Abstract
Background: With controlled ovarian hyperstimulation (COH) with gonadotrophin releasing hormone (GnRH) antagonists, sometimes it is associated with incomplete luteolysis leading to elevated serum progesterone in early follicular phase. Persistence of this elevation might reduce the chance for clinical pregnancy. Objective: To assess the effect of elevated early and late follicular progesterone (P) levels during gonadotrophins releasing hormone (GnRH) antagonist cycles on pregnancy outcome. Design: Prospective single center study. Setting: North-western Military hospital, Kingdom of Saudi Arabia. Patients: 302 in vitro fertilization/intra-cytoplasmic sperm injection (IVF-ICSI) patients. Intervention(s): Recombinant follicle stimulating hormone (r-FSH), (150 - 300 IU) started daily from cycle day 2; GnRH antagonist treatment started on day 6 of the cycle. The serum progesterone (P) measured twice on cycle day 2 and human chorionic gonadotrophin (hCG) day. Main Outcome Measures: Clinical pregnancy and live birth rates per started cycle. Results: The incidence of elevated serum P on day 2 was (5.3%) and on hCG day was (17.5%), statistically significant differences in clinical pregnancy rate (32.3% versus 13.0%) and in live birth rate (23.4% versus 11.1%) were present between the normal and high serum progesterone groups on hCG day, but these differences were not statistically significant in the groups of elevated basal progesterone. Conclusion: Follicular phase progesterone rise either on day 2 or the day of hCG trigger was associated with lower clinical pregnancy and live birth rates. This impact was more prominent with trigger day elevation.
Highlights
The usage of controlled ovarian stimulation created the necessity for continuous research efforts to adjust the physiological performance of the stimulated cycle and increase the chance for pregnancy after intra-cytoplasmic sperm injection (ICSI) cycles
Follicular phase progesterone rise either on day 2 or the day of human chorionic gonadotrophin (hCG) trigger was associated with lower clinical pregnancy and live birth rates
We aimed to study the impact of elevated basal serum progesterone and at the time of ovulation triggering by hCG on the success of achieving clinical pregnancy, in patients receiving controlled ovarian hyperstimulation with gonadotrophin releasing hormone (GnRH) antagonist with normal response and in the light of other possible confounders
Summary
The usage of controlled ovarian stimulation created the necessity for continuous research efforts to adjust the physiological performance of the stimulated cycle and increase the chance for pregnancy after intra-cytoplasmic sperm injection (ICSI) cycles. With controlled ovarian hyperstimulation (COH) with gonadotrophin releasing hormone (GnRH) antagonists, sometimes it is associated with incomplete luteolysis leading to elevated serum progesterone in early follicular phase. Persistence of this elevation might reduce the chance for clinical pregnancy. Conclusion: Follicular phase progesterone rise either on day 2 or the day of hCG trigger was associated with lower clinical pregnancy and live birth rates This impact was more prominent with trigger day elevation
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