title: Revisiting the progesterone to oocyte ratio.
abstract: To critically evaluate the P to oocyte (O) ratio (P/O) in the prediction of live birth in assisted reproductive technology (ART) cycles.
  
  
  
  Retrospective cohort study.
  
  
  
  Not applicable.
  
  
  
  A total of 7,608 fresh autologous ART ET cycles.
  
  
  
  None.
  
  
  
  Live birth.
  
  
  
  Generalized estimating equation (GEE) models and receiver operating characteristic curves assessed the ability of P, O, and the P/O ratio to predict live birth. In univariate GEE models, P, O, and P/O were each associated with live birth. However, in multivariate GEE models, the P/O ratio was not associated with live birth, but P alone was. This suggested that converting P and O into a ratio of P/O was not more helpful than the two independent variables themselves. Measures of overall model fit further suggested that P/O did not increase the predictive ability of the model over P and O alone. Receiver operating characteristic curves using incremental predictors further demonstrated that the P/O provided no incremental improvement in predicting live birth over P and O separately.
  
  
  
  These data suggest that P and O have utility in prediction modeling but demonstrate that additional oocytes were not protective from the negative association of P with live birth. There was no incremental improvement related to the P/O ratio specifically for predicting live birth over each variable independently.
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: hillmicah@mail.nih.gov.
authors.forename: Micah J
authors.initials: MJ
authors.lastname: Hill
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: Mae Wu
authors.initials: MW
authors.lastname: Healy
authors.affiliation: Shady Grove Fertility Reproductive Science Center, Rockville, Maryland.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Richter
authors.affiliation: Shady Grove Fertility Reproductive Science Center, Rockville, Maryland.
authors.forename: Eric
authors.initials: E
authors.lastname: Widra
authors.affiliation: Shady Grove Fertility Reproductive Science Center, Rockville, Maryland.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Levens
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: 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: Division of Biostatistics and Epidemiology, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Whitcomb
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D005260:Female; D005298:Fertility / Q000187:drug effects; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007246:Infertility / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth; D015999:Multivariate Analysis; D016017:Odds Ratio; D054315:Oocyte Retrieval / Q000009:adverse effects; D009865:Oocytes / Q000187:drug effects*; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005300:Fertility Agents, Female; D011374:Progesterone
keywords: ART; premature progesterone elevation; progesterone; progesterone to oocyte ratio