title: Reproducibility and clinical significance of pre-ovulatory serum progesterone level and progesterone/estradiol ratio on the day of human chorionic gonadotropin administration in infertile women undergoing repeated in vitro fertilization cycles.
abstract: BACKGROUND
  The objective of this study was to explore the cycle-to-cycle reproducibility of serum progesterone level and progesterone/estradiol (P/E2) ratio in the final step of triggering oocyte maturation in patients undergoing repeated consecutive controlled ovarian hyperstimulation for in vitro fertilization (COH-IVF) treatment and to investigate the clinical parameters associated with serum progesterone concentration and P/E2 ratio.
  
  
  METHODS
  We retrospectively studied 524 cycles in 203 infertile women who underwent two or more fresh COH-IVF cycles from July 1998 to May 2012 in a university hospital IVF unit. The patients were divided into groups according to the number (2, 3 or >=4) of total successive IVF cycles with successful oocyte retrieval. The within-subject reproducibility of serum P and P/E2 was tested by calculating intra-class correlation coefficients (ICCs). Multiple linear regression analysis was used to assess the association between patient variables and pre-ovulatory serum P level and P/E2 ratio.
  
  
  RESULTS
  The ICCs in women who underwent 2, 3 and >=4 IVF cycles were -0.052, 0.163 and 0.212, respectively, for serum P concentration and 0.180, 0.168 and 0.148, respectively, for P/E2 ratio. All ICCs for both serum P and P/E2 ratio were indicative of poor reproducibility. The number of oocytes was significantly positively related to P concentration, and endometrial thickness was significantly negatively related to P concentration and P/E2 ratio.
  
  
  CONCLUSIONS
  The cycle-to-cycle reproducibility of pre-ovulatory serum P concentration and P/E2 ratio was poor in individual patients, and these fluctuations were more cycle- than patient-dependent. The number of oocytes was the most significant factor relating to P concentration. By using milder stimulation approach to produce fewer oocytes in the next cycle is a strategy to overcome the high serum P concentration, while clinicians should consider each patient's general condition including the age, ovarian reserve, embryo grading and the capacity of frozen-thawed embryo transfer.
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. lyu015@cgmh.org.tw.|Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chia Yi, Taiwan. lyu015@cgmh.org.tw.
authors.forename: Yu-Ju
authors.initials: YJ
authors.lastname: Lin
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. lankuochung@gmail.com.
authors.forename: Kuo-Chung
authors.initials: KC
authors.lastname: Lan
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. kcgcrm1885@cgmh.org.tw.
authors.forename: Fu-Jen
authors.initials: FJ
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. m7031@cgmh.org.tw.
authors.forename: Pin-Yao
authors.initials: PY
authors.lastname: Lin
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. n22370@cgmh.org.tw.
authors.forename: Hsin-Ju
authors.initials: HJ
authors.lastname: Chiang
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. ftkung@cgmh.org.tw.
authors.forename: Fu-Tsai
authors.initials: FT
authors.lastname: Kung
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000627:therapeutic use*; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D016014:Linear Models; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D006063:Chorionic Gonadotropin; D011374:Progesterone; D004958:Estradiol