title: Are extremely high progesterone levels still an issue in IVF?
abstract: BACKGROUND
  Premature luteinization of one or more developing follicles complicates 1-2 % of controlled ovarian stimulation cycles for assisted reproduction. The management of this complication is controversial, with cycle cancellation likely representing the most commonly used strategy. The aim of this study was to evaluate the efficacy of the "freeze-all" policy-where the entire cohort of blastocysts is cryopreserved for subsequent frozen-thawed embryo transfer-in treating cases of premature luteinization.
  
  
  METHODS
  Patients experiencing premature luteinization during controlled ovarian stimulation-identified by extremely high progesterone levels at induction (P levels ≥3.0 ng/ml and/or P/estradiol ratio ≥1, n = 42)-were included in a "freeze-all" program and compared to controls undergoing a "freeze-all" program with normal progesterone levels at induction (P < 1.5 ng/ml, n = 67).
  
  
  RESULTS
  Blastulation rate was comparable between patients with premature luteinization and controls (48.1 ± 20.5 % in Cases vs. 52.3 ± 24.9 % in Controls, p = 0.36). Ongoing pregnancy rates after the first frozen-thawed embryo transfer (38.1 % in Cases and 41.0 % in Controls, p = 0.83) and cumulative ongoing pregnancy rates after three frozen-thawed embryo transfer cycles (40.5 % in Cases vs. 47.8 % in Controls, p = 0.55) were also similar.
  
  
  CONCLUSIONS
  These results show that extremely marked progesterone elevation throughout controlled ovarian stimulation does not impair blastocyst development and implantation potential in the context of a "freeze-all" strategy. Based on this, adoption of the "freeze-all" strategy represents a valuable tool in treating premature luteinization. In contrast, cycle cancellation-likely the most frequently used method for management of this complication-currently represents a misconduct.
authors: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20136, Milan, Italy.
authors: V S
authors: VS
authors: Vanni
authors: Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20136, Milan, Italy.
authors: P
authors: P
authors: Viganò
authors: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20136, Milan, Italy.
authors: L
authors: L
authors: Quaranta
authors: Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20136, Milan, Italy.
authors: L
authors: L
authors: Pagliardini
authors: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20136, Milan, Italy.
authors: P
authors: P
authors: Giardina
authors: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20136, Milan, Italy.
authors: M
authors: M
authors: Molgora
authors: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20136, Milan, Italy.
authors: M
authors: M
authors: Munaretto
authors: Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20136, Milan, Italy.
authors: M
authors: M
authors: Candiani
authors: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20136, Milan, Italy. papaleo.enrico@hsr.it.
authors: E
authors: E
authors: Papaleo
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D034461:Luteinization / Q000502:physiology*; D009865:Oocytes / Q000166:cytology / Q000378:metabolism*; D010062:Ovulation Induction; D011247:Pregnancy; D011374:Progesterone / Q000097:blood*; D012189:Retrospective Studies
chemical_list: D011374:Progesterone
keywords: Blastulation; Ovulation; Pregnancy; Premature luteinization; Progesterone; “Freeze-all” strategy