title: Serum progesterone concentration on day of embryo transfer in donor oocyte cycles.
abstract: OBJECTIVE
  To evaluate the association between serum progesterone (P) levels on the day of embryo transfer (ET) and pregnancy rates in fresh donor IVF/ICSI cycles.
  
  
  METHODS
  Fresh donor cycles with day 3 ET from 10/2007 to 8/2012 were included (n = 229). Most cycles (93 %) were programmed with a gonadotropin releasing hormone (GnRH) agonist; oral, vaginal or transdermal estradiol was used for endometrial priming, and intramuscular P was used for luteal support (50-100 mg/day). Recipient P levels were measured at ET, and P dose was increased by 50-100 % if <20 ng/mL per clinic practice. The main outcome measure was rate of live birth (> = 24 weeks gestational age). Generalized estimating equations were used to account for multiple cycles from the same recipient, adjusted a priori for recipient and donor age.
  
  
  RESULTS
  Mean recipient serum P at ET was 25.5 ± 10.1 ng/mL. Recipients with P < 20 ng/mL at ET, despite P dose increases after ET, were less likely to achieve clinical pregnancy (RR = 0.75, 95 % CI = 0.60-0.94, p = 0.01) and live birth (RR = 0.77, 95 % CI = 0.60-0.98, p = 0.04), as compared to those with P ≥ 20 ng/mL. P dose increases were more often required in overweight and obese recipients.
  
  
  CONCLUSIONS
  Serum P levels on the day of ET in fresh donor IVF/ICSI cycles were positively correlated with clinical pregnancy and live birth rates. An increase in P dose after ET was insufficient to rescue pregnancy rates. Overweight and obese recipients may require higher initial doses of P supplementation. Future research is needed to define optimal serum P at ET and the interventions to achieve this target.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Division of Reproductive Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Paula C
authors.initials: PC
authors.lastname: Brady
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kaser
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Ginsburg
authors.forename: Rachel K
authors.initials: RK
authors.lastname: Ashby
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Missmer
authors.forename: Katharine F
authors.initials: KF
authors.lastname: Correia
authors.forename: Catherine
authors.initials: C
authors.lastname: Racowsky
mesh_terms: D000328:Adult; D004624:Embryo Transfer / Q000379:methods*; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D050177:Overweight; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000008:administration & dosage* / Q000097:blood*; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D011374:Progesterone; D004958:Estradiol