title: High progesterone levels in women with high ovarian response do not affect clinical outcomes: a retrospective cohort study.
abstract: BACKGROUND
  The potentially detrimental role of progesterone during the follicular phase has been a matter of controversy for several years; however, few studies have analyzed the effects of combined raised estradiol and progesterone levels on pregnancy outcomes. The aim of the present study was to determine the influence of high progesterone levels on clinical outcomes in the context of high ovarian response.
  
  
  METHODS
  We performed a retrospective cohort study that included 2850 women classified as high responders. The women were subdivided into six groups depending on their progesterone concentration on the day of human chorionic gonadotropin (hCG) administration: <0.5 ng/ml (<p10), 0.50-0.70 ng/ml (p10-p25), 0.71-1.00 ng/ml (p25-p50), 1.01-1.40 ng/ml (p50-p75), 1.41-1.80 ng/ml (p75-p90) and >1.81 ng/ml (>p90). Ovarian response was classified as high when>=20 oocytes were retrieved or when estradiol was >=3000 pg/ml. Clinical outcomes of each subgroup were analyzed. We also examined data from frozen-thawed embryo transfers. Results were analyzed with Student's t- test to compare continuous variables and chi-squared test to compare proportions. A p-value of< =0.05 was considered statistically significant.
  
  
  RESULTS
  The progesterone concentration increased with ovarian response, and elevated progesterone did not show a significant clinical impact on implantation rate and pregnancy rates. These data provide evidence that progesterone levels higher than 1.8 ng/ml do not have detrimental effect on oocyte quality or endometrial receptivity.
  
  
  CONCLUSIONS
  These data allow us to conclude that high progesterone levels correlate significantly with high estradiol levels and that in high responder women; progesterone levels do not show a significant clinical impact on results.
authors: Reproductive Medicine Department, Instituto Valenciano de Infertilidad IVI Madrid, Avenida del Talgo 68-70, Aravaca, Madrid 28023, Spain. antonio.requena@ivi.es.
authors: Antonio
authors: A
authors: Requena
authors: María
authors: M
authors: Cruz
authors: Ernesto
authors: E
authors: Bosch
authors: Marcos
authors: M
authors: Meseguer
authors: Juan Antonio
authors: JA
authors: García-Velasco
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000494:pharmacology*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D015331:Cohort Studies; D004958:Estradiol / Q000097:blood / Q000378:metabolism; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology*; D005307:Fertilization in Vitro; D005498:Follicular Phase / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000473:pathology / Q000628:therapy*; D009866:Oogenesis / Q000187:drug effects*; D010053:Ovary / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood* / Q000378:metabolism; D012372:ROC Curve; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D020554:Sperm Injections, Intracytoplasmic; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D005300:Fertility Agents, Female; D011374:Progesterone; D004958:Estradiol