Serum progesterone trend after day of transfer as possible predictor of live birth in fresh IVF cycles

Abstract

Progesterone(P4) levels on day of transfer have been shown to be a possible predictor of live birth outcome. Our objective was to determine if a change in serum progesterone from day 19(day of transfer) to day 28 predicts birth outcomes in fresh IVF cycles. Retrospective chart review. We performed a retrospective analysis of fresh IVF cycles from 2010 to 2013 at the NYU Fertility Center. Patients who used crinone or whose progesterone dose was increased were excluded, resulting in a total of 332 patients analyzed. Primary outcomes were percent change in serum progesterone (%ΔP4), live birth rate, missed abortion, and biochemical pregnancies. Statistical analyses included receiver operator curves and chi-squared tests as well as t-tests of means. The incidence of live birth or ongoing pregnancy (LBOPR) was associated with the percent change in P4 between day 19 and day 28. An ROC curve assessing the ability of %P4 to predict LBOPR had an area under the curve of 0.704. A cutoff for %ΔP4 of 10% drop from day 19 to 28 was used to segregate patients into two groups. Group A (with %ΔP4 of 10% or more drop) had significantly poorer outcome than Group B (with %ΔP4 that rose or with a drop of less than 10%) 26% versus 63%, respectively. (p< 0.001, RR 0.42 [0.31-0.56]. Comparison of these groups for pregnancy losses (missed abortion and biochemical pregnancies) was not significant (21% vs. 16%, respectively, p <0.16, RR 1.34 [0.85-2.12]). Patients in Group A had lower levels of serum progesterone on day 19 (30.54±19.18 vs 64.66±43.2, p<0.001). Table 1 demonstrates these outcomes as well as characteristics of both groups. Subgroup analysis of any patient with a decrease in P4 demonstrated that a change in p4 was statistically significant (p<0.01) at 10%, 20%, 30% and 40% decreases.Tabled 1Outcomes and characteristics of fresh IVF cycles compared by %P4 change between days 19 and 28Group A P4 drop > 10% (n = 179)Group B P4 drop < 10% (n = 153)p valueLBR,OPR26%63%p < 0.001* RR 0.42 (0.31-0.56)Missed Ab/Biochem21%16%p = 0.16* RR 1.34 (0.85-2.12)Day 19 P430.54 ± 19.1864.66 ± 43.2p < 0.001**Age39.4 ± 5.638.5 ± 5.8p = 0.15**# eggs retrieved18.4 ± 11.616.3 ± 9.1p = 0.071**# embryos transferred1.81 ± 0.692.02 ± 0.84p < 0.05*** = Chi-Squared, ** = T-test of means Open table in a new tab * = Chi-Squared, ** = T-test of means A 10% or greater drop in serum progesterone between day 19 and day 28 is associated with decreased rates of live birth and ongoing pregnancy in fresh IVF cycles, despite a “normal” serum progesterone level on day of transfer.