Abstract
Objective: To investigate the effect of progesterone elevation during late follicular phase on early pregnancy outcomes and live births after fresh embryo transfers. Methods: Patients who underwent IVF/ICSI treatment cycles were retrospectively enrolled. The effect of progesterone elevation was analyzed on early pregnancy outcome and live births after fresh embryo transfers. Results: A total of 2,404 patients were enrolled on the day of HCG triggering (HCG0), 1,584 patients on the day before HCG triggering (HCG-1), and 800 patients 2 days before HCG triggering (HCG-2). With a 1 ng/ml increase in the progesterone level on HCG0 day when the progesterone level was ≥1.5 ng/ml, the clinical pregnancy rate decreased by 60% (95% CI: 0.2–0.7, p = 0.004), the intrauterine pregnancy rate decreased by 70% (95% CI: 0.2–0.7, p = 0.003), and the live birth rate decreased by 70% (95% CI: 0.1–0.7, p = 0.004). With a 1 ng/ml increase in the progesterone level on HCG-1 day, the clinical pregnancy rate decreased by 90% (95% CI: 0.0–0.5, p = 0.003) when the progesterone level was ≥1.6 ng/ml, the intrauterine pregnancy rate decreased by 90% (95% CI: 0.0–0.5, p = 0.001) when the progesterone was ≥1.5 ng/ml, and the live birth rate decreased by 90% (95% CI: 0.0–0.6, p = 0.015) when the progesterone was ≥1.7 ng/ml. On HCG-2 day when the progesterone was ≥1.2 ng/ml, the clinical pregnancy rate decreased by 80% (95% CI: 0.1–0.6, p = 0.003), and the intrauterine pregnancy rate decreased by 70% (95% CI: 0.1–0.7, p = 0.007) with a 1 ng/ml increase in the progesterone level. Conclusion: Elevated progesterone level during the late follicular phase is an independent risk factor affecting the clinical pregnancy rate, intrauterine pregnancy rate, and live birth rate among infertile patients undergoing IVF/ICSI after fresh embryo transfers. When the progesterone level exceeds a certain level, the early pregnancy and live birth rates after fresh embryo transfers show a rapid downward trend.
Highlights
For more than 2 decades, the effect of elevated progesterone on the outcome of in vitro fertilization and embryo transfer (IVFET) has been the focus of intensive scientific research
There were significant associations of the live birth rate with age, anti-Müllerian hormone (AMH), antral follicles (AFC), male factor, controlled ovarian stimulation (COS) protocol, average Gn dosage, number of oocytes, number of 2 PN embryos, number of 2 PN cleavage embryos, number of available embryos, or number of transferred embryos (p < 0.05) (Table 4), whereas AFC, male factor, number of oocytes, number of 2 PN embryos, number of 2 PN cleavage embryos, number of available embryos, and number of transferred embryos were significantly associated with the clinical pregnancy rate (p < 0.05) (Table 2)
When the progesterone level was ≥1.5 ng/ml on HCG0 day, with a 1 ng/ml increase in the progesterone level, the clinical pregnancy rate decreased by 60%, the intrauterine pregnancy rate decreased by 70%, and the live birth rate decreased by 70%
Summary
For more than 2 decades, the effect of elevated progesterone on the outcome of in vitro fertilization and embryo transfer (IVFET) has been the focus of intensive scientific research. The most commonly used cutoff value for elevated progesterone on the day of human chorionic gonadotrophin (HCG) administration is 1.5 ng/ml (Bosch et al, 2010; Venetis et al, 2013) This cutoff value of progesterone elevation should be treated with caution because of the high variability of assays used for progesterone measurement, making it difficult to compare the results of different studies (Bosch et al, 2003; Kiliçdag et al, 2010; Santos-Ribeiro et al, 2014; Connell et al, 2016; Cui et al, 2017). The second objective of this study was to evaluate the effect of elevated progesterone levels on the pregnancy outcomes of IVF-ET in the late follicular phase and the live birth rate
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