Effects of elevated serum estrogen on dry eye in women undergoing in vitro fertilisation

Ocul Surf. 2023 Jul:29:511-520. doi: 10.1016/j.jtos.2023.06.015. Epub 2023 Jul 6.


Purpose: Sex hormones impact inflammatory and immune-mediated diseases. During IVF (in vitro fertilisation) treatment, circulating estrogen levels increase dramatically (10-50x) alongside changes in other hormones. This study examined changes in dry eye with IVF and its relationship with sex hormones.

Methods: A two visit study was conducted on first day of menstruation when estrogen levels are lowest (baseline visit), and on day 9-11 (peak estrogen visit (PO)) of IVF. Symptoms of dry eye and ocular pain and signs of dry eye were examined. Serum hormone levels were assessed using mass spectrometry and immunoassay. Changes in signs and symptoms and associations were explored. Hierarchical multiple regression analysis assessed factors contributing to signs and symptoms.

Results: 40 women (36.2 ± 4.0 years) completed the study. Baseline and PO oestradiol (E2) levels were 28.9 pg/ml (20) (median (IQR)); 1360 pg/ml (1276) respectively. Ocular pain and dry eye symptoms worsened (p = 0.02 and p < 0.01) and tear break up and tear secretion values decreased (p = 0.005 and 0.01) at PO. Higher E2 and lower luteinizing hormone (LH) were associated with worsening of dry eye symptoms (ρ = 0.34 p = 0.03, ρ = -0.49 p = 0.001). Reduction in LH and increase in progesterone (P4) were associated with increased ocular pain (ρ = 0.45, p = 0.004 and ρ = 0.39, p = 0.01). Dry eye symptoms were predicted by LH and tear break up (p = 0.02; R2 = 0.18).

Conclusions: IVF treatment resulted in significantly increased ocular symptoms and tear film alterations although these changes were not clinically significant. Dry eye signs and symptoms were poorly predicted by hormone levels.

Keywords: Dry eye; Estrogen; In vitro fertilisation; Ocular symptoms; Sex hormones.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Dry Eye Syndromes* / diagnosis
  • Estrogens
  • Eye Pain
  • Female
  • Fertilization in Vitro
  • Gonadal Steroid Hormones / analysis
  • Humans
  • Pain
  • Tears / chemistry


  • Estrogens
  • Gonadal Steroid Hormones