Elevated serum progesterone during in vitro fertilization treatment and the risk of ischemic placental disease.

Abstract

Elevated progesterone on the day of human chorionic gonadotropin (hCG) administration is associated with decreased live birth rates in IVF cycles. The association with adverse pregnancy outcomes is unknown. Assess the association between serum progesterone on the day of hCG administration and the risk of ischemic placental disease [IPD; preeclampsia, placental abruption, and/or small for gestational age (SGA)]. We conducted a retrospective cohort study of autologous fresh IVF cycles resulting in delivery between 2005 and 2018. All IVF procedures were conducted at a large, university-affiliated infertility center. Patients were divided into tertiles based on their serum progesterone level on the day of hCG administration; the lowest tertile served as the reference group. We identified pregnancies complicated by preeclampsia and placental abruption using ICD-9/10 codes and medical record review. We defined SGA as<10th percentile using U.S. growth curves. The cohort included 166 deliveries in the lowest tertile of progesterone (0.2-0.73ng/ml), 166 deliveries in the middle (0.64-1.05ng/ml) and 167 deliveries in the highest tertile (1.05-5.6ng/ml). Compared with the lowest tertile, the risk of IPD was greater in the middle (RR 1.6; 95% CI 1.1-2.5) tertile after adjustment for age, parity, number of oocytes retrieved, and estradiol. The highest tertile was also not associated with an increased risk of IPD. In an IVF population, elevated serum progesterone in the range of 0.64-1.05ng/mL on the day of hCG administration was associated with a small increased risk of IPD.