Objective: To report a case of a patient in whom serum E2, as measured by an automated E2 assay, remained elevated at levels corresponding to the periovulatory phase(>380 pg/mL), despite 3 weeks of treatment by a GnRH agonist(GnRH-a). Design: Case report. Setting: Tertiary-care academic center. Patient(s): A 39-year-old patient accepted for IVF treatment. In view of controlled ovarian hyperstimulation, down-regulation by a GnRH-a was monitored by serum E2 measurement. Intervention( s): Obvious causes for high serum E2 levels(pregnancy, E2-produ- cing ovarian cysts, and noncompliance of the patient)-were excluded. The IVF cycle was canceled. Main Outcome Measure(s): Serum samples were analyzed retrospectively by radioimmunoassay(RIA), and ether extraction of the samples was performed before measurement by the automated E2 assay. Result(s): Radioimmunoassay revealed adequately suppressed serum E2 levels under GnRH-a treatment(< 15 pg/mL). Ether extraction revealed an interfering component that was soluble in the aqueous phase. Conclusion(s): If a patient on a long controlled ovarian hyperstimulation IVF protocol still has high serum E2 levels after 2 to 3 weeks of down-regulation, and obvious reasons for this(pregnancy, E2 producing ovarian cysts, noncompliance of the patient) are excluded, E2 immunoassay interference should be excluded to avoid unnecessary cancellation of the IVF cycle.
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