title: Elevated progesterone at initiation of stimulation is associated with a lower ongoing pregnancy rate after IVF using GnRH antagonists.
abstract: BACKGROUND
  The objective of this prospective study was to assess the impact of elevated serum progesterone levels on day 2 of the cycle on pregnancy rates in patients treated by IVF using GnRH antagonists.
  
  
  METHODS
  Ovarian stimulation was started on day 2 of the cycle if progesterone levels were normal (normal-P group, n = 390). In the presence of elevated progesterone, initiation of stimulation was postponed for 1 or 2 days (high-P group, n = 20) and was started if repeat progesterone levels returned to normal range (n = 16). Stimulation was performed with recombinant FSH (rFSH) and GnRH antagonist was always started on day 6 of stimulation.
  
  
  RESULTS
  A significantly higher exposure to progesterone and a significantly lower exposure to estradiol was present in the high-P as compared with the normal-P group from day 1 to day 8 of stimulation. In addition, a significantly lower ongoing pregnancy rate both per started cycle (5.0% versus 31.8%; P = 0.01) and per embryo transfer (6.3% versus 36.9%; P = 0.01) was present in the high-P compared with the normal-P group, respectively.
  
  
  CONCLUSIONS
  The presence of elevated serum progesterone on day 2 of the cycle is associated with a decreased chance of pregnancy in patients treated with rFSH and GnRH antagonists.
authors.affiliation: Centre for Reproductive Medicine, Dutch-Speaking Brussels Free University, 1090 Brussels, Belgium. stratis@easynet.be
authors.forename: E M
authors.initials: EM
authors.lastname: Kolibianakis
authors.forename: K
authors.initials: K
authors.lastname: Zikopoulos
authors.forename: J
authors.initials: J
authors.lastname: Smitz
authors.forename: M
authors.initials: M
authors.lastname: Camus
authors.forename: H
authors.initials: H
authors.lastname: Tournaye
authors.forename: A C
authors.initials: AC
authors.lastname: Van Steirteghem
authors.forename: P
authors.initials: P
authors.lastname: Devroey
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006801:Humans; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood*; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D005640:Follicle Stimulating Hormone