Outcome and recurrence risk of premature progesterone rise in IVF/ICSI cycles using GnRH antagonists for pituitary down-regulation

Abstract

Summary: To assess the outcome and recurrence risk of premature progesterone rise (PPRR) in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles using gonadotropin-releasing hormone (GnRH) antagonists. Materials and Methods: Two hundred and two patients undergoing IVF/ICSI using GnRH antagonists for pituitary down-regulation had measurements of luteinizing hormone (LH), progesterone (P), and estradiol (E2) on specific days of the first and subsequent stimulation cycle. Results: The overall clinical pregnancy rate including the total of 280 cycles was 29.3% (82/280). The incidence of PPRR on the day of triggering for P ≥ 1.5 ng/ml its was 20.8% (42/202). The risk of PPRR ≥ 1.5 ng/ml on the triggering day of the subsequent cycle was 40% if the previous cycle P was ≥ 1.5 ng/ml, 13.3% if the previous cycle P was ≥ 1.2 ng/ml and Conclusion: The presence of PPRR in IVF/ICSI cycles using GnRH antagonists affects negatively the pregnancy rates and poses a significant risk of recurrence in a subsequent cycle.