Abstract
Objective:To evaluate the association between progesterone elevation on the day of human chorionic gonadotropin (hCG) administration and clinical pregnancy rates of gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles with the transfer of embryos at different developmental stages (day-3 versus day-5 ETs).Material and Methods:This is a retrospective analysis of fresh IVF/ICSI; 194 cycles out of 2676 conducted in a single center.Results:A total of 2676 cycles were analyzed, of which 386 had no progesterone measurements available. Two hundred eighteen cycles had progesterone elevation (p>1.5 ng/mL) giving an overall incidence of 9.5%. Twenty-four cycles were excluded from further analysis. Of the remaining 194 cycles, 151 had day-3 transfers and 43 had blastocyst transfers. There was no statistically significant difference in pregnancy and clinical pregnancy rates per transfer between the D3-ET and D5-ET groups (46% vs. 49%, and 39% vs. 35%, respectively).Conclusion:The results of this study suggest that blastocyst transfer does not improve cycle outcomes compared with D3 transfer in GnRH antagonist cycles with an elevated progesterone level on the day of hCG.
Highlights
Attention has been extensively paid during the last 20 years to serum progesterone measurement during ovarian stimulation
D5 transfer was not found to be superior to D3 transfer of embryos in patients with elevated P4 levels, respectively, when the cutoff level for P4 was set at 1.5 ng/mL on the day of human chorionic gonadotropin (hCG) administration
It is more likely that the elevated P4 levels reflect the total amount of progesterone secreted by maturing follicles, and these levels have been found to correlate positively with the number of mature follicles and with estradiol levels on hCG day
Summary
Attention has been extensively paid during the last 20 years to serum progesterone measurement during ovarian stimulation. A favorable effect on pregnancy rates was documented in an earlier study [13] It was reported for the first time in 1991 that serum progesterone may increase during the last few days of ovarian stimulation [14]. This has been widely confirmed during the last two decades, but the incidence of progesterone elevation greatly varies between published studies (2-35%) [15, 16]. This increase does not reflect “premature luteinization”. High serum P4 levels on the day of human chorionic gonadotropin (hCG) administration induce both
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