Progesterone rise on the day of HCG administration (premature luteinization) in IVF: An overdue update

Abstract

Premature luteinization (PL) refers to a rise in serum progesterone (P) levels on the day of hCG administration. Most studies used an absolute P level on the day of hCG administration as an indicator of PL, and the cutoff level differed from 0.8 to 2 ng/mL. Some authors defined PL as a P/E2 ratio of >1. There is a marked variation in the incidence (13% to 71%), of PL due to discrepancies in definition, population characteristics and/or treatment protocols. The pathogenesis of PL in COH is still poorly understood. Several hypotheses may be considered to explain this phenomenon: elevation of follicular LH levels, serum accumulation of HCG from HMG, increased LH receptor sensitivity of the granulosa cells to FSH, or poor ovarian response with increased LH sensitivity. The consequences of this premature elevation of serum P on IVF outcome remain controversial. Attempts to prevent COH include: use of Low-dose hCG alone in the late COH stages, flexible antagonist protocol, use of mifepristone, aspiration of a single leading follicle, hCG administration when the levels of serum P exceeded 1.0 ng/mL.

Progesterone levels on the hCG day and outcomes in vitro fertilization in women with polycystic ovary syndrome

“…Despite the role of down-regulation of the pituitarygonadal axis in IVF protocols, several researchers have described a phenomenon of premature luteinization in COH cycles [20]. There may have been a number of problems in interpreting the results of previous studies due to varying diagnostic criteria for premature luteinization, use of different ovarian stimulation methods [21] and differences in initial rFSH dose during ovarian stimulation [22].…”

Aging-related premature luteinization of granulosa cells is avoided by early oocyte retrieval

“…One striking example of metabolic cooperation between oocytes and surrounding CCs pertains to glutathione synthesis. Because glutathione derived from GCs and CCs is required for sperm decondensation and male pronucleus formation, lack of ability to produce glutathione in DOs restrains their development (Perreault et al 1988, Zhou et al 2008, 2010. Hence, when DOs are co-cultured with GC monolayer during IVM, glutathione levels are restored and developmental competence is reestablished (Zhou et al 2008(Zhou et al , 2010.…”

Our Reasons for Cancellation During Intracytoplasmic Sperm Injection Cycles

“…[22] Çalışmalarda prematür lüteinizasyon tanısında kabul edilen progesteron değeri 0.8-2 ng/mL arasında değişkenlik gösterdiği için insidansı %13-71 gibi geniş bir varyasyon göstermektedir. [23] IVF sikluslarında etiyolojisi hala net olmamakla beraber progesteron seviyesi 1 ng/mL'i geçtiğinde hCG yapılması ve mifepriston kullanılması önerilmektedir. [23] Sönmezer ve ark.…”

“…[23] IVF sikluslarında etiyolojisi hala net olmamakla beraber progesteron seviyesi 1 ng/mL'i geçtiğinde hCG yapılması ve mifepriston kullanılması önerilmektedir. [23] Sönmezer ve ark. antagonist protokol uygulanan prematür LH ve progesteron yükselmesi gözledikleri iki hastalarında hem matür oosit elde ettiklerini hem de iyi kalitede embriyo geliştirdiklerini bildirmişlerdir.…”