High estrogen exposure may not be detrimental on endometrial receptivity in women with PCOS

• Published in: Gynecological endocrinology Vol. 34; no. 9; pp. 798 - 803
• Main Authors: Abide Yayla, Cigdem, Ozkaya, Enis, Beydilli Nacak, Gulay, Sanverdi, Ilhan, Devranoglu, Belgin, Bostanci Ergen, Evrim, Kilicci, Cetin, Kutlu, Tayfun
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02.09.2018
• Subjects: Adult; Case-Control Studies; endometrial receptivity; estrogen exposure; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone - antagonists & inhibitors; Hormone Antagonists - adverse effects; Humans; Ovarian hyperstimulation syndrome; Ovarian Hyperstimulation Syndrome - etiology; Ovulation Induction - adverse effects; polycystic ovaries; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Rate; premature progesterone rise; Retrospective Studies; Ovarian hyperstimulation syndrome; endometrial receptivity; estrogen exposure; premature progesterone rise; polycystic ovaries
• ISSN: 0951-3590; 1473-0766
• DOI: 10.1080/09513590.2018.1460344

The study aimed to assess the effect of high estrogen exposure and coasting on cycle outcome in women at risk for developing ovarian hyperstimulation syndrome (OHSS). Retrospective case-control study was conducted to figure out the outcomes of GnRH antagonist cycles in which women were at risk to develop OHSS. Women who underwent coasting (n = 100) were compared with a control group of women who did not undergo coasting (n = 287). Effect of endometrial estrogen exposure was determined by calculating area under curve of temporal estrogen measurements (AUCEM) through the cycle. Among 387 women with PCOS, 100 cases were required to undergo coasting to avoid OHSS. All participants reached to embryo transfer stage and clinical pregnancy rate was 44% in group with coasting whereas 39% in group without coasting (p > .05). AUCEM was a significant predictor for the cases who required coasting to avoid OHSS (AUC = 0.754, p < .001). Optimal cut off value was calculated to be 6762 with 71% sensitivity and 67% specificity. ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women with coasting (AUC = 0.496, p > .05). Consistently, ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women without coasting (AUC = 0.494, p > .05). In conclusion, neither coasting nor the high endometrial estrogen exposure was found to have detrimental effect on endometrial receptivity and cycle outcome in PCOS.