Measurement of serum estradiol/progesterone ratio on the day of embryo transfer to predict clinical pregnancies in intracytoplasmic sperm injection (ICSI) cycles. Is this of real clinical value?

Study objectiveTo assess the value of measuring serum estradiol/progesterone (E2/P) ratio on the day of embryo transfer (ET) in intracytoplasmic sperm injection (ICSI) cycles to predict clinical pregnancies.DesignA prospective study.SettingThe assisted reproduction unit of a large University Maternity Hospital.Materials and methodsFifty seven women consecutively treated by ICSI for male factor infertility were included in the study. Early luteal serum E2 and P were measured on the day of ET and serum E2/P ratios were calculated for clinical pregnancies and non-clinical pregnancy cycles.Main outcome measureClinical pregnancy rate.ResultsThirty four women failed to have clinical pregnancy (Non-clinical pregnancy group) while 23 women had clinical pregnancies (Clinical pregnancy group). There were no statistically significant differences between the two outcome groups regarding the median values for E2 levels, P levels and E2/P ratios (655 pmol/l, 172.5 nmol/l and 2.8 for non-clinical pregnancy cycles versus 814 pmol/l, 180 nmol/l and 2.9 for clinical pregnancy cycles, respectively). Receiver-operating characteristic (ROC) curve for E2/P ratio was constructed to predict clinical pregnancies, the area under the curve (AUC) was 0.513 (95% confidence interval, 0.377–0.648; P, 0.865) and the best cut-off value was an E2/P ratio of 2.5 (sensitivity of 69.57%, specificity of 44.12%, positive predictive value of 45.7% and negative predictive value of 68.2%).Major conclusionsMeasurement of E2/P ratio on the day of embryo transfer in ICSI cycles is not of clinical value to predict clinical pregnancies.