Review of clinical practice for patients with elevated levels of serum progesterone on the day of human chorionic gonadotrophin trigger

Abstract

OBJECTIVE: To determine if patients with elevated levels of serum progesterone on the day of HCG trigger have a reduced pregnancy potential and to identify appropriate protocols for treatment of such patients. DESIGN: Retrospective analysis of over 1700 cycles between February 2004 and December 2007. MATERIALS AND METHODS: 1754 cycles were divided into three groups depending upon the progesterone level recorded on the day of HCG trigger (Group 1 - P below 6nmol/l, n = 1407; Group 2 - P 6 to 8nmol/l, n = 172; Group 3 - P above 8nmol/l, n = 74). The cycles consist of both IVF and ICSI and involve both GnRH- antagonists and agonists and were for all ages. The progesterone levels were measured by enzyme linked chemi-luminescence immunoassay. The cycles from each group were reviewed to determine if the progesterone on day of trigger impacted upon pregnancy rates. The frozen embryo transfers (FET) from groups 2 and 3 where no pregnancy was achieved following a fresh transfer were reviewed and compared with the overall FET pregnancy rates to determine if the increased progesterone levels were resulting in embryos with reduced potential being created.Table 1Group 1Group 2Group 3n140717274Age35.5 ± 4.436.0 ± 4.236.9 ± 3.6FSH Used3730 ± 54034268 ± 23894866 ± 2860Mean # ET'd1.9 ± 0.62.0 ± 0.62.1 ± 0.7% of cases failing to reach ET1.83.97.2Clinical pregnancy rate (per ET) %34.022.117.2 Open table in a new tab RESULTS: Clinical pregnancy rates from frozen embryo transfers where the embryos were created in a fresh cycle with P above 6nmol/l was 25.4% (n = 134) compared with 27.8% for all FETs for 2004 to 2007 (n = 3899). CONCLUSIONS: This study indicates that there is a reduction in clinical pregnancy rates with increasing progesterone level on day of HCG trigger. When the groups were reviewed with patients only 38 years or younger this reduction in clinical pregnancy rate was still observed. As there was no significant difference in the clinical pregnancy rate for frozen embryo transfers the practice of freezing suitable embryos from such cycles for later transfer is recommended.