Impact of relative estradiol changes during ovarian stimulation on blastocyst formation and live birth in assisted reproductive technology

Abstract This study aimed to evaluate the predictive value of relative change in E2 levels during controlled ovarian stimulation (COS) on embryo development and pregnancy outcomes in assisted reproductive technology (ART). We retrospectively analyzed 9,376 patients who underwent their first fresh AR...

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Main Authors: Wenjie Huang, Liuyan Wei, Juan Tang, Liuying Nong, Ni Tang, Qiuyue Wen, Zuxing Qin, Lixiang Xu, Jingjing Li, Li Fan
Format: Article
Language:English
Published: Nature Portfolio 2025-05-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-00200-5
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author Wenjie Huang
Liuyan Wei
Juan Tang
Liuying Nong
Ni Tang
Qiuyue Wen
Zuxing Qin
Lixiang Xu
Jingjing Li
Li Fan
author_facet Wenjie Huang
Liuyan Wei
Juan Tang
Liuying Nong
Ni Tang
Qiuyue Wen
Zuxing Qin
Lixiang Xu
Jingjing Li
Li Fan
author_sort Wenjie Huang
collection DOAJ
description Abstract This study aimed to evaluate the predictive value of relative change in E2 levels during controlled ovarian stimulation (COS) on embryo development and pregnancy outcomes in assisted reproductive technology (ART). We retrospectively analyzed 9,376 patients who underwent their first fresh ART cycle from January 1, 2020, to December 31, 2022. Patients were classified into four groups based on relative change in E2 levels: low response group, moderate response group, moderate-high response group, and high response group. The primary outcomes were blastocyst formation rate, clinical pregnancy rate, and live birth rate, while secondary outcomes included miscarriage rate and ectopic pregnancy rate. Most cycles (96.5%) demonstrated an increase in E2 levels during COS. The blastocyst formation rate significantly increased across the groups (low response group: 0.13, moderate response group: 0.21, moderate-high response group: 0.28, high response group: 0.34; P < 0.001). Multivariable logistic regression showed significantly higher blastocyst formation rates in the moderate response group (adjusted OR = 2.012, 95% CI: 1.687–2.399), moderate-high response group (adjusted OR = 4.613, 95% CI: 3.853–5.523), and high response group (adjusted OR = 11.295, 95% CI: 9.192–13.880) compared to the low response group. Both clinical pregnancy rate and live birth rate were significantly higher in the moderate-high response group and high response group compared to the low response group (clinical pregnancy rate: 54.5% and 61.5% vs. 35.5%, adjusted RR = 1.21 [95% CI: 1.03–1.42] and 1.27 [95% CI: 1.08–1.51]; live birth rate: 44.9% and 52.0% vs. 25.7%, adjusted RR = 1.27 [95% CI: 1.06–1.52] and 1.35 [95% CI: 1.11–1.64]). However, no significant differences were observed in either clinical pregnancy rate or live birth rate between the moderate response group and low response group (clinical pregnancy rate: adjusted RR = 1.07 [95% CI: 0.91–1.25]; live birth rate: adjusted RR = 1.11 [95% CI: 0.92–1.33]). No significant differences in miscarriage rate or ectopic pregnancy rate were observed across the groups. Higher E2 responses were associated with improved embryo development and better pregnancy outcomes.
