Journal of Human Reproductive Sciences

: 2010  |  Volume : 3  |  Issue : 1  |  Page : 30--31


Hong Ye 
 Chongqing Reproductive and Genetic Institute in Chongqing Obstetric and Gynecology Hospital, Chongqing, China

Correspondence Address:
Hong Ye
Chongqing Reproductive and Genetic Institute in Chongqing Obstetric and Gynecology Hospital, Chongqing

How to cite this article:
Ye H. Commentary.J Hum Reprod Sci 2010;3:30-31

How to cite this URL:
Ye H. Commentary. J Hum Reprod Sci [serial online] 2010 [cited 2021 Apr 12 ];3:30-31
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Full Text

In this issue, there is an interesting paper on "The degree of serum estradiol decline in early and midluteal phase had no adverse effect on IVF/ICSI outcome." To analyze the possible impact of E2 decline in luteal phase in stimulated cycles, the authors found no correlation between degree of E2 decline and pregnancy results. [1]

Although the progesterone (P) and estradiol (E2) are essential for a successful pregnancy, the function of E2 in luteal phase is still uncertain. In stimulation cycles, a typical characteristic of in vitro fertilization (IVF) therapy, the luteal phase is different from normal natural cycles in two ways. Firstly, ovarian stimulation produces multiple corpora luteal; the levels of both E2 and P in early luteal phase are supraphysiological. Secondly, the duration of ovarian steroid production in stimulated cycles is usually shorter than normal by 1-3 days. This truncated luteal phase might prevent a successful implantation. To improve the luteal phase function, progesterone is supplemented in luteal phase routinely. While it is unclear whether the decrease of E2 in luteal phase impairs IVF outcome and the supplementation of E2 can ameliorate it. It is suggested that E2 plays a permissive, rather than an obligatory role. [2 3] It is reported that the E2 decline does not comprise IVF outcome for the luteal estradiol, which is not essential for normal endometrial development [4] and its depletion in human luteal phase does not appear to have adverse effect on the morphological developmental capacity of the endometrial. [5] Conversely, other studies [6,7] demonstrated that a sharp decline of E2 in the midluteal phase results in a significantly lower implantation and pregnancy rate because the endometrial integrity might be compromised when dramatic decline of E2 around the mid-luteal phase occurs. So these studies raised the issue about the supplementation of E2 around luteal phase as it may have potential benefits for implantation. Recently, Gelbaya et al.[8] reported a systematic review and meta-analysis on the effect of luteal phase E2 supplementation on pregnancy rate in IVF cycles. They did not find any beneficial effect on pregnancy rates by the addition of E2 in the luteal phase support. Based on the evidences reported in the current literature, hormone treatment during the luteal phase is usually conducted empirically, owing the lack of clearly defined morphological or hormone criteria in relation to appropriated endometrial preparation for implantation. Thus a large, well-designed, multicenter RCT is required to clarify the role of luteal E2 supplementation on IVF/ICSI outcomes.


1Narvekar SA, Gupta N, Shetty N, Kottur A, Srinivas MS, Rao KA. The degree of serum estradiol decline in early and midluteal phase had no adverse effect on IVF/ICSI outcome. J Hum Reprod Sci 2010;3:25-30.
2de Ziegler D. Hormonal control of endometrial receptivity. Hum Reprod 1995;10:4-7.
3Ghosh D, Sengupta J. Another look at the issue of peri-implantation oestrogen. Hum Reprod 1995;10:1-2.
4Ng EH, Yeung WS, Lau EY, Wai Ki SW, Chung HP. A rapid decline in serum oestradiol concentrations around the mid-luteal phase had no adverse effect on outcome in 763 assisted reproduction cycles. Hum Reprod 2000;15:1903-8.
5Younis JS, Ezra Y, Sherman Y, Simon A, Schenker JG, Laufer N. The effect of estradiol depletion during the luteal phase on endometrium development. Fertil Steril 1994;62:103-7.
6Sharara FI, McClamrock HD. Ratio of oestradiol concentration on the day of human chorionic gonadotrophin administration to mid-luteal oestradiol concentration is predictive of in-vitro fertilization outcome. Hum Reprod 1999;14:2777-82.
7Smitz J, Devroey P, Camus M, Deschacht J, Khan I, Staessen C, et al. The luteal phase and early pregnency after combined GnRH agonist/HMG treatment for superovulation in IVF or GIFT. Hum Reprod 1988;3:585-90.
8Gelbaya TA, Kyrgiou M, Tsoumpou I, Nardo LG. The use of estradiol for luteal phase support in invitro fertilization/intracytoplasmic sperm injection cycles: A systematic review and meta-analysis. Fertil Steril 2008;90:2116-25.