title: Does a frozen embryo transfer ameliorate the effect of elevated progesterone seen in fresh transfer cycles?
abstract: OBJECTIVE
  To compare the effect of progesterone (P) on the day of trigger in fresh assisted reproduction technology (ART) transfer cycles versus its effect on subsequent frozen embryo transfer (FET) cycles.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Large private ART practice.
  
  
  METHODS
  Fresh autologous and FET cycles from 2011-2013.
  
  
  METHODS
  None.
  
  
  METHODS
  Live birth.
  
  
  RESULTS
  A paired analysis of patients who underwent both a fresh transfer and subsequent FET cycle and an unpaired analysis of data from all fresh transfer cycles and all FET cycles were performed. We analyzed 1,216 paired and 4,124 unpaired cycles, and P was negatively associated with birth in fresh but not FET cycles in all analyses. Interaction testing of P and cycle type indicated P had a different association with birth in fresh versus FET cycles. When P was ≥ 2 ng/mL at the time of trigger, live birth was more likely in FET versus fresh cycles in the paired analysis (47% vs. 10%), in the unpaired analysis (51% vs. 14%), and in unpaired, good blastocyst only transfer subgroup (51% vs. 29%). Live birth was similar in FET cycles, with P ≥ 2 ng/mL versus P < 2 ng/mL (51% vs. 49%). Conversely, live birth was lower in fresh cycles, with P ≥ 2 ng/mL versus P <2 ng/mL (15% vs. 45%).
  
  
  CONCLUSIONS
  Elevated P levels on the day of trigger during the initial fresh cycle were negatively associated with live birth in the fresh transfer cycles but not in subsequent FET cycles. Freezing embryos and performing a subsequent FET cycle ameliorates the effect of elevated P on live-birth rates.
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland. Electronic address: mae.healy@mail.nih.gov.
authors.forename: Mae Wu
authors.initials: MW
authors.lastname: Healy
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: George
authors.initials: G
authors.lastname: Patounakis
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Matt T
authors.initials: MT
authors.lastname: Connell
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Shady Grove Fertility Science Center, Rockville, Maryland.
authors.forename: Kate
authors.initials: K
authors.lastname: Devine
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Alan H
authors.initials: AH
authors.lastname: DeCherney
authors.affiliation: Shady Grove Fertility Science Center, Rockville, Maryland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Shady Grove Fertility Science Center, Rockville, Maryland.
authors.forename: Micah J
authors.initials: MJ
authors.lastname: Hill
mesh_terms: D015415:Biomarkers / Q000097:blood; D001755:Blastocyst / Q000502:physiology*; D015925:Cryopreservation; D004624:Embryo Transfer / Q000009:adverse effects; D005260:Female; D005298:Fertility / Q000187:drug effects; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D007246:Infertility / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D005300:Fertility Agents, Female; D011374:Progesterone
keywords: Elevated progesterone; fresh transfer versus FET cycles; live birth