title: Basal progesterone level as the main determinant of progesterone elevation on the day of hCG triggering in controlled ovarian stimulation cycles.
abstract: OBJECTIVE
  Modest increases of serum progesterone at human chorionic gonadotrophin (hCG) administration in controlled ovarian hyperstimulation (COH) cycles have been shown to have a negative impact on pregnancy outcomes. The aim of this study was to identify early predictors of progesterone elevation at hCG.
  
  
  METHODS
  Pregnancy outcome of 303 consecutive patients undergoing COH and fresh day-3 embryo transfer was analysed. Considering the non-linear relationship between progesterone at hCG triggering and pregnancy outcomes, partial area under the curve (pAUC) analysis was used to implement marker identification potential of receiver operating characteristic (ROC) curve analysis. Multivariate logistic analysis was then performed to identify predictors of progesterone rise.
  
  
  RESULTS
  Pregnancy outcomes could be predicted by pAUC analysis (pAUC = 0.58, 95 % CI 0.51-0.66, p = 0.02) and a significant detrimental cut-off could be calculated (progesterone at hCG > 1.35 ng/ml). Total dose of rFSH administered, E2 level at hCG but mostly basal progesterone level (OR = 12.21, 95 % CI 1.82-81.70) were predictors of progesterone rise above the cut-off.
  
  
  CONCLUSIONS
  Basal progesterone is shown to be the main prognostic factor for progesterone elevation. This observation should be taken into consideration in the clinical management of IVF/ICSI cycles to improve pregnancy outcomes.
authors.affiliation: Centro Scienze Natalità, Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Papaleo
authors.forename: Laura
authors.initials: L
authors.lastname: Corti
authors.forename: Valeria Stella
authors.initials: VS
authors.lastname: Vanni
authors.forename: Luca
authors.initials: L
authors.lastname: Pagliardini
authors.forename: Jessica
authors.initials: J
authors.lastname: Ottolina
authors.forename: Francesca
authors.initials: F
authors.lastname: De Michele
authors.forename: Antonio
authors.initials: A
authors.lastname: La Marca
authors.forename: Paola
authors.initials: P
authors.lastname: Viganò
authors.forename: Massimo
authors.initials: M
authors.lastname: Candiani
mesh_terms: D000328:Adult; D019540:Area Under Curve; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000378:metabolism*; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000097:blood / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D008597:Menstrual Cycle; D016471:Ovarian Hyperstimulation Syndrome / Q000097:blood; D010053:Ovary / Q000187:drug effects / Q000502:physiology*; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome; D011374:Progesterone / Q000097:blood*; D012372:ROC Curve; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D004958:Estradiol