Abstract
ABSTRACTObjective To evaluate the predictive capacity for pregnancy of the progesterone level on the day of administering human chorionic gonadotropin, in women submitted to assisted reproductive techniques.Methods An observational study with 914 women submitted to assisted reproductive techniques from August 2014 to June 2016.Results Total pregnancy rate was 34.58%; in that, the pregnancy rate in women <35 years, between 35 and 38, and >38 years was, respectively, 42.3%, 38.7% and 16.1% (p<0.001). For embryo transfer in the same cycle, and progesterone of 1.3ng/dL, sensitivity was 4.78%, specificity, 84.18%, accuracy, 56.72%, positive likelihood ratio of 0.3019, and negative likelihood ratio of 1.1312, with receiver operating characteristic curve of 0.46 (95%CI: 0.42-0.49).Conclusion The progesterone level on the day of administering human chorionic gonadotropin of 1.3ng/dL differs from that empirically adopted at the study site (1.7ng/dL), and has a better predictive capacity for pregnancy in the patients studied. However, the low sensitivity of this examination raises questions about its real importance.
Highlights
Progesterone was tested by Elecsys 1010 Immunoanalyzer (Roche, Indianapolis, USA) only on the day of human chorionic gonadotropin (hCG) administration, since the local protocol does not measure it on the beginning of the cycle
Data related to the procedure and laboratory progression results, such as metaphase I (MI), MII and number of embryos evolved until transfer or cryopreservation were evaluated
The transfer of frozen-thawed embryos is a practice already used in many centers, considering that a hyperstimulated endometrium, which is typical of controlled ovarian hyperstimulation (COH) in the same cycle, would affect embryo implantation.[25]. The reduced progesterone level of 1.7ng/mL adopted is expected to increase the number of embryo transfers and, improve positive outcome
Summary
The results of assisted reproductive techniques (ART) depend on both patient-related clinical aspects and embryo cleavage and development.[1] In this process, searching for success predictors of high-complexity ART, such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), is key to enable single embryo transfer with acceptable pregnancy rate and reduction of multiple pregnancyrelated risks.[2]. Several studies[3,4,5] reported that increased serum progesterone levels in high-complexity ART, measured on the day that human chorionic gonadotropin (hCG) is administered, leads to poorer reproductive results This higher progesterone level, even when comparing hCG-triggered ovulation and the gonadotropin-releasing hormone agonist (GnRH), has a negative effect on pregnancy rate,(6) corroborating the importance of such evaluation. Extreme progesterone levels were associated to poor pregnancy outcome.[19]
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