Premature progesterone elevation impairs implantation and live birth rates in GnRH-agonist IVF/ICSI cycles.
BACKGROUND
Our aim was to investigate the clinical significance of premature elevated progesterone levels in women with good ovarian response treated with long gonadotropin-releasing hormone agonist (GnRH-a) cycles and IVF. Premature elevated progesterone levels refer to a rise in serum progesterone levels on the day of human chorionic gonadotrophin (hCG) administration for final oocyte maturation above a threshold level, which is usually arbitrarily defined.


METHODS
This is a retrospective case study, which consists of 1,045 treatment cycles in women with low P/E2 [progesterone (ng/mL) x 1,000/estradiol (pg/mL)] on the day of hCG. Elevated P levels on the day of hCG administration were defined as >1.1 ng/mL. The data of the control group (< or =1.1 ng/mL, n = 900 patients) were compared with those of the high P group (>1.1 ng/mL, n = 145).


RESULTS
Compared with the control group, those in the high progesterone group had higher levels of estradiol on the day of hCG (3,143 vs. 2,382 pg/ml) (p: 0.000) and higher numbers of MII oocytes (14.0 and 12.9) (p: 0.001). The total number of embryos and the number of good-quality embryos transferred did not differ significantly between the groups. Implantation rate (18.1 vs. 24.4%) (p: 0.008), and live birth rate (27.6 vs. 40%) (p: 0.004), were significantly lower in patients with high progesterone levels. OR and 95% CI were 0.57 (0.39-0.84) for the live birth rate.


CONCLUSIONS
In women stimulated with GnRHa and hMG/FSH for IVF, elevated serum progesterone levels on the day of hCG administration were associated with diminished implantation rates and live birth rates regardless of ovarian reserve.
Division of Reproductive and Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Adana, Turkey. esrabulgan1972@mynet.com
Esra Bulgan
EB
Kiliçdag
Bulent
B
Haydardedeoglu
Tayfun
T
Cok
Servet Ozden
SO
Hacivelioglu
Tayfun
T
Bagis
D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D010064:Embryo Implantation; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood*; D012189:Retrospective Studies
D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone