Premature progesterone rise on day of hCG negatively correlated with live birth rate in IVF cycles: An analysis of 1022 cycles

Abstract

ObjectiveTo investigate the relationship between serum P levels on the day of hCG administration and pregnancy outcomes in patients undergoing IVF. DesignRetrospective study. SettingTeaching hospital. PatientsA total of 1022 IVF-ICSI cycles, frozen embryo transfer excluded. Intervention(s)Patients-all types of responder – underwent IVF with agonist or antagonist protocols. Clinical outcomes of IVF were analyzed according to plasma P levels. Main outcome measure(s)Ongoing pregnancy rates. ResultsWe proposed a serum P level of 1.57ng/ml on day of hCG as a threshold for all types of responders and all protocols combined. Ongoing implantation rates were not affected by elevated progesterone. Live birth rate was inversely associated with serum P levels on day of hCG and more miscarriages were associated with P>1.57ng/ml. We have not found the progesterone>1.57ng/ml on the day of hCG as a prognostic factor for pregnancy. Conclusion(s)Elevated P level on the day of hCG administration negatively influence live birth rate and is correlated to an increase of miscarriage. The detrimental effect of P elevation on pregnancy seems not to be related substantially to endometrium receptivity. Thus, despite a comparable clinical pregnancy rate and an initial implantation rate, we demonstrate more spontaneous abortion and it would seem that the effect of progesterone is later.