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Nardin Aslih Department of Obstetrics and Gynecology, MDIVF Unit, Hillel Yaffe Medical Center, IsraelTechnion – Israel Institute of Technology, Hadera, Haifa, Israel

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Mediea Michaeli Department of Obstetrics and Gynecology, MDIVF Unit, Hillel Yaffe Medical Center, IsraelTechnion – Israel Institute of Technology, Hadera, Haifa, Israel

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Diana Mashenko Department of Obstetrics and Gynecology, MDIVF Unit, Hillel Yaffe Medical Center, IsraelTechnion – Israel Institute of Technology, Hadera, Haifa, Israel

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Adrian Ellenbogen Department of Obstetrics and Gynecology, MDIVF Unit, Hillel Yaffe Medical Center, IsraelTechnion – Israel Institute of Technology, Hadera, Haifa, Israel

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Oshrit Lebovitz Department of Obstetrics and Gynecology, MDIVF Unit, Hillel Yaffe Medical Center, IsraelTechnion – Israel Institute of Technology, Hadera, Haifa, Israel

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Yuval Atzmon Department of Obstetrics and Gynecology, MDIVF Unit, Hillel Yaffe Medical Center, IsraelTechnion – Israel Institute of Technology, Hadera, Haifa, Israel

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Einat Shalom-Paz Department of Obstetrics and Gynecology, MDIVF Unit, Hillel Yaffe Medical Center, IsraelTechnion – Israel Institute of Technology, Hadera, Haifa, Israel

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Aim

To find a cut-off ratio of estradiol/metaphase II oocyte (E2/M2) ratio and to evaluate the correlation with patients’ characteristics, embryo morphokinetics using EmbryoScope™ and IVF cycle outcomes.

Material and methods

For this retrospective cohort study, records of all fresh cycles that were cultured and scored by EmbryoScope™ were evaluated. The peak E2/M2 ratio was calculated on the day of human chorionic gonadotropin (hCG) administration and correlated to embryo morphokinetic quality and cycle outcomes. A receiver operating characteristics analysis was calculated for the E2/M2 ratio and clinical pregnancy rates.

Results

A total of 2461 oocytes were collected from 319 patients. Receiver operating characteristics analysis revealed a cutoff of 204 as a discriminative point to predict clinical pregnancy with a sensitivity of 69.5% and specificity of 62.1% (P < 0.001). E2/M2 > 204 group were older, had higher E2 concentration, fewer M2 oocytes despite elevated gonadotrophin doses. E2/M2 ratio ≤ 204 was correlated with higher fertilization rate, better embryo quality, higher pregnancy and live birth rates, and more frozen embryos.

Conclusion

E2/M2 ratio < 204 yielded the best probability to achieve good quality embryos with good morphokinetic scores and better pregnancy outcomes and may be used to predict IVF cycle outcomes. Advanced maternal age and low ovarian response received higher concentrations of gonadotrophins, which resulted in higher E2/M2 ratio. Milder stimulation to those patients may improve their cycle outcomes.

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Yasmin Shibli Abu Raya Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel

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Asaf Bilgory Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel

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Nardin Aslih Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel

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Yuval Atzmon Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel

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Maya Shavit Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel

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Daniela Estrada Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel

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Moamina Sharqawi Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel

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Einat Shalom-Paz Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
Ruth and Bruce Rappaport School of Medicine, The Technion Institute of Technology, Haifa, Israel

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This study evaluated β-human chorionic gonadotropin (hCG) changes during the early period of pregnancy in an attempt to predict successful pregnancy outcomes in ART. It determined the median values of the β-hCG and the 2-day β-hCG increments of clinical vs biochemical pregnancies. The results of fresh day 3 embryo, frozen day 3 embryo, and frozen day 5 embryo transfers were evaluated. The cutoff values of β-hCG and the 2-day increments predicting clinical pregnancy and delivery were determined. All women who underwent embryo transfer and had a singleton pregnancy from January 2017 to December 2019 were included. As expected, clinical pregnancies had higher initial median β-hCG values compared to biochemical pregnancies (fresh day 3 (400 vs 73 mIU/mL), frozen day 3 (600 vs 268.5 mIU/mL) and frozen day 5 (937 vs 317 mIU/mL)). Nonetheless, the abortion rate was significantly lower in the group with β-hCG above the cutoff values in fresh (141 mIU/mL) and frozen (354.5 mIU/mL) cleavage stage transfers (17.2% vs 44%, P < 0.001 and 18.5% vs 38%, P = 0.003, respectively). Blastocyst transfers resulted in higher median initial β-hCG compared to cleavage embryo transfers (937 vs 600 mIU/mL), and the initial β-hCG values from frozen cleavage embryos were higher compared to fresh cleavage embryos (600 vs 400 mIU/mL). Earlier implantation in frozen cycles may be caused by freezing–thawing procedures. Moreover, in fresh cycles, negative effects of the hormonal milieu of fresh cycles may delay implantation. These results indicate that high initial β-hCG and high 2-day β-hCG increments demonstrated better outcomes, including more clinical pregnancies and fewer abortions.

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