Premature progesterone elevation impairs implantation and live birth rates in GnRH-agonist IVF/ICSI cycles

Kılıçdağ, Esra Bulgan; Haydardedeoğlu, Bülent; Çok, Tayfun; Hacıvelioğlu, Servet; Bağış, Tayfun

doi:10.1007/s00404-009-1248-0

Cited by 82 publications

(65 citation statements)

References 29 publications

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“…oocyte retrieval exhibit a significant lower live birth rate in the case of a subtle P rise on the day of hCG administration. This observation is in line with earlier studies from the 1990s (10-13) and recent large-scale studies (7,14,15,22). To the best of our knowledge, there exist only two other studies reporting on day-5 ET in GnRH agonist cycles, and they both show negative effects of elevated P levels on pregnancy outcome (15,28).…”

Section: Resultssupporting

confidence: 92%

“…Similar effects were observed 7 days after hCG administration, corresponding to the window of implantation, when a total of 370 analyzed genes were dysregulated by more than twofold in patients with P levels >1.5 ng/mL (32). Both studies support the concept of an endometrial impairment in the presence of elevated P and accordingly lower ongoing pregnancy rates (7,14,15). Consistent with these observations, elevated P levels >0.9 ng/mL on the day of hCG administration are associated with an accelerated increase of the endometrial echogenicity during the early luteal phase of COH cycles (33).…”

Section: Our Data Suggest That Women Undergoing Coh With Pituitary Dosupporting

confidence: 77%

“…A large number of clinical studies examined the effect of a subtle rise in serum P levels on the day of hCG administration in GnRH agonist cycles on pregnancy rates, but results remained controversial: effects on pregnancy rates were either positive (8,9) or detrimental (7,(10)(11)(12)(13)(14)(15), with variable P cutoffs. Other investigations failed to demonstrate any correlation between P levels and pregnancy outcome (2,(16)(17)(18)(19)(20)(21).…”

mentioning

confidence: 99%

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Subtle progesterone rise on the day of human chorionic gonadotropin administration is associated with lower live birth rates in women undergoing assisted reproductive technology: a retrospective study with 2,555 fresh embryo transfers

Ochsenkühn¹,

Arzberger²,

Schönfeldt

et al. 2012

Fertility and Sterility

100

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Section: Resultssupporting

confidence: 92%

Section: Our Data Suggest That Women Undergoing Coh With Pituitary Dosupporting

confidence: 77%

mentioning

confidence: 99%

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Subtle progesterone rise on the day of human chorionic gonadotropin administration is associated with lower live birth rates in women undergoing assisted reproductive technology: a retrospective study with 2,555 fresh embryo transfers

Ochsenkühn¹,

Arzberger²,

Schönfeldt

et al. 2012

Fertility and Sterility

100

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“…In the final follicular phase, the subtle increases in progesterone levels are associated with advancements in the endometrium's ultrastructural morphology and echogenicity, and these levels seem to have a negative impact on embryo implantation [13,14]. These alterations may result in embryo-endometrium asynchrony, and they may decrease the implantation rates during ART treatments [6].…”

Section: Discussionmentioning

confidence: 99%

Ratio of progesterone-to-number of follicles as a prognostic tool for in vitro fertilization cycles

