Abstract
BackgroundThe potentially detrimental role of progesterone during the follicular phase has been a matter of controversy for several years; however, few studies have analyzed the effects of combined raised estradiol and progesterone levels on pregnancy outcomes. The aim of the present study was to determine the influence of high progesterone levels on clinical outcomes in the context of high ovarian response.MethodsWe performed a retrospective cohort study that included 2850 women classified as high responders. The women were subdivided into six groups depending on their progesterone concentration on the day of human chorionic gonadotropin (hCG) administration: <0.5 ng/ml (<p10), 0.50-0.70 ng/ml (p10-p25), 0.71-1.00 ng/ml (p25-p50), 1.01-1.40 ng/ml (p50-p75), 1.41-1.80 ng/ml (p75-p90) and >1.81 ng/ml (>p90). Ovarian response was classified as high when > =20 oocytes were retrieved or when estradiol was > =3000 pg/ml. Clinical outcomes of each subgroup were analyzed. We also examined data from frozen-thawed embryo transfers. Results were analyzed with Student’s t- test to compare continuous variables and chi-squared test to compare proportions. A p-value of < =0.05 was considered statistically significant.ResultsThe progesterone concentration increased with ovarian response, and elevated progesterone did not show a significant clinical impact on implantation rate and pregnancy rates. These data provide evidence that progesterone levels higher than 1.8 ng/ml do not have detrimental effect on oocyte quality or endometrial receptivity.ConclusionsThese data allow us to conclude that high progesterone levels correlate significantly with high estradiol levels and that in high responder women; progesterone levels do not show a significant clinical impact on results.
Highlights
The potentially detrimental role of progesterone during the follicular phase has been a matter of controversy for several years; few studies have analyzed the effects of combined raised estradiol and progesterone levels on pregnancy outcomes
Overall results A total of 2850 women defined as high responders and undergoing Gonadotropin-releasing hormone (GnRH) antagonist cycles were included in this study
Several authors have suggested that high responders have significantly lower implantation and pregnancy rates in addition to impaired endometrial receptivity [15], while others have failed to find an association between high estradiol levels on the day of human chorionic gonadotropin (hCG) administration and harmful effect on pregnancy outcomes [16,17]
Summary
The potentially detrimental role of progesterone during the follicular phase has been a matter of controversy for several years; few studies have analyzed the effects of combined raised estradiol and progesterone levels on pregnancy outcomes. It was demonstrated recently that patients with high estradiol concentrations have significantly higher progesterone concentrations [11,12]; this association suggests that at least one of the mechanisms that play a role in increased progesterone levels is linked to a high ovarian response during controlled ovarian stimulation. This idea has been recently confirmed by Griesinger et al [13] which show that the incidence of progesterone elevation on the day of hCG increased with the ovarian response from 4.5% in low responders to 19.0% in high responders
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