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Estradiol serum level on progesterone support day among frozen embryo transfer IVF patients and pregnancy outcomes a systematic review and meta-analysis


Introduction: The relationship between estradiol serum levels on the day of progesterone injection and the outcomes of in vitro fertilization (IVF) pregnancies has been extensively explored in various studies and clinical inquiries. This study aims to conduct a systematic review and meta-analysis to investigate the influence of estradiol serum levels on the day of progesterone injection on pregnancy outcomes in IVF cycles.

Method: By conducting a thorough search of the PubMed and Embase databases, a total of eight studies were selected for inclusion in the analysis. The results indicated a risk ratio of 1.34 (95% CI 0.85-2.11) for live birth rate, 0.94 (95% CI 0.90-0.99) for biochemical pregnancy rate, 1.02 (95% CI 0.79-1.31) for clinical pregnancy rate, 0.84 (95% CI 0.51-1.41) for miscarriage rate, 0.81 (95% CI 0.49-1.35) for implantation rate, and a mean difference of -0.01 (95% CI -0.35 to 0.33) for endometrial thickness.

Results: The study indicates that there is no significant association between progesterone serum levels on the day of hCG administration and IVF pregnancy outcomes. However, the substantial heterogeneity observed across the included studies underscores the necessity for more comprehensive and standardized investigations to uncover the intricate associations between estradiol levels and IVF success.

Conclusion: This research enhances our comprehension of the role of estradiol serum levels in IVF outcomes and lays the groundwork for future studies aimed at refining fertility treatment protocols.


  1. Kushnir VA, Smith GD, Adashi EY. The Future of IVF: The New Normal in Human Reproduction. Reprod Sci. 2022/01/03. 2022;29(3):849–56. Available from:
  2. Paulson RJ. Hormonal induction of endometrial receptivity. Fertil Steril. 2011;96(3):530–5. Available from:
  3. Dashti S, Eftekhar M. Luteal-phase support in assisted reproductive technology: An ongoing challenge. Int J Reprod Biomed. 2021;19(9):761–72. Available from:
  4. Mackens S, Santos-Ribeiro S, Orinx E, De Munck N, Racca A, Roelens C, et al. Impact of Serum Estradiol Levels Before Progesterone Administration in Artificially Prepared Frozen Embryo Transfer Cycles. Front Endocrinol (Lausanne). 2020;11:255. Available from:
  5. Banz C, Katalinic A, Al-Hasani S, Seelig AS, Weiss JM, Diedrich K, et al. Preparation of cycles for cryopreservation transfers using estradiol patches and Crinone® 8% vaginal gel is effective and does not need any monitoring. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2002;103(1):43–7. Available from:
  6. Niu Z, Feng Y, Sun Y, Zhang A, Zhang H. Estrogen level monitoring in artificial frozen-thawed embryo transfer cycles using step-up regime without pituitary suppression: is it necessary? J Exp Clin Assist Reprod. 2008;5:4. Available from:
  7. Fritz R, Jindal S, Feil H, Buyuk E. Elevated serum estradiol levels in artificial autologous frozen embryo transfer cycles negatively impact ongoing pregnancy and live birth rates. J Assist Reprod Genet. 2017/08/19. 2017;34(12):1633–8. Available from:
  8. Beck-Fruchter R, Nothman S, Baram S, Geslevich Y, Weiss A. Progesterone and estrogen levels are associated with live birth rates following artificial cycle frozen embryo transfers. J Assist Reprod Genet. 2021/09/18. 2021;38(11):2925–31. Available from:
  9. Zhang WY, Gardner RM, Kapphahn KI, Ramachandran MK, Murugappan G, Aghajanova L, et al. The impact of estradiol on pregnancy outcomes in letrozole-stimulated frozen embryo transfer cycles. F S Rep. 2021;2(3):320–6. Available from:
  10. Zhou R, Zhang X, Huang L, Zhu X, Dong M, Liu W, et al. Association between serum estradiol levels before progesterone administration in artificial frozen–thawed blastocyst transfer cycles and live birth rate: a retrospective study. BJOG: An International Journal of Obstetrics & Gynaecology. 2021;128(13):2092–100. Available from:
  11. Goldman RH, Greer A, Racowsky C, Farland L V, Lanes A, Thomas AM, et al. Association between serum estradiol level on the day of progesterone start and outcomes from frozen blastocyst transfer cycles utilizing oral estradiol. J Assist Reprod Genet. 2022/05/18. 2022;39(7):1611–8. Available from:
  12. Li Q, Ruan L, Zhu L, Yang Z, Zhu M, Luo Y. Elevated estradiol levels in frozen embryo transfer have different effects on pregnancy outcomes depending on the stage of transferred embryos. Sci Rep. 2022;12(1):5592. Available from:

How to Cite

Herida, A. R., & Soelaeman, M. F. (2023). Estradiol serum level on progesterone support day among frozen embryo transfer IVF patients and pregnancy outcomes a systematic review and meta-analysis. Bali Medical Journal, 13(1), 1–10.




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Alifia Ramadhani Herida
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BMJ Journal

Muhammad Faza Soelaeman
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BMJ Journal