Abstract
Progesterone elevation (PE) on the day of hCG trigger is associated with decreased pregnancy outcome in fresh cycles. Evidence for this comes from overall patient estimates that mostly ignore different ovarian responses. To compare the impacts of PE on the day of hCG trigger on live birth rates (LBs) in low, intermediate and high ovarian responders and to explore the cut-off value for PE in different populations according to the ovarian response, we retrospectively analyzed a total of 2,351 patients receiving fresh assisted reproduction technology (ART) transfer cycles with GnRH agonist using a long or short protocol. Trend and multivariate logistic regression analyses were performed to identify the cutoff values of PE and to evaluate the effects of PE on LB rates (LBRs) in different ovarian responders. The study found that PE has a detrimental effect on LBRs in low to intermediate ovarian responders rather than in high responders. The cut-off values for PE were 1.0 ng/mL and 2.0 ng/mL for low and intermediate ovarian responders, respectively. The different associations between PE and LBRs according to ovarian response could more accurately predict the prognosis of the IVF cycle and could be used to optimize the treatment of patients undergoing In Vitro Fertilization (IVF)/ Intracytoplasmic Sperm Injection (ICSI).
Highlights
Despite routine suppression of endogenous gonadotropins by gonadotropin-releasing hormone (GnRH) agonists, serum progesterone elevation (PE) on the day of human chorionic gonadotropin trigger has been reported in controlled ovarian stimulation (COS) cycles in short protocols and long protocols
The role of Progesterone elevation (PE) on the day of human chorionic gonadotropin (hCG) trigger on pregnancy rates has been estimated through simple bivariate analyses, which are unable to control for confounders such as the number of oocytes, female age, or body mass index (BMI), and the available studies may underestimate the true effect of PE on pregnancy rates[14]
It is reasonable and important to assess the relationship between serum progesterone level and In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) outcome according to different ovarian responses
Summary
Despite routine suppression of endogenous gonadotropins by gonadotropin-releasing hormone (GnRH) agonists, serum progesterone elevation (PE) on the day of human chorionic gonadotropin (hCG) trigger has been reported in controlled ovarian stimulation (COS) cycles in short protocols and long protocols. The role of PE on the day of hCG trigger on pregnancy rates has been estimated through simple bivariate analyses, which are unable to control for confounders such as the number of oocytes, female age, or body mass index (BMI), and the available studies may underestimate the true effect of PE on pregnancy rates[14]. These varying results may be attributed to the use of different arbitrary cut-off levels.
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