Single Progesterone Measurement Research Articles

P-692 Intra-subject variability of mid-luteal progesterone levels in natural/modified natural frozen embryo transfer cycles (NC/MNC): can we predict the need for luteal phase support?

Abstract Study question Are progesterone levels different in a NC versus a MNC? What is the predictive value of progesterone for the level in a next cycle? Summary answer Progesterone levels were not different in the mid-luteal phase of natural or modified natural cycles and only moderately agree with progesterone in a subsequent cycle. What is known already Progesterone is essential for successful implantation and pregnancy. Classical studies have shown considerable variability in progesterone levels during the luteal phase. More recently, progesterone levels during the mid-luteal phase have regained interest, in order to improve chances of pregnancy in frozen embryo transfer cycles. Several studies have suggested that if progesterone on the day of embryo transfer are below a certain cut off level, progesterone production would not be sufficient and luteal support should be provided. Study design, size, duration This was a prospective observational study at a tertiary fertility centre in Belgium, performed between January 2022 until March 2023. Serum progesterone on the day of frozen embryo transfer was measured in all patients undergoing frozen embryo transfer in a natural (NC) or modified natural cycle (MNC). Patients were eligible for the current study if at least two progesterone levels in two frozen embryo transfer cycles were available. Participants/materials, setting, methods A linear mixed model was used to calculate systematic differences in progesterone levels between NC and MNC. The intra-subject agreement was quantified by means of the intra-class correlation coefficient (ICC) with 95% confidence interval. The ICC ranges between 0 and 1, with high values (> 0.75) indicating a good to excellent level of agreement between measurements taken in the same subject. Progesterone levels were measured with COBAS Elecsys ECLIA progesteron assay by Roche Diagnostics. Main results and the role of chance All women were between 18 and 40 years of age. Forty patients with at least two frozen embryo transfers in NC and in MNC were included, i.e. 87 cycles. Their mean age was 32 (26-42) years, the mean BMI was 23.1 (16.9-34.5) kg/m2. Mean progesterone levels on the day of transfer were 13.0 ng/ml (11.0-15.0) in NC and 13.8 ng/ml (12.0-15.6) in MNC. These levels were not systematically different (P = 0.47). The intra-subject agreement showed an ICC of 0.66 in NC and 0.61 in MNC. Hence, our data indicate that progesterone levels in the mid-luteal phase of a NC are similar to those in a MNC. However, progesterone levels in one cycle only moderately agree with those in a next cycle. Limitations, reasons for caution Our data were obtained from women who had at least two frozen embryo transfer cycles and therefore may include progesterone levels different from those in good prognosis patients who got pregnant after a fresh embryo transfer or after a first frozen embryo. Wider implications of the findings Our data indicate that the moderate agreement of progesterone between cycles would imply assessment of progesterone in each cycle. In daily clinical practice, luteal phase support should be considered once a single progesterone measurement is below earlier described cut off levels predictive of ongoing pregnancy after frozen embryo transfer. Trial registration number not applicable

Can single progesterone concentration predict miscarriage in early pregnant women with threatened miscarriage: a systematic review and meta-analysis

BackgroundAbout 25% of pregnant women experience bleeding in the early stage, and half of them eventually progress to pregnancy loss. Progesterone serves as a useful biomarker to predict miscarriage in threatened miscarriage, yet its performance is still debated.AimTo evaluate the performance of single serum progesterone predicting miscarriage in early pregnant patients with threatened miscarriage.MethodThe online database was searched to yield the literature using the terms of ‘Abortion’, ‘Miscarriage’, and ‘serum Progesterone’, including PubMed, Scopus, Embase, Cochrane library, and China national knowledge infrastructure. Receiver operating characteristic (ROC) curve, likelihood ratio (LLR) and diagnostic odds ratio (DOR) and 95% confidence interval (CI) were computed. Publication bias was assessed by the deeks funnel plot asymmetry test. Subgroup analyses were conducted according to the progesterone level (< 12 ng/mL), recruited location and region, progesterone measurement method, exogenous progesterone supplement and follow up.ResultsIn total, 12 studies were eligible to be included in this study, with sample sizes ranging from 76 to 1087. The included patients’ gestational age was between 4 and 12 weeks. No significant publication bias was detected from all included studies. The threshold of progesterone reported ranged from 8 to 30 ng/ml. The synthesized area under the ROC curve (0.85, 95% CI 0.81 to 0.88), positive LLR (6.2, 4.0 to 9.7) and DOR (18, 12 to 27) of single progesterone measurement distinguishing miscarriage were relatively good in early pregnant patients with threatened miscarriage. When the threshold of < 12 ng/mL was adapted, the progesterone provided a higher area under the ROC curve (0.90 vs. 0.78), positive LLR (8.3 vs. 3.8) and DOR (22 vs.12) than its counterpart (12 to 30 ng/mL).ConclusionSingle progesterone measurement can act as a biomarker of miscarriage in early pregnant patients with threatened miscarriage, and it has a better performance when the concentration is <12 ng/mL.Trial registrationPROSPERO (CRD42021255382).