Roque

Valle

Sampaio

et al. 2015

J Assist Reprod Genet

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Purpose To establish a ratio of the P level to the number of follicles (P/F ratio) on the day of human chorionic gonadotropin (hCG) administration and to evaluate whether this ratio is associated with in vitro fertilization (IVF) outcome. Methods This study was conducted between January 2012 and June 2013. A total of 337 patients with cleavage-stage day-3 fresh embryo transfer with P levels ≤1.5 ng/mL on the day of hCG administration were included in the study. The main outcome was ongoing pregnancy rate. Result(s) The P/F ratio was calculated according to the equation (P[ng/mL]/number of follicles) on the day of final oocyte maturation. Using ROC, we established a cut-off level of 0.075 for the P/F ratio. The area under the curve (AUC) (0.756; 95 % confidence interval [CI]: 0.704-0.807) indicated that it was a good prognostic test. In group 1 (patients under 36 years old), the ongoing pregnancy rates were 57 and 30 % for patients with P/F ratios≤.075 and>.075, respectively, (p= 0.003). In group 2 (patients between 36 and 39 years old), the ongoing pregnancy rates were 58 % and 17 % (p=0.001) for patients with P/F ratios ≤.075 and>.075, respectively. In group 3 (patients≥40 years old), the ongoing pregnancy rates were 41.7 and 10.9 % (p=0.001) for patients with P/F ratios≤.075 and>.075, respectively. Conclusions The P/F ratio is a good prognostic test for predicting IVF outcome that can correlate the P level with ovarian response.

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“…A large number of clinical studies have affirmed that the subtle progesterone rise on the day of hCG administration negatively affects the pregnancy rate in IVF [9][10][11]. It has been demonstrated that the pregnancy rate will drop dramatically when the progesterone level is over 1.5 ng/ml on the day of hCG administration [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

The effect of progesterone level prior to oocyte retrieval on the numbers of oocytes retrieved and embryo quality in IVF treatment cycles: an analysis of 2,978 cycles

Zhu

Liu

Yang

et al. 2014

J Assist Reprod Genet

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Purpose The study was designed to evaluate the relationship between serum progesterone (P4) response after hCG administration and the number of oocytes retrieved and the embryo quality in fresh IVF cycles. Methods We conducted a retrospective cohort study of women aged 24-43 years who underwent first fresh IVF cycle from 2011 to 2013 at a single practice. We compared the post-hCG serum P4 level with values on the day of hCG trigger. Patients were analyzed in long and short protocols independently. In addition, patients were stratified by post-hCG P4 response. Number of oocytes retrieved and embryo quality were the primary outcomes of interest. Ordinary least square regression models and logistic regression analysis models were created to identify predictive factors associated with embryological outcomes while adjusting for potential confounders. Results Among the 2,978 IVF cycles, 2,484 patients were in long protocols, and 494 patients were in short protocols. After adjusting for patient age, rFSH duration, and basal FSH levels, the associations between P4 response after hCG administration and number of oocytes retrieved (P<0.001) remained statistically significant in both long and short protocols. Additionally, mature oocyte rate, fertilization rate, good quality embryo rate, pregnancy rate and implantation rate were not significantly associated with the P4 increase when adjusting for the same factors. However, pregnancy rate and implantation rate from frozen-thawed cycles increased gradually across the seven groups.Conclusions Post-hCG P4 levels were positively associated with the number of oocytes retrieved, but did not affect oocyte or embryo quality. Our study suggests that the change in the posthCG P4 level is another parameter that can be used by clinicians to assess the number of oocytes retrieved, and may further to estimate the pregnancy rate and live birth rate indirectly.

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Premature progesterone elevation impairs implantation and live birth rates in GnRH-agonist IVF/ICSI cycles

Abstract: In women stimulated with GnRHa and hMG/FSH for IVF, elevated serum progesterone levels on the day of hCG administration were associated with diminished implantation rates and live birth rates regardless of ovarian reserve.

Cited by 82 publications

References 29 publications

Subtle progesterone rise on the day of human chorionic gonadotropin administration is associated with lower live birth rates in women undergoing assisted reproductive technology: a retrospective study with 2,555 fresh embryo transfers

Subtle progesterone rise on the day of human chorionic gonadotropin administration is associated with lower live birth rates in women undergoing assisted reproductive technology: a retrospective study with 2,555 fresh embryo transfers

Ratio of progesterone-to-number of follicles as a prognostic tool for in vitro fertilization cycles

The effect of progesterone level prior to oocyte retrieval on the numbers of oocytes retrieved and embryo quality in IVF treatment cycles: an analysis of 2,978 cycles

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