title: Progesterone elevation on the day of human chorionic gonadotropin administration adversely affects the outcome of IVF with transferred embryos at different developmental stages.
abstract: BACKGROUND
  The effect of progesterone elevation (PE) on the day of human chorionic gonadotropin (hCG) administration on the pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles is a matter of ongoing debate. The replacement of cleavage-stage embryos with blastocyst-stage embryos for transfer was proposed to avoid the possible impairment of PE in fresh cycles. This study aimed to assess the association between PE on the day of human chorionic gonadotropin (hCG) administration and clinical pregnancy rates (CPRs) in IVF/ICSI cycles with embryos transferred at different developmental stages (cleavage and blastocyst). Moreover, a secondary aim was to determine the thresholds at which PE has a detrimental effect on CPRs.
  
  
  METHODS
  This single-center retrospective cohort study included more than 10,000 patients undergoing day 3 cleavage-stage embryo transfer (ET) and 1146 patients undergoing day 5 blastocyst-stage embryo transfer (ET) using gonadotropin and GnRH agonist for controlled ovarian stimulation.
  
  
  RESULTS
  Serum PE was inversely associated with CPRs in both cleavage- and blastocyst-stage ET cycles. In the day 3 ET cycles, CPRs (progesterone levels < 0.5 ng/ml, 49.2 %) significantly declined when the progesterone concentration reached 1.0 ng/ml (45.5 %) and decreased further when the progesterone concentration increased to 1.5 ng/ml (36.2 %). In the day 5 blastocyst-stage ET cycles, patients with serum progesterone levels ≥1.75 ng/ml had significantly lower CPRs (31.3 % VS. 41.4 %, p < 0.001) compared to patients with serum progesterone levels <1.75 ng/ml. The negative association of PE with CPRs was noted in both ET groups, even after adjusting for confounders. Furthermore, the developmental stage of the transferred embryos was not linked to the effect of PE on CPRs because the interaction between the developmental stage of the transferred embryos and PE was not significant.
  
  
  CONCLUSIONS
  PE on the day of hCG administration is associated with decreased CPRs in GnRH agonist IVF/intracytoplasmic sperm injection (ICSI) cycles regardless of the developmental stage of the transferred embryos (cleavage versus blastocyst stage).
authors.affiliation: Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China. hy51370@163.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China. wey551144@163.com.
authors.forename: En-Yin
authors.initials: EY
authors.lastname: Wang
authors.affiliation: Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China. xiaodu.feixiang@163.com.
authors.forename: Qing-Yun
authors.initials: QY
authors.lastname: Du
authors.affiliation: Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China. xiongyujing08@163.com.
authors.forename: Yu-Jing
authors.initials: YJ
authors.lastname: Xiong
authors.affiliation: Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China. guoxiaoyi116@163.com.
authors.forename: Xiao-Yi
authors.initials: XY
authors.lastname: Guo
authors.affiliation: Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China. yyplcyx@163.com.
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Yu
authors.affiliation: Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China. syp2008@vip.sina.com.
authors.forename: Ying-Pu
authors.initials: YP
authors.lastname: Sun
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000627:therapeutic use*; D004624:Embryo Transfer / Q000379:methods*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin; D011374:Progesterone