Application of estrogen during early follicular phase to the elderly aged patients without apparent antral follicle

Objective To investigate the clinical value of estrogen supplementation during early follicular phase in the advanced aged patients with no apparent antral follicle. Methods Totally 24 elderly patients with no apparent antral follicle were included in the study, the ovarian reserve before and after estrogen supplementation was compared. They were categorized into group A (1-5 d), group B (6-10 d) and group C (≥11 d) according to the duration of estrogen administration that inducing follicle recruitment. Ovarian stimulation parameters and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes were compared among the three groups. Results 1) After estrogen supplementation, follicles appeared and the serum follicle stimulating hormone (FSH) levels [(16.53±9.74) IU/L] significantly declined compared with the baseline FSH levels [(24.87±11.02) IU/L](P=0.032), as well as serum estradiol (E2) levels [(108.90 (93.93,222.60) ng/L, 10.98 (0.0,21.23) ng/L, P=0.001)] significantly increased. 2) The number of follicle after estrogen supplementation reduced in series among group A, group B and group C [2.0(1.5,3.0), 1.0(1.0,2.8), 1.0(1.0,1.0)](P=0.019) and the oocyte yield rate was 80.0%, 70.8% and 28.6%, respectively (P=0.039). After estrogen supplementation, the serum FSH and E2 levels, the number of oocyte yield and normal fertilization rates were not statistically significant among the three groups. 3) The linear regression model identified that the duration of estrogen supplement was positively associated with baseline FSH levels. Conclusion Estrogen supplementation during early follicular phase might facilitate follicular recruitment to achieve oocytes and embryos as well as to improve IVF/ICSI outcomes in elderly aged patients with no apparent antral follicle. Key words: Estrogen; Diminished ovarian reserve (DOR); In vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)