title: Progesterone/estradiol ratio <0.25 on the day of human chorionic gonadotropin administration is associated with adverse pregnancy outcomes in prolonged protocols for in vitro fertilization/intracytoplasmic sperm injection.
abstract: OBJECTIVE
  It has been suggested that a progesterone/estradiol ratio (P/E2) ≥ 1.0 on the day of human chorionic gonadotropin (hCG) administration indicates premature luteinization and might be associated with an adverse pregnancy; however, a lower limit of this ratio has not been determined. We aimed to identify a lower limit of P/E2 that correlates significantly with an increase in adverse pregnancies in patients undergoing a prolonged in vitro fertilization/intracytoplasmic sperm injection therapy.
  
  
  METHODS
  This retrospective analysis involved 7451 patients who received the first cycle of in vitro fertilization/intracytoplasmic sperm injection therapy treatment at the Reproductive and Genetic Hospital of Citic-Xiangya between January 2008 and April 2012. Patients were stratified into six groups according to their P/E2 on the day of hCG administration. Primary pregnancy outcomes, rates of implantation, clinical pregnancy, ongoing pregnancies, spontaneous abortions, and live births were recorded. The association between P/E2 on the day of hCG administration and primary pregnancy outcomes was assessed using logistic regression analysis.
  
  
  RESULTS
  The rates of implantation (23.85-33.44%), clinical pregnancy (47.42-67.12%), ongoing pregnancy (40.83-61.48%), and live birth (34.40-57.65%) were significantly decreased in patients with a P/E2 < 0.25. These indicators were significantly associated with P/E2, but no significant correlation was observed between P/E2 and early spontaneous abortion rate.
  
  
  CONCLUSIONS
  P/E2 < 0.25 on the day of hCG administration was associated with adverse pregnancy outcomes in extended treatments of gonadotropin-releasing hormone agonist IVF/ICSI.
authors.affiliation: Reproductive & Genetic Hospital of Citic-Xiangya, Changsha, Hunan, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Reproductive & Genetic Hospital of Citic-Xiangya, Changsha, Hunan, China; Institute of Reproductive & Stem Cell Engineering, Central South University, Changsha, Hunan, China.
authors.forename: Keli
authors.initials: K
authors.lastname: Luo
authors.affiliation: Reproductive & Genetic Hospital of Citic-Xiangya, Changsha, Hunan, China; Institute of Reproductive & Stem Cell Engineering, Central South University, Changsha, Hunan, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Tang
authors.affiliation: Reproductive & Genetic Hospital of Citic-Xiangya, Changsha, Hunan, China; Institute of Reproductive & Stem Cell Engineering, Central South University, Changsha, Hunan, China.
authors.forename: Ge
authors.initials: G
authors.lastname: Lin
authors.affiliation: Reproductive & Genetic Hospital of Citic-Xiangya, Changsha, Hunan, China; Institute of Reproductive & Stem Cell Engineering, Central South University, Changsha, Hunan, China.
authors.forename: Guangxiu
authors.initials: G
authors.lastname: Lu
authors.affiliation: Reproductive & Genetic Hospital of Citic-Xiangya, Changsha, Hunan, China; Institute of Reproductive & Stem Cell Engineering, Central South University, Changsha, Hunan, China. Electronic address: 282841533@qq.com.
authors.forename: Fei
authors.initials: F
authors.lastname: Gong
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage* / Q000097:blood; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000628:therapy*; D065851:Ovarian Reserve; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome; D011980:Receptors, Progesterone / Q000097:blood*; D012102:Reproductive Control Agents / Q000008:administration & dosage*; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods
chemical_list: D006063:Chorionic Gonadotropin; D011980:Receptors, Progesterone; D012102:Reproductive Control Agents; D004958:Estradiol
keywords: estradiol; in vitro fertilization/intracytoplasmic sperm injection; pregnancy outcome; premature lutenization; progesterone