title: Is measurement of progesterone level prior to FSH stimulation useful in GnRH-antagonist cycles?
abstract: OBJECTIVE
  To reduce patient inconvenience during in vitro fertilization (IVF) cycles, some protocols delay intensive monitoring until mid-follicular stimulation. Others assess hormone levels prior to follicle-stimulating hormone (FSH) administration, not commencing stimulation until baseline progesterone (P4) levels (< 5 nmol/l) are achieved. Higher P4 levels (> 4.8 nmol/L) on the day of FSH trigger have been implicated in poorer pregnancy rates. This study evaluates the association of P4 levels at day 1-2 in gonadotrophin-releasing hormone (GnRH)-antagonist cycles with pre-trigger P4 levels and clinical pregnancy rates (CPRs).
  
  
  METHODS
  All fresh GnRH-antagonist IVF cycles between June 2011 and June 2012, in which pre-FSH P4 levels were not routinely performed (group 1), were retrieved from the IVF Australia database and compared with controls (group 2).
  
  
  RESULTS
  There were 163 cycles in each group. P4 levels on the day of trigger were significantly higher in group 1 (3.75 vs. 2.77, p < 0.05). The incidence of pre-trigger P4 levels >4.8 nmol/l was significantly higher in group 1 (30 vs. 16, p < 0.05). The number of oocytes retrieved was higher in group 1 (11.1 vs. 9, p < 0.05), however fertilization rates were significantly lower in that group (53.6% vs. 61.2%, p < 0.05); CPRs were similar between the two groups (27.8% vs. 31.8%, p = ns). Overall, pregnancy rates were lower in cycles with pre-trigger P4 level of > 4.8 nmol/L compared with those with lower levels (15% vs. 32.5%, p < 0.05).
  
  
  CONCLUSIONS
  We found that measurement of P4 level at early follicular phase was associated with significantly lower pre-trigger levels. However, this did not translate into a difference in CPR between the monitored and unmonitored groups. We have confirmed that elevation in pre-trigger P4 level is associated with halving of the CPR, indicating that the most important P4 measurements are those in the late follicular/pre-trigger phase.
authors.affiliation: a School of Women and Children's Health, University of New South Wales , Sydney , Australia.
authors.forename: Dave
authors.initials: D
authors.lastname: Listijono
authors.affiliation: b Department of Embryology , IVFAustralia , Maroubra , Australia.
authors.forename: Suha
authors.initials: S
authors.lastname: Kilani
authors.affiliation: b Department of Embryology , IVFAustralia , Maroubra , Australia.
authors.forename: Liza
authors.initials: L
authors.lastname: Tilia
authors.affiliation: b Department of Embryology , IVFAustralia , Maroubra , Australia.
authors.forename: Don
authors.initials: D
authors.lastname: Garrett
authors.affiliation: a School of Women and Children's Health, University of New South Wales , Sydney , Australia.|b Department of Embryology , IVFAustralia , Maroubra , Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Chapman
mesh_terms: D000328:Adult; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005307:Fertilization in Vitro / Q000379:methods; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood*
chemical_list: D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D005640:Follicle Stimulating Hormone; C062876:cetrorelix
keywords: gonadotrophin-releasing hormone antagonist/agonist; in vitro fertilization (IVF); progesterone