Elevated Progesterone Levels on the Day of Oocyte Maturation May Affect Top Quality Embryo IVF Cycles

Abstract

In contrast to the impact of elevated progesterone on endometrial receptivity, the data on whether increased progesterone levels affects the quality of embryos is still limited. This study retrospectively enrolled 4,236 fresh in vitro fertilization (IVF) cycles and sought to determine whether increased progesterone is associated with adverse outcomes with regard to top quality embryos (TQE). The results showed that the TQE rate significantly correlated with progesterone levels on the day of human chorionic gonadotropin (hCG) trigger (P = 0.009). Multivariate linear regression analysis of factors related to the TQE rate, in conventional IVF cycles, showed that the TQE rate was negatively associated with progesterone concentration on the day of hCG (OR was -1.658, 95% CI: -2.806 to -0.510, P = 0.005). When the serum progesterone level was within the interval 2.0–2.5 ng/ml, the TQE rate was significantly lower (P <0.05) than when the progesterone level was < 1.0 ng/ml; similar results were obtained for serum progesterone levels >2.5 ng/ml. Then, we choose a progesterone level at 1.5ng/ml, 2.0 ng/ml and 2.5 ng/ml as cut-off points to verify this result. We found that the TQE rate was significantly different (P <0.05) between serum progesterone levels < 2.0 ng/ml and >2.0 ng/ml. In conclusion, the results of this study clearly demonstrated a negative effect of elevated progesterone levels on the day of hCG trigger, on TQE rate, regardless of the basal FSH, the total gonadotropin, the age of the woman, or the time of ovarian stimulation. These data demonstrate that elevated progesterone levels (>2.0 ng/ml) before oocyte maturation were consistently detrimental to the oocyte.

Top quality blastocyst formation rates in relation to progesterone levels on the day of oocyte maturation in GnRH antagonist IVF/ICSI cycles

“…Our results thus extend the observation of two recent studies focused on Day 3 embryos [15–16] and deserve further research.…”

Does elevated serum progesterone on the day of human chorionic gonadotropin administration decrease live birth rates?

“…7,11,12,20–23,34 However, in our own data we observed a linear relationship between serum progesterone and live birth so we conclude that it is not possible to report a threshold above which we observe a significantly reduced live birth rate. Instead, we observed a steady decline in live birth rate with increasing progesterone.…”

Use of progestins to inhibit spontaneous ovulation during ovarian stimulation: the beginning of a new era?

“…Although previous studies and a metaanalysis (Melo et al, 2006;Shapiro et al, 2010;Venetis et al, 2013) have shown that progesterone elevation in the late follicular phase has no adverse effect on oocyte and embryo quality, suggesting that elevated exposure of the developing follicles to progestins is safe, several recent publications have challenged this concept. Elevated progesterone concentrations on the day of oocyte maturation induction have in fact been said to significantly reduce the formation rate of top-quality blastocysts (Huang et al, 2016;Vanni et al, 2017). Progesterone elevation on the day of HCG administration has been said also to adversely affect the cumulative live birth rate per oocyte retrieval cycle (Bu et al, 2014), even if this result seems more dependent on the detrimental effect of progestin on the endometrium.…”