Plasma estradiol is superior to ultrasound and urinary estriol glucuronide as a predictor of ovarian hyperstimulation during induction of ovulation with menotropins

In order to compare the effectiveness of 8:00 A.M. plasma 17β-estradiol (E2), 24-hour urinary estriol glucuronide (E3G), and ultrasound as predictors of ovarian hyperstimulation, 70 cycles of induction of ovulation with 5:00 P.M. to 8:00 P.M. injection of menotropins from 28 subjects were evaluated. Hyperstimulation was four times more frequent in pregnancy than in nonpregnancy cycles (P < 0.005). The hyperstimulation score (range, 0 to 6) was correlated with plasma E2 (0.63, P < 0.01), the number of follicles (0.31, P < 0.05), the duration of treatment (0.31, P < 0.05), and urinary E3G (0.25, P < 0.05). Plasma E2 was the best predictor of the hyperstimulation score, and plasma E2 was far superior to both urinary E3G and the number of follicles. Management with ultrasound alone is insufficient to prevent severe ovarian hyperstimulation. With this protocol, human chorionic gonadotropin may be given as soon as the first follicle reaches 1.4cm in diameter as long as plasma E2 is < 4000pg/ml. The values of plasma E2 are dependent on the interval between blood sampling and injection of menotropins.