Elevated serum progesterone on the day of HCG administration in IVF is associated with a higher pregnancy rate in polycystic ovary syndrome

Abstract

Our study compared 84 patients with polycystic ovary syndrome (PCOS) with 84 control patients who had normal ovaries and who were matched for the main determinants of success in in-vitro fertilization (IVF) and embryo transfer. Serum concentrations of oestradiol and progesterone on the day of human chorionic gonadotrophin (HCG) injection were significantly higher in PCOS than in normal patients (oestradiol 2016 +/- 1.8 pg/ml versus 1456 +/- 40.9 pg/ml, P < 0.01; progesterone 1.6 +/- 0.1 ng/ml versus 1.2 +/- 0.1 ng/ml, P = 0.03). Furthermore despite oocytes from PCOS patients having a reduced fertilization rate compared with normal patients (61.8 +/- 4.1% versus 73.5 +/- 4.3%, P = 0.03), the differences in pregnancy rate (22.6 versus 19%) and miscarriage (31.5 versus 18.7%) were not statistically significant. In PCOS patients, a critical breakpoint was identified at serum progesterone concentrations of 1.2 ng/ml on the day of HCG injection. The PCOS patients with progesterone > or = 1.2 ng/ml showed a higher pregnancy and miscarriage rate than PCOS patients with progesterone < 1.2 ng/ml (26.6 versus 17.9%, P < 0.01; and 41.7% versus 14.3%, P < 0.01 respectively). These findings suggest that premature progesterone production does not have an adverse effect on pregnancy rate in PCOS, but on the contrary, may be a predictor for success in IVF/embryo transfer.

Serum progesterone level effects on the outcome of in vitro fertilization in patients with different ovarian response: an analysis of more than 10,000 cycles

“…At present, there is no consensus on whether P elevation is associated with the achievement of pregnancy. Several studies have denied the presence of such an association (7)(8)(9)(10)(11)(12)(13)(14)(15), others have confirmed the presence of a negative association between P elevation and PRs (16)(17)(18)(19)(20), and yet others have found a favorable effect on pregnancy outcome (21).…”

“…Yet in the late follicular phase, the secretion of P and the number of mature follicles correlate positively (22,23). Therefore, it is reasonable to hypothesize that the P levels at the end of COH tend to be higher in patients with a good ovarian response (21). The raised peripheral concentrations of P in the late follicular phase are likely to influence the secretory changes of the endometrium, leading to impaired endometrial receptivity (24).…”

Premature luteinization and in vitro fertilization outcome in gonadotropin/gonadotropin-releasing hormone antagonist cycles in women with polycystic ovary syndrome

“…Bosch and colleagues (10) established a discriminatory P concentration of 1.2 ng/mL as an indicator of premature luteinization, as did Doldi et al (7). In the present study, a P level of R1.3 ng/mL was used as the discriminatory value for premature luteinization.…”

“…For example, Fanchin et al (6) observed premature elevation of P before hCG administration and suggested that endometrial receptivity may be affected as a result. Other studies have reported better pregnancy outcome when P levels are increased (7).…”

A Comparative Study between Abdominal and Laparoscopic Diathermy in Evaluation of Ovulatory Response in Women with Polycystic Ovary Syndrome

“…The classification of the disease is based on both clinical and endocrine features with a well known ultrasound ovarian pattern, obesity, menstrual cycle disturbances, hyperandrogenaemia, chronic anovulation, abnormal gonadotrophin secretion and hyperinsulinemia [9,10] .…”