Association between Follicular Fluid Estradiol and clinical pregnancy outcome in Intracytoplasmic Sperm Injection Cycles

Abstract

Association between Follicular Fluid Estradiol and clinical pregnancy outcome in Intracytoplasmic Sperm Injection Cycles Hussein M1 ., Al-Kady M1 ., Abdel Wahab H1 ., Rushdy E 2 ., Refaat N 2 ., Yahia D1 . 1Department of Obstetrics and Gynecology. Ain Shams University Maternity Hospitals 2Department of Clinical Pathology - Faculty of Medicine - Ain Shams University, Faculty of medicine-Al Azhar university. * Correspondence: Mohamed Hussein Mostafa, Assistant professor, Department of Obstetrics and Gynecology – Faculty of Medicine – Ain Shams University – Abbasyia - Cairo - Egypt. Email: karimabdel2013@outlook.com. Objective: This study aims to assess the accuracy of follicular fluid Estradiol level in predicting clinical pregnancy outcome, oocyte quality and embryo quality in women undergoing ICSI. Patients and Methods: The current study was prospective study that included 180 women underwent Intra-cytoplasmic sperm injection (ICSI) procedure using Flexible Antagonist protocol. During oocyte retrieval, follicular fluids of mature follicles (>17 mm) aspirated. Follicular fluid concentrations of 17β-estradiol was determined by ELISA. Upon retrieval, oocytes were analyzed for hallmarks of maturity and classified as GV, MI, or MII based on appearance. Fertilization status observed at 24 h and the nutrient solution renewed, morphology of the dividing embryo was observed and ‘embryo grading’ done. At least in the two-cell stage embryo transfer were done at third or fifth day after the oocyte collection. Quantitative S.B HCG measured at 14 days post transfer, followed by a vaginal ultrasound 2 weeks later demonstrating an embryonic cardiac pulse. Results: Our results showed that, the number of retrieved oocytes ranged from (1 to 33 oocytes) mean number 10±7. Follicular fluid E2 concentration ranged from 246±199 (0 to 700) (ng\ ml). Serum E2 concentration ranged from 2361±1583 (100 to 7589) pg\ml. The mean of total number oocytes was 10 with 53% of MII of good quality. And (47%) were of bad quality. All cases had normal fertilization. Number of transferred Embryos ranged from one to three embryos (good quality was of 63.9%), (bad quality was of 36.1) and 103 of cases had embryo transfer on day 5 ,77 had transfer on day 3. Chemical pregnancy was positive in 90 cases (50%) and the clinical pregnancy positive in 66 cases (36.7%). In follicular fluid E2 concentration ranged from 220 to 476 ng\ml that they had clinical pregnancy and ranges from 36 to 320 ng\ml had no clinical pregnancy. Conclusion: Follicular fluid E2 concentration had fair predictive value in oocyte maturation, embryo quality, chemical and clinical pregnancy. But it was an independent predictor of MII-grading. Key words: Follicular Fluid Estradiol, clinical pregnancy, Intracytoplasmic Sperm Injection, oocyte quality.