A paradigm of higher success rate of intracytoplasmic sperm injection - preovulatory human chorionic gonadotropin-day serum oestradiol.

Introduction: The aim of the study is to evaluate the correlation between the level of serum oestradiol (E) on the day of human chorionic gonadotropin (hCG-day) administration and successful intracytoplasmic sperm injection (ICSI) outcome.

Material And Methods: This prospective study was performed during the period from January 2019 to September 2021, at Zagazig Obstetrics and Gynecology Department, and Al-Azhar Obstetrics and Gynecology Department, and private ART centers. One hundred and fifty women attending the infertility clinic for ICSI cycles. All women were divided into 5 groups according to the serum E level on the day of hCG administration: Group A - serum E < 1000 pg/ml; Group B - serum E 1000 to < 2000 pg/ml; Group C - serum E 2000 to < 3000 pg/ml;Group D - serum E 3000 to < 4000 pg/ml; Group E - serum E ≥ 4000 pg/ml.

Results: The highest fertilization rate (58.1%) was among women with E ≥ 4000 pg/ml, while the lowest (37%) was in women with E 1000 to < 2000 pg/ml. Also, the highest pregnancy rate (21.5%) was among women with E > 4000 pg/ml, while the lowest (5.3%) was in women with E < 1000 pg/ml. In the current study the median serum E level on the day of hCG administration was highly significant in women who became pregnant when compared to women who did not. The best cut-off value of serum E at hCG administration was ≥ 3682.3 pg/ml.

Conclusions: this study suggests that the optimal range of E level for achieving a successful pregnancy is > 4000 pg/ml.