GRHantagonist使用最佳時機為最大濾泡1.4cm  & E2 300-1100pg/ml
屆時E2 過高或過低均會下降PR

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Fertil Steril. 2018 Mar 28. pii: S0015-0282(17)32162-3. doi: 10.1016/j.fertnstert.2017.12.021. [Epub ahead of print]

Cycle day, estrogen level, and lead follicle size: analysis of 27,790 in vitro fertilization cycles to determine optimal start criteria for gonadotropin-releasing hormone antagonist.

Schumacher BML1, Mersereau JE2, Steiner AZ2.

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Abstract

OBJECTIVE:

To determine the optimal criteria at which to start GnRH antagonists during controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF).

DESIGN:

Retrospective clinical cohort.

SETTING:

IVF clinics.

PATIENT(S):

Women undergoing fresh autologous IVF using GnRH antagonist for ovulation suppression during COH.

INTERVENTION(S):

Measurement of lead follicle size, E2 level, and cycle day of stimulation on day of antagonist initiation.

MAIN OUTCOME MEASURE(S):

Clinical pregnancy rate (PR).

RESULT(S):

The highest clinical PR was achieved when the antagonist was started when a lead follicle reached 14-15.9 mm in size (mean clinical PR 21.3; 95% confidence interval [CI] 19.3, 23.6) on cycle day 6 (mean clinical PR 22.2; 95% CI 17, 28.4), or when the E2 level was between 500 and 599 pg/mL (mean clinical PR 25.4; 95% CI 19.5, 32.4). Starting antagonists when the E2 level was <300 or >1,100 pg/mL reduced the odds of clinical pregnancy by 40% (odds ratio 0.60, 95% CI 0.5, 0.7).

CONCLUSION(S):

Cycle day, E2 level, and follicle size at time of antagonist start are all independent predictors of a clinical pregnancy after IVF. Initiating antagonists when the E2 level is extremely low (<300 pg/mL) or extremely high (>1,100 pg/mL) significantly reduces the odds of pregnancy.