Progesterone levels on the human chorionic gonadotropin trigger day affect the pregnancy rates for embryos transferred at different stages of development in both general and selected IVF/ICSI populations

Abstract

Background Two meta-analyses have shown that pregnancy and birth rates are significantly higher after blastocyst transfer than after cleaved embryo transfer. Other studies have revealed that a serum progesterone level > 1.5 ng/ml on the trigger day is responsible for premature luteinization and is associated with a low pregnancy rate. The objectives of this retrospective study were to determine whether blastocyst transfer gave higher pregnancy rates than cleaved embryo transfer at day 3 in both the general and selected IVF/ICSI populations, and whether the serum progesterone level influenced the pregnancy rate. Method We studied IVF/ICSI cycles with GnRH antagonist - FSH/hMG protocols in a general population (n = 1210) and a selected “top cycle” population (n = 677), after blastocyst transfer on day 5 or cleaved embryo transfer on day 3. The selected couples had to meet the following criteria: female age < 35, first or second cycle, and one or two embryos transferred. We recorded predictive factors for pregnancy and calculated the progesterone to oocyte index (POI), the progesterone:estradiol ratio (P:E2 ratio), and the progesterone to follicle (> 14 mm) index (PFI). Results In the general population, the clinical pregnancy rate was significantly higher after blastocyst transfer (33.3%) than after cleaved embryo transfer (25.3%; p < 0.01); the same was true for the birth rate (32.1 and 22.8%, respectively, p < 0.01). The differences between blastocyst and embryo transfer groups were not significant in the selected population (respectively 35.7% vs. 35.8% for the clinical pregnancy rate, and 33.9 and 34.9% for the birth rate). The serum progesterone levels on the eve of the trigger day and on the day itself were significantly lower in the pregnant women (p < 0.01). We found a serum progesterone threshold of 0.9 ng/ml, as also reported by other researchers. The POI and the PFI appear to have predictive value for cleaved embryos transfers. Conclusions Blastocyst transfers were associated with higher clinical pregnancy and birth rates than cleaved embryo transfers in a general population but not in a selected population. The serum progesterone levels on the eve of the trigger day and on the day itself predicted the likelihood of pregnancy.

Premature progesterone rise incidence & its effects on in vitro fertilization cycles

“…The difference with our study is that the difference the team got was more pronounced than ours and statistically significant. Merviel et al (28) in the same vein with our findings showed that serum progesterone level was significantly lower among pregnant women compared to non-pregnant (p <0.01) and that progesterone follicular index of >0.6 and progesterone oocyte index of >0.36/ng/ml/oocyte were more predictive of lower pregnancy rate, thus bringing to fore the correlating nature of both numbers of oocytes retrieved and numbers of follicles above 14mm on HCG day to progesterone level. It differed from our study in that cut-off value used for progesterone was 0.9ng/ml.…”

Duration of late-follicular elevated progesterone and in vitro fertilization outcomes in pituitary down-regulation treatment cycles

“…First, there has been robust evidence that LFEP impairs endometrial receptivity, but LFEP in the fresh cycle does not affect the cumulative birth rate of the frozen transfers in a freeze-only approach (18). A freeze-all policy should be proposed for LFEP patients to avoid the adverse impact of LFEP (19)(20)(21). We agree with the conclusion that LFEP has deleterious impact on fresh embryo transfers, but we should also be cautious regarding the cost of a freeze-all policy, especially for good-prognosis patients with sufficient high-quality embryos.…”

Letrozole Supplementation and the Increased Risk of Elevated Progesterone Levels on Trigger Day

“…2) The progesterone to oocyte index (POI), i.e., the relative value of the ratio of progesterone to aspirated oocytes. A high POI predicts poor clinical pregnancy and live birth rates in fresh IVF/ICSI cycles ( 22 ). Extreme situations, such as early ovulation, due to which a very few oocytes are obtained on the day of egg retrieval, might have affected the results.…”