Abstract
BackgroundPolycystic ovary syndrome (PCOS) is a common endocrine disorder with the disorders of estrogen(E2) and progesterone(P) secretion. The purpose of this study was to evaluate the association between the progesterone level or progesterone/estradiol(P/E2) ratio on human chorionic gonadotropin (hCG) trigger day and the outcome of in vitro fertilization in PCOS patients and explore the value of progesterone and P/E2 ratio for predicting the clinical pregnancy.MethodsThe clinical data of 1254 PCOS patients who satisfied the inclusion criteria were retrospectively analyzed, including baseline characteristics such as age, body mass index, basal sex hormone levels, et al., as well as ovarian stimulation data and clinic outcome.ResultsThe number of follicles larger than 14 mm in diameter (P < 0.001) and retrieved oocytes (P < 0.001) was greater in the high progesterone group (progesterone ≥ 0.92 ng/mL). In the high P/E2 group(P/E2 ratio ≥ 0.3), the number of follicles larger than 14 mm in diameter (P < 0.001) and retrieved oocytes (P < 0.001), as well as the rate of high-quality embryos (P = 0.040) were significantly decreased. In ultralong GnRH agonist protocol, the implantation rate(P < 0.001), hCG positive rate (P < 0.001), clinical pregnancy rate (P < 0.001) and live birth rate (P < 0.001) were all significantly higher than long GnRH agonist protocol and GnRH antagonist protocol. The clinical pregnancy rate of high progesterone group was significantly lower than that of low progesterone group in ultralong GnRH agonist (P = 0.008). The progesterone level could be used as an indicator to predict the positive clinical pregnancy (long GnRH agonist: P = 0.001; ultralong GnRH agonist: P < 0.001) except in cycles using GnRH antagonist (P = 0.169). In the ultralong GnRH agonist, the value of progesterone level in the prediction of clinical pregnancy was significantly higher than that of the P/E2 ratio (P = 0.021).ConclusionsIn PCOS patients, the progesterone level is associated with clinical pregnancy rate while P/E2 ratio is not. In subgroup analysis using three different COS protocols, a significant association between progesterone level and clinical pregnancy rate can be observed in the long GnRH agonist protocol and ultralong GnRH agonist protocol. The progesterone level is significantly better than the P/E2 ratio in predicting the pregnancy outcome of PCOS patients, especially in ultralong GnRH agonist cycles.
Highlights
Polycystic ovary syndrome (PCOS) is a common endocrine disorder, affecting approximately 6–25% of women of childbearing age worldwide [1]
The progesterone level is significantly better than the P/E2 ratio in predicting the pregnancy outcome of PCOS patients, especially in ultralong Gonadotropin-releasing hormone (GnRH) agonist cycles
The progesterone levels on human chorionic gonadotropin (hCG) trigger day were lower than the women with non-pregnancy (P < 0.001), but the P/E2 ratio was of no significant difference between the two groups (P > 0.05)
Summary
Polycystic ovary syndrome (PCOS) is a common endocrine disorder, affecting approximately 6–25% of women of childbearing age worldwide [1]. It has been reported that women with polycystic ovary syndrome are at a higher risk of adverse pregnancy outcomes including miscarriage and very preterm delivery after adjusting for differences in maternal characteristics [4]. Another study proposed that compared with normal individuals, PCOS patients have a series of adverse pregnancy outcomes, such as low embryo implantation rate and high miscarriage rate. This may be attributable to decreased endometrial receptivity. Even with the same ovulation stimulation protocol, PCOS patients can produce more than 3 times of follicles than non-PCOS patients These women are more sensitive to gonadotropins(Gn) and even respond to the endogenous release of Gn [6]. The purpose of this study was to evaluate the association between the progesterone level or progesterone/estradiol(P/E2) ratio on human chorionic gonadotropin (hCG) trigger day and the outcome of in vitro fertilization in PCOS patients and explore the value of progesterone and P/E2 ratio for predicting the clinical pregnancy
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