title: Progesterone/Estradiol Ratio as a Predictor in the ART Cycles with Premature Progesterone Elevation on the Day of hCG Trigger.
abstract: BACKGROUND
  The purpose of the study was to evaluate the role of Progesterone/ Estradiol (P4/E2) ratio as a predictive tool for clinical pregnancy in ART cycles with a premature progesterone rise of >1.5 ng/ml on the day of human chorionic gonadotropin (hCG) trigger.
  
  
  METHODS
  Retrospective analysis was done on 569 fresh embryo transfer cycles from January 2011 to December 2012 at the infertility unit of a tertiary care hospital. Age, BMI, number of cycles and number of clinical pregnancies have been considered.
  
  
  RESULTS
  The overall clinical pregnancy rate per embryo transfer was 42.8% (244/569). The clinical pregnancy rate in the 36 cycles with progesterone (P4) level >1.5 ng/ml was significantly lower than the 533 cycles with normal p4 ≤1.5 ng/ml (22.2% vs. 44.2%; p=0.0092). The 36 cycles with progesterone level >1.5 ng/ml were divided into subgroups of P4/E2 >1 (n=20) and P4/E2 ≤1 (n=16). The 20 cycles with P4/E2 >1 and P4 >1.5 ng/ml had a significantly lower pregnancy rate than the cycles with P4 ≤1.5 ng/ml (15% vs. 42.8%; p=0.0103). The 15 cycles with P4/E2 ≤1 and P4 >1.5 ng/ml had a similar pregnancy rate as the cycles with P4 ≤1.5 ng/ml.
  
  
  CONCLUSIONS
  A premature progesterone elevation in ART cycles is possibly associated with lower clinical pregnancy rates; this adverse impact of elevated progesterone seems to be limited mainly to a subgroup with an elevated P4/E2 ratio >1.
authors.affiliation: - Reproductive Medicine Unit, Christian Medical College, Vellore, India.
authors.forename: Mariano
authors.initials: M
authors.lastname: Mascarenhas
authors.affiliation: - Reproductive Medicine Unit, Christian Medical College, Vellore, India.
authors.forename: Mohan Shashikant
authors.initials: MS
authors.lastname: Kamath
authors.affiliation: - Reproductive Medicine Unit, Christian Medical College, Vellore, India.
authors.forename: Achamma
authors.initials: A
authors.lastname: Chandy
authors.affiliation: - Reproductive Medicine Unit, Christian Medical College, Vellore, India.
authors.forename: Aleyamma T
authors.initials: AT
authors.lastname: Kunjummen
keywords: ART; Pregnancy; Premature progesterone elevation; Progesterone estradiol ratio