In vivo embryo development in bitches inseminated laparoscopically after ovulation time estimated based on a single progesterone determination.

Logistic and economical limitations are often the causes of dog owners not accurately monitoring the estrous cycle and the optimal insemination time. The aim of this study was to evaluate in vivo early embryonic development in bitches, after the analysis of sequential vaginal cytologies associated to single progesterone measurement and single laparoscopic insemination with high quality semen (fresh and with high spermatozoa concentration) or low-quality semen (frozen/thawed and with low spermatozoa concentration) at 48 h post- ovulation time predicted on a single progesterone measurement. Ten bitches were inseminated with 250 x 106 fresh spermatozoa (80% motility), and ten with 80 x 106 frozen/thawed spermatozoa (60% motility) in the cranial part of each uterine horn. Seven days later, ovariohysterectomy was performed and the oviducts and uterine horns and body were flushed to recover embryos and unfertilized oocytes. In 80% of the bitches inseminated with fresh and 50% of bitches inseminated with frozen/thawed semen, embryos at 2 to 8 cells stage were recovered mostly from the, oviducts. This study indicates that pregnancies can be obtained with a single laparoscopic intrauterine insemination after single serum progesterone measurement, although with a low number of embryos. This result should be taken into account in case economic or logistic restrictions that affect the possibility of owners to plan an accurate monitoring of the optimal breeding time using fresh and frozen semen.

The Accuracy of Single Progesterone, Single β-hCG, and Their Combination Measurement in Predicting Early Miscarriage: A Prospective Study in Outpatient Setting

&lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; Most of miscarriage events occurred during the first trimester of pregnancy. Recent studies found the beneficial effects of maternal serum markers to predict pregnancy outcomes. However, study in Indonesian setting was still limited, especially in outpatient setting. The aim of this study was to evaluate serum progesterone and β-hCG measurement as a beneficial predictor of miscarriage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials &amp;amp; Methods:&lt;/strong&gt; This was a prospective study recruiting outpatients pregnant women in Aceh who seek first medical attention for their pregnancy during January 2013 to January 2015. Serum progesterone and β-hCG level were measured beside routine obstetric procedure. The discrimination attained between miscarriage and non-miscarriage groups of pregnant women at the end of first trimester was evaluated using logistic regression and receiver operating curve analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 70 pregnant recruited in this study, nineteen of them (27.1%) experienced miscarriage. Serum progesterone level of women in miscarriage group was lower than non-miscarriage group (17.85 (IQR 13.26-21.15) ng/dl vs 33.67 (IQR 21.83-44.14), p&amp;lt;0.001). Serum β-hCG level was also lower in miscarriage group (10 681 (IQR 5 787.5-26 577.5) mIU/ml vs 48 109 (IQR 17 137-93 915) mIU/ml, p=0.001). Single progesterone measurement gave a good predictor ability for miscarriage with 82.2% accuracy, 86.3% sensitivity and 73.7% specificity if 19.5 ng/dl was used as a cut-off point.&lt;/p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Maternal serum progesterone level could be a good predictor for miscarriage during the first trimester of pregnancy. Single β-hCG serum in combination with progesterone serum measurement only had little added value for predicting miscarriage.

Progesterone test predicts early pregnancy outcome in women with pain or bleeding.

A single progesterone measurement can discriminate between a viable and non-viable pregnancy in women who have pain or bleeding in the early stages of their pregnancy, an analysis of the evidence has found.

Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies

Objective To determine the accuracy with which a single progesterone measurement in early pregnancy discriminates between viable and non-viable pregnancy.Design Systematic review and meta-analysis of diagnostic accuracy studies.Data sources Medline,...

Intérêt du dosage de la progestérone sérique dans la prise en charge des grossesses anormales (grossesse extra-utérine, fausses couches spontanées) au cours du premier trimestre

Low serum progesterone measurement, described in ectopic pregnancy (GEU), has been advocated as a diagnostic tool, with hCG measurement, in the non-invasive diagnosis of GEU. To access the accuracy of this test in the diagnosis of GEU, progesterone measurements were obtained from 67 pregnancies with outcome defined as GEU or spontaneous abortion. The diagnostic accuracy of the test was analysed by generating “receiver operating characteristics” (Roc) curves. The Roc curve for the diagnostic of pregnancy failure vs viable intra-uterine pregnancy showed a good discriminative capacity. Yet, single progesterone measurement could not discriminate between ectopic pregnancy and non-ectopic pregnancy. In conclusion, a threshold progesterone value of 5 ng/ml is proposed as a safe value for identification of patients with first trimester pregnancy failure, including GEU, but is insufficient for establishing a definite diagnosis.

The role of a single progesterone measurement in the diagnosis of early pregnancy failure and the prognosis of fetal viability: Al-Sebai M.A.H.; Kingsland C.R.; Diver M.; Hipkin L. Br J Obstet Gynaecol 1995 102/5 (364–369)

The role of a single progesterone measurement in the diagnosis of early pregnancy failure and the prognosis of fetal viability: Al-Sebai M.A.H.; Kingsland C.R.; Diver M.; Hipkin L. Br J Obstet Gynaecol 1995 102/5 (364–369)

Progesterone concentration as a predictor of pregnancy normalcy is the most useful when hCG levels are less than 2000 mIU/mL.

Measurements of serum progesterone to predict early gestational normalcy have been found to be as predictive as serial hCG titers. Since ultrasound would be the diagnostic tool of choice if hCG was > 2000 mIU/ml, the purpose of the present study was to determine the best predictive value of a single progesterone measurement when hCG levels were < 2000 mIU/ml. Relative operating characteristic analysis of progesterone level as a predictor of early gestational normalcy when hCG is < 2000 mIU/ml. Ninety-three pregnant patients that conceived spontaneously were evaluated with progesterone measurements when the patient's hCG was < 2000 mIU/ml. Two-by-two contingency tables were constructed that compared pregnancy outcome with multiple discriminatory serum progesterone concentrations between 0 and 38 ng/mL. From these tables, a relative operating characteristic (ROC) curve was generated to compare the sensitivity and false-positive rates. Of a total of 93 pregnancies, 27 had a normal outcome and 66 had an abnormal outcome. The ROC curve indicated that a serum progesterone concentration of 12 ng/ml had the highest sensitivity associated with the lowest false-positive rate. The area under the curve was equal to 0.941 +/- 0.024. This observation was compared to our previously reported data of progesterone levels that included hCG levels > 2000 mIU/ml, yielding an area under the curve of 0.772 +/- 0.053. Calculation of the critical ratio z revealed that there is a significant improvement in the predictive value of progesterone when hCG is < 2000 mIU/ml (P < 0.005). A single serum progesterone level has a better predictive value of pregnancy normalcy when hCG measurements are < 2000 mIU/ml.

Interpretation of single progesterone measurement in diagnosis of anovulation and defective luteal phase

Interpretation of single progesterone measurement in diagnosis of anovulation and defective luteal phase

Interpretation of single progesterone measurement in diagnosis of anovulation and defective luteal phase: observations on analysis of the normal range.

Single serum progesterone determinations were made in 79 apparently normal women with a regular menstrual cycle. A normal range (40 subjects) was derived from the concentrations in the follicular phase and used to define an "anovular" range for luteal phase values (nine out of 39 subjects). The remaining luteal phase values were used to construct an "ovular" range for the luteal phase and, within this range, to define a group of values (less than the 20th centile) which could be described as a "defective luteal phase." The cut off limits between ovular and anovular and between normal and defective luteal phases were respectively two and four times the follicular phase median. It is proposed that the numerical findings of this study may be used as a rule of thumb for defining normality and abnormality from a single serum progesterone determination.