title: Progesterone level and progesterone/estradiol ratio on the day of hCG administration: detrimental cutoff levels and new treatment strategy.
abstract: OBJECTIVE
  To identify if there are certain cutoff levels for P and or the P/E(2) ratio on the day of hCG that would be defined as detrimental for occurrence of pregnancy in women with normal ovarian reserve undergoing cleavage-stage embryo transfer (ET). Secondarily, to determine if these same cutoffs might have the same potential negative effect in women undergoing blastocyst ET.
  
  
  METHODS
  Prospective cohort study including two randomized cohorts.
  
  
  METHODS
  Private and university fertility centers.
  
  
  METHODS
  A total of 240 women undergoing long agonist protocol with at least four grade 1 day 3 embryos.
  
  
  METHODS
  Women were randomized in a 1:1 ratio to undergo day 3 or day 5 embryo transfer.
  
  
  METHODS
  Clinical pregnancy rate (CPR) was the primary outcome.
  
  
  RESULTS
  Using receiver operator characteristics, cutoffs for P and P/E(2) ratio were 1.5 ng/mL and 0.55, respectively. Patients with P ≤ 1.5 ng/mL and P/E(2) ≤ 0.55 undergoing cleavage-stage ET had higher CPR. Using multiple regression, P/E(2) ratio was the only independent predictor for pregnancy. The P and P/E(2) cutoffs were not correlated with CPR in blastocyst transfers.
  
  
  CONCLUSIONS
  Progesterone >1.5 ng/mL and P/E(2) >0.55 affect the CPR in women undergoing cleavage-stage, but not blastocyst ET. P/E(2) ratio is the only independent prognosticator for cycle outcome in women undergoing cleavage-stage ET.
authors.affiliation: Department of Obstetrics and Gynecology, Zagazig University School of Medicine, Zagazig, Egypt. eman_elgindy@hotmail.com
authors.forename: Eman A
authors.initials: EA
authors.lastname: Elgindy
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004624:Embryo Transfer / Q000379:methods* / Q000592:standards; D004958:Estradiol / Q000097:blood* / Q000592:standards; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood* / Q000592:standards; D011379:Prognosis; D012016:Reference Values; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D011374:Progesterone; D004958:Estradiol