Serum progesterone on the day of human chorionic gonadotropin administration predicts clinical pregnancy of sibling frozen embryos

Abstract

Objective-To evaluate patient characteristics and fresh IVF cycle parameters that influence success of sibling frozen-thawed embryo transfer (FET) cycles.Design-Retrospective study. Setting-Academic infertility practice.Patient(s)-Infertile women undergoing FET cycles utilizing embryos cryopreserved on day 3 postinsemination following an initial fresh IVF cycle. Intervention(s)-90 FET cycles. Main Outcome Measure(s)-Clinical pregnancy (CP).Result(s)-The likelihood of CP following FET was significantly higher in women who had achieved CP in the preceding fresh IVF cycle (71.4% vs. 40.6%). Multivariable logistic regression analysis confirmed that patients achieving CP following the fresh IVF cycle were more likely to achieve CP following FET (OR= 5.5, 95% CI 1.2 to 25.3) after adjusting for age, number and cleavage status of embryos transferred. Additionally, higher serum levels of progesterone on the day of hCG administration emerged as predictive of CP after FET at a statistically significant level. Conclusion(s)-The outcome of the fresh ET cycle is the foremost predictor of CP after FET of the sibling embryos. Relationship between serum P on the day of hCG administration in the fresh cycle and the outcome of subsequent FET is noteworthy and merits further investigation.

Elevated progesterone during ovarian stimulation for IVF

“…This may explain the impairment of endometrial receptivity in the presence of elevated progesterone reflected in the lower pregnancy rates reported in the literature (Van Vaerenbergh et al, 2011). On the other hand, no negative impact of progesterone rise on oocyte/embryo quality could be found in several studies (Fanchin et al, 1996;Hofmann et al, 1993;Legro et al, 1993;Melo et al, 2006;Polotsky et al, 2009;Silverberg et al, 1994). These data support the notion that progesterone exerts its adverse effect on the IVF outcome by a reduction in endometrial receptivity and not by a negative impact on oocyte/embryo quality.…”

“…This confirms the negative impact of progesterone rise on the endometrium rather than the oocyte/embryo quality. Furