title: Effect of premature serum progesterone rise on embryo transfer outcomes and the role of blastocyst culture and transfer in assisted reproductive technology cycles with premature progesterone rise.
abstract: OBJECTIVE
  In 1991, researchers reported that a modest preovulatory increase in serum progesterone levels is associated with lower pregnancy rates and higher incidence of pregnancy loss in in vitro fertilization (IVF). We wonder whether embryo transfer (ET) in assisted reproductive technology (ART) cycles in patients with premature progesterone rise (PPR) have a negative impact on the clinical pregnancy rates (CPRs) and/or live birth rates (LBRs) in our series. Consequently, will blastocyst transfer reverse the negative impact?
  
  
  METHODS
  This noninterventional, retrospective, observational tertiary center study was conducted between January 2010 and December 2012. All fresh ET cycles with serum progesterone levels measured (n = 599) on the day of hCG administration were analyzed.
  
  
  RESULTS
  Sera lutenizing hormone (LH), E2, and progesterone (P) were measured and analyzed. The CPRs of cycles in patients with p ≤ 1.5 ng/mL (low) versus those with p > 1.5 ng/mL (high) were 37.04% versus 41.03% [odds ratio (OR) = 1.18, 95% confidence interval (CI): 0.728-1.920; p = 0.50). The LBRs of cycles in patients with low progesterone level versus those with PPR were 30.52% versus 34.62% (OR = 1.21, 95% CI: 0.729-1.992; p = 0.47). No statistically significant association was detected. We further analyzed the outcomes according to different stages of ET and found that blastocyst (D5) ET significantly increase the LBRs as compared with cleavage stage (D2/D3) ET in the PPR group (44.44% versus 21.43%; p = 0.043).
  
  
  CONCLUSIONS
  PPR did not significantly compromise the clinical outcomes in this series. However, shifting to blastocyst transfer probably could increase the live birth in cycles with PPR.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Pei-Chen
authors.initials: PC
authors.lastname: Huang
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: mingjer_chen@yahoo.com.tw.
authors.forename: Ming-Jer
authors.initials: MJ
authors.lastname: Chen
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Hwa-Fen
authors.initials: HF
authors.lastname: Guu
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Yu-Chiao
authors.initials: YC
authors.lastname: Yi
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Jason Yen-Ping
authors.initials: JY
authors.lastname: Ho
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Ya-Fang
authors.initials: YF
authors.lastname: Chen
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Chen
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Min-Min
authors.initials: MM
authors.lastname: Chou
mesh_terms: D000328:Adult; D001755:Blastocyst / Q000166:cytology*; D046149:Embryo Culture Techniques; D004624:Embryo Transfer; D005260:Female; D006801:Humans; D050498:Live Birth; D007986:Luteinizing Hormone / Q000097:blood; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood*; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies
chemical_list: D011374:Progesterone; D007986:Luteinizing Hormone
keywords: assisted reproductive technology; blastocyst transfer; clinical pregnancy rates; live birth rates; premature progesterone rise