THE PREDICTIVE VALUE OF CHANGES IN PROGESTERONE (P) LEVELS AFTER ADMINISTRATION OF A HUMAN CHORIONIC GONADOTROPIN (HCG) TRIGGER IN IN-VITRO FERTILIZATION (IVF) CYCLES

Abstract

To evaluate the predictive value of changes in post hCG trigger serum P levels during IVF cycles on IVF outcomes. A retrospective query of all electronically available IVF cycles, from 2005 to March 2021, at a single academic institution was performed. All stimulation protocols were included if they used only an hCG trigger in a fresh transfer cycle and had complete cycle information available. The change in P (ΔP) was calculated by subtracting the serum morning P level the day of trigger from the morning P the day after trigger. A ΔP of 0.75 ng/mL was chosen as a cut-off based on observed group differences during initial iterations of data analyses. A subgroup analysis was performed excluding poor responders as defined by the Bologna criteria. Descriptive statistics with independent t-tests for continuous data, and chi squared tests for categorical data were used. A two-sided p-value of <0.05 was considered statistically significant. A total of 3883 cycles met the inclusion criteria for the study. Summary statistics are shown below.Tabled 1Baseline Characteristic/Outcome (mean ± SEM)ΔP < 0.75N= 151 (3.9%)ΔP > 0.75N= 3732 (96.1%)p valueAge (years)38.1 ± 0.435.9 ± 0.1<0.01AMH (ng/mL)1.18 ± 0.221.93 ± 0.03<0.01Total gonadotropin dose (IU)3128 ± 1072345 ± 31<0.01Peak estradiol (pg/mL)1007 ± 431691 ± 12<0.01Day 3 FSH (mIU/mL)9.22 ± 0.367.50 ± 0.06<0.01Stimulation trigger day11.26 ± 0.2010.43 ± 0.03<0.01Oocytes retrieved (n)4.70 ± 0.2910.39 ± 0.09<0.012PN (n)2.80 ± 0.205.66 ± 0.06<0.01Fertilization rate (# of 2pn/count of mature oocytes) (%)55.59 ± 3.7053.89 ± 0.370.65Embryos (n)2.23 ± 0.175.21 ± 0.06<0.01Clinical pregnancy rate (%)24.6645.10<0.01Ongoing pregnancy rate (%)21.2337.09<0.01 Open table in a new tab 2078 cycles met the inclusion criteria for the sub-analysis. 1.44% (n=30) of cycles had a ΔP<0.75. After the exclusion of poor responders, baseline characteristics were similar between the two ΔP groups. The differences in outcomes showed similar findings to the initial analysis, with a mean of 2.4 fewer eggs (p<0.01), 2.4 fewer embryos (p<0.01), and lower ongoing pregnancy rates by 12.5% (p=0.17) in the group with ΔP<0.75. A low ΔP after hCG trigger in IVF cycles may have predictive value and connote poorer prognosis for ongoing pregnancy. Clinicians may note that a low ΔP has a potential association with markedly poorer oocyte number, embryo development, and pregnancy outcomes. This may be useful for counseling regarding outcomes and potential cycle modification. Further investigation is needed to understand the reasons for poor P rise post hCG trigger.