Value of estrogen pretreatment in patients with diminished ovarian reserve and elevated FSH on a line antagonist regimen: a retrospective controlled study

Abstract

Abstract Background Estrogen pretreatment during in vitro fertilization–embryo transfer (IVF–ET) fertility treatment improves follicular development and increases the number of eggs in patients with a normal ovarian response. However, the effect of estrogen pretreatment in patients with a diminished ovarian reserve (DOR) and elevated basal follicle-stimulating hormone (FSH) levels has not been well studied. Methods We retrospectively analyzed the clinical data of patients with elevated basal FSH levels and DOR (401 cycles) who underwent IVF/intracytoplasmic monosperm injection (ICSI)-assisted conception. Both groups were treated with a flexible gonadotropin-releasing hormone (GnRH) antagonist regimen and were further divided into two groups according to whether they received luteal estrogen pretreatment. There were 79 patients in the estrogen pretreatment group and 322 patients in the control group. Gonadotropin (Gn) stimulation of the ovaries was started on day 2 of the menstrual cycle, and the general data, ovulation promotion, embryonic development, and clinical outcomes of the two groups were compared. Results The basic profiles of the two groups were similar (P > 0.05). More patients in the pretreatment group showed FSH rebound after gonadotropin (Gn) initiation, resulting in a significantly higher number of Gn days and total Gn than those in the control group (P < 0.05). There was no statistically significant difference in the number of days of antagonist use, follicle output rate, number of metaphase II(MII) eggs obtained, number of Two pronuclei༈2PN༉ fertilized, number of D3 quality embryos, blastocyst formation rate, fresh embryo clinical pregnancy rate, cumulative pregnancy rate, and non-transferable embryo rate between the two groups (P > 0.05). Conclusions The use of luteal phase estrogen pretreatment in patients with elevated basal FSH combined with DOR resulted in high FSH levels after the release of negative feedback, which was detrimental to early follicular growth, did not increase the follicular output rate, may have increased the use and duration of controlled ovarian stimulation drugs, and did not increase the number of eggs gained or improve clinical outcomes.