions Supraphysiological estradiol after ovarian stimulation may adversely affect pregnancy outcomes in women with PCOS but not in ovulatory women.

AB - Context Supraphysiological estradiol exposure after ovarian stimulation may disrupt embryo implantation after fresh embryo transfer. Women with polycystic ovary syndrome (PCOS), who usually overrespond to ovarian stimulation, have a better live birth rate after frozen embryo transfer (FET) than after fresh embryo transfer; however, ovulatory women do not. Objective To evaluate whether the discrepancy in live birth rate after fresh embryo transfer vs FET between these two populations is due to the variation in ovarian response (i.e., peak estradiol level or oocyte number). Design, Setting, Patients, Intervention(s), and Main Outcome Measure(s) This was a secondary analysis of data from two multicenter randomized trials with similar study designs. A total of 1508 women with PCOS and 2157 ovulatory women were randomly assigned to undergo fresh or FET. The primary outcome was live birth. Results Compared with fresh embryo transfer, FET resulted in a higher live birth rate (51.9% vs 40.7%; OR, 1.57; 95% CI, 1.22 to 2.03) in PCOS women with peak estradiol level >3000pg/mL but not in those with estradiol level ≤3000 pg/mL. In women with PCOS who have ≥16 oocytes, FET yielded a higher live birth rate (54.8% vs 42.1%; OR, 1.67; 95% CI, 1.20 to 2.31), but this was not seen in those with <16 oocytes. In ovulatory women, pregnancy outcomes were similar after fresh embryo transfer and FET in all subgroups. Conclusions Supraphysiological estradiol after ovarian stimulation may adversely affect pregnancy outcomes in women with PCOS but not in ovulatory women.

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