title: Elevated progesterone in GnRH agonist down regulated in vitro fertilisation (IVFICSI) cycles reduces live birth rates but not embryo quality.
abstract: OBJECTIVE
  To assess the impact of pre-hCG elevated progesterone on live birth outcomes during GnRH agonist long down regulated protocol assisted reproduction cycles.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Single Centre Private IVF Clinic.
  
  
  METHODS
  A total of 582 consecutive cycles of IVF/ICSI in 2003.
  
  
  METHODS
  All patients underwent a long down-regulation protocol, controlled ovarian stimulation and IVF/ICSI. Serum progesterone concentrations were measured just prior to HCG administration. 253 patients were followed to 2009 for outcomes of their frozen embryo cycles.
  
  
  METHODS
  Live birth rate in fresh and frozen cycles.
  
  
  RESULTS
  Patients in the upper quartile pre-hCG progesterone concentration (≥ 5.4 pmol/L) had a higher final estradiol level, more oocytes collected and more usable embryos, when compared to those with lower quartiles. They also had lower live birth rates per cycle started (21.9% vs. 15%, P < 0.05). However, live birth rates from frozen embryo cycles were not significantly different between the groups.
  
  
  CONCLUSIONS
  Pre-hCG progesterone elevation leads to lower live birth rates in stimulated IVF cycles. Live birth rates achieved with frozen embryos in the high progesterone cycles suggest, that pre-hCG progesterone elevation negatively affects endometrial receptivity without adversely affecting embryo quality.
authors.affiliation: IVF Australia, 176 Pacific Highway, Greenwich, Sydney, NSW 2065, Australia. rlahoud@ivf.com.au
authors.forename: Robert
authors.initials: R
authors.lastname: Lahoud
authors.forename: Michele
authors.initials: M
authors.lastname: Kwik
authors.forename: John
authors.initials: J
authors.lastname: Ryan
authors.forename: Moamar
authors.initials: M
authors.lastname: Al-Jefout
authors.forename: Jane
authors.initials: J
authors.lastname: Foley
authors.forename: Peter
authors.initials: P
authors.lastname: Illingworth
mesh_terms: D000328:Adult; D001755:Blastocyst; D015925:Cryopreservation; D010064:Embryo Implantation; D004624:Embryo Transfer; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D050498:Live Birth; D017274:Nafarelin / Q000627:therapeutic use; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D017274:Nafarelin; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone