Estradiol Decline Post-Retrieval: Implications for IVF Success

In a new study published in the Journal of Assisted Reproduction and Genetics, post-retrieval estradiol decline predicts lower IVF success in high responders managed on antagonist cycles.

A retrospective cohort of high responders on antagonist protocols evaluated clinical pregnancy rate and live birth rate as primary endpoints and correlated those outcomes with the magnitude of post-retrieval estradiol decline.

An E2 ratio ≤0.2 at 48 hours post-retrieval was associated with significantly lower clinical pregnancy and live birth rates compared with higher ratios, demonstrating an inverse, data-driven relationship between larger post-retrieval E2 drops and reduced CPR and LBR in this population.

Monitoring estradiol within 24–72 hours after retrieval captures the trajectory linked to outcomes. Track absolute E2 drop and percent decline relative to the pre-retrieval peak (for example, post-retrieval E2 / pre-retrieval E2 ≤0.2); steeper declines correlate with lower oocyte yield and less favorable early embryo metrics.

These measurements create actionable decision points in antagonist cycles—examples include protocolized 48-hour checks, targeted luteal-support trials for high-decline patients, or closer follow-up to inform transfer timing while awaiting prospective validation.