The effect of an increased serum progesterone-to-estradiol ratio on the day of hCG administration on IVF outcomes in infertility women with normal ovarian reserve

Abstract

OBJECTIVE: To evaluate the relationship between serum P/E2 ratio on the day of hCG administration and the clinical outcomes in infertile women with normal ovarian reserve.DESIGN: Retrospective study.MATERIALS AND METHODS: One hundred thirty-nine infertile women with normal ovarian reserve, who received IVF-ET treatment with the long GnRH-a protocol at Cathay General Hospital HsinChu from March 2003 to April 2007, were included in this retrospective study. Institutional Review Board approval was obtained for a retrospective review of the medical charts. The excluding criteria were as follows: [1] infertility attributed to endocrine abnormalities, such as hyperprolactinemia, polycystic ovarian syndrome and absence of ovarian function; [2] age > 40 years; [3] previous COH with poor response; [4] poor ovarian reserve with a day 3 FSH concentration ≥10 IU/L; [5] using stimulation protocols other than GnRH-a pituitary desensitization; and [6] inadequate data for analysis. Patients were grouped according to the P/E2 ratio on the day of HCG administration by using ROC curve analysis. The optimal cut-off value of the P/E2 ratio as Premature luteinization (PL) was ≥ 1.2 ng/mL for not achieving pregnancy, which had a sensitivity of 75.0 %, a specificity of 32.0 %, a positive predictive value of 37.0 %, and a negative predictive value of 71.0 %. The area under the ROC curve (AUC) was 0.534 (95% CI, 0.456 to 0.613).RESULTS: The PL group (n=41) consisted of the patients with the P/E2 ≥ 1.2. The non-PL group (n=98) consisted of the patients with P/E2 <1.2. The mean ages of the patients between the PL and non-PL groups were not statistically significant. Ovarian reserve parameters, including day 3 FSH, LH, and E2, did not differ between the two groups. There were also no differences in stimulation days, numbers of embryos transferred, and total doses of exogenous gonadotropins used between the two groups. The P/E2 ratio on the HCG day was significantly higher in the PL as compared to the non-PL group (2.4±1.5 and 0.6±0.3, respectively; P<0.05). The mean numbers of oocytes retrieved in the PL and non-PL groups were 4.2±2.8 and 12.7±6.6, respectively (P<0.05). However, the difference between the clinical pregnancy rates in the PL and non-PL groups was not statistically significant (29.3% versus 34.5%, respectively).CONCLUSIONS: The serum P/E2 ratio on the day of HCG administration, as an indicator of premature luteinization, has poor predictive value on IVF outcomes in infertile women with normal ovarian reserve. OBJECTIVE: To evaluate the relationship between serum P/E2 ratio on the day of hCG administration and the clinical outcomes in infertile women with normal ovarian reserve. DESIGN: Retrospective study. MATERIALS AND METHODS: One hundred thirty-nine infertile women with normal ovarian reserve, who received IVF-ET treatment with the long GnRH-a protocol at Cathay General Hospital HsinChu from March 2003 to April 2007, were included in this retrospective study. Institutional Review Board approval was obtained for a retrospective review of the medical charts. The excluding criteria were as follows: [1] infertility attributed to endocrine abnormalities, such as hyperprolactinemia, polycystic ovarian syndrome and absence of ovarian function; [2] age > 40 years; [3] previous COH with poor response; [4] poor ovarian reserve with a day 3 FSH concentration ≥10 IU/L; [5] using stimulation protocols other than GnRH-a pituitary desensitization; and [6] inadequate data for analysis. Patients were grouped according to the P/E2 ratio on the day of HCG administration by using ROC curve analysis. The optimal cut-off value of the P/E2 ratio as Premature luteinization (PL) was ≥ 1.2 ng/mL for not achieving pregnancy, which had a sensitivity of 75.0 %, a specificity of 32.0 %, a positive predictive value of 37.0 %, and a negative predictive value of 71.0 %. The area under the ROC curve (AUC) was 0.534 (95% CI, 0.456 to 0.613). RESULTS: The PL group (n=41) consisted of the patients with the P/E2 ≥ 1.2. The non-PL group (n=98) consisted of the patients with P/E2 <1.2. The mean ages of the patients between the PL and non-PL groups were not statistically significant. Ovarian reserve parameters, including day 3 FSH, LH, and E2, did not differ between the two groups. There were also no differences in stimulation days, numbers of embryos transferred, and total doses of exogenous gonadotropins used between the two groups. The P/E2 ratio on the HCG day was significantly higher in the PL as compared to the non-PL group (2.4±1.5 and 0.6±0.3, respectively; P<0.05). The mean numbers of oocytes retrieved in the PL and non-PL groups were 4.2±2.8 and 12.7±6.6, respectively (P<0.05). However, the difference between the clinical pregnancy rates in the PL and non-PL groups was not statistically significant (29.3% versus 34.5%, respectively). CONCLUSIONS: The serum P/E2 ratio on the day of HCG administration, as an indicator of premature luteinization, has poor predictive value on IVF outcomes in infertile women with normal ovarian reserve.