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spelling doaj-art-7d13ce8527624856920ee831ebd865562025-08-20T03:53:12ZengNature PortfolioScientific Reports2045-23222025-05-0115111110.1038/s41598-025-00200-5Impact of relative estradiol changes during ovarian stimulation on blastocyst formation and live birth in assisted reproductive technologyWenjie Huang0Liuyan Wei1Juan Tang2Liuying Nong3Ni Tang4Qiuyue Wen5Zuxing Qin6Lixiang Xu7Jingjing Li8Li Fan9Department of Reproductive Medicine, Guangzhou Women and Children’s Medical center Liuzhou HospitalDepartment of Reproductive Medicine, Guangzhou Women and Children’s Medical center Liuzhou HospitalDepartment of Reproductive Medicine, Guangzhou Women and Children’s Medical center Liuzhou HospitalDepartment of Reproductive Medicine, Guangzhou Women and Children’s Medical center Liuzhou HospitalDepartment of Reproductive Medicine, Guangzhou Women and Children’s Medical center Liuzhou HospitalLiuzhou maternity and Child Healthcare HospitalLiuzhou maternity and Child Healthcare HospitalLiuzhou maternity and Child Healthcare HospitalDepartment of Reproductive Medicine, Guangzhou Women and Children’s Medical center Liuzhou HospitalDepartment of Reproductive Medicine, Guangzhou Women and Children’s Medical center Liuzhou HospitalAbstract This study aimed to evaluate the predictive value of relative change in E2 levels during controlled ovarian stimulation (COS) on embryo development and pregnancy outcomes in assisted reproductive technology (ART). We retrospectively analyzed 9,376 patients who underwent their first fresh ART cycle from January 1, 2020, to December 31, 2022. Patients were classified into four groups based on relative change in E2 levels: low response group, moderate response group, moderate-high response group, and high response group. The primary outcomes were blastocyst formation rate, clinical pregnancy rate, and live birth rate, while secondary outcomes included miscarriage rate and ectopic pregnancy rate. Most cycles (96.5%) demonstrated an increase in E2 levels during COS. The blastocyst formation rate significantly increased across the groups (low response group: 0.13, moderate response group: 0.21, moderate-high response group: 0.28, high response group: 0.34; P < 0.001). Multivariable logistic regression showed significantly higher blastocyst formation rates in the moderate response group (adjusted OR = 2.012, 95% CI: 1.687–2.399), moderate-high response group (adjusted OR = 4.613, 95% CI: 3.853–5.523), and high response group (adjusted OR = 11.295, 95% CI: 9.192–13.880) compared to the low response group. Both clinical pregnancy rate and live birth rate were significantly higher in the moderate-high response group and high response group compared to the low response group (clinical pregnancy rate: 54.5% and 61.5% vs. 35.5%, adjusted RR = 1.21 [95% CI: 1.03–1.42] and 1.27 [95% CI: 1.08–1.51]; live birth rate: 44.9% and 52.0% vs. 25.7%, adjusted RR = 1.27 [95% CI: 1.06–1.52] and 1.35 [95% CI: 1.11–1.64]). However, no significant differences were observed in either clinical pregnancy rate or live birth rate between the moderate response group and low response group (clinical pregnancy rate: adjusted RR = 1.07 [95% CI: 0.91–1.25]; live birth rate: adjusted RR = 1.11 [95% CI: 0.92–1.33]). No significant differences in miscarriage rate or ectopic pregnancy rate were observed across the groups. Higher E2 responses were associated with improved embryo development and better pregnancy outcomes.https://doi.org/10.1038/s41598-025-00200-5IVF/ICSI outcomesEstrogenControlled ovarian stimulationOvarian responsePregnancy outcomes
spellingShingle Wenjie Huang
Liuyan Wei
Juan Tang
Liuying Nong
Ni Tang
Qiuyue Wen
Zuxing Qin
Lixiang Xu
Jingjing Li
Li Fan
Impact of relative estradiol changes during ovarian stimulation on blastocyst formation and live birth in assisted reproductive technology
Scientific Reports
IVF/ICSI outcomes
Estrogen
Controlled ovarian stimulation
Ovarian response
Pregnancy outcomes
title Impact of relative estradiol changes during ovarian stimulation on blastocyst formation and live birth in assisted reproductive technology
title_full Impact of relative estradiol changes during ovarian stimulation on blastocyst formation and live birth in assisted reproductive technology
title_fullStr Impact of relative estradiol changes during ovarian stimulation on blastocyst formation and live birth in assisted reproductive technology
title_full_unstemmed Impact of relative estradiol changes during ovarian stimulation on blastocyst formation and live birth in assisted reproductive technology
title_short Impact of relative estradiol changes during ovarian stimulation on blastocyst formation and live birth in assisted reproductive technology
title_sort impact of relative estradiol changes during ovarian stimulation on blastocyst formation and live birth in assisted reproductive technology
topic IVF/ICSI outcomes
Estrogen
Controlled ovarian stimulation
Ovarian response
Pregnancy outcomes
url https://doi.org/10.1038/s41598-025-00200-5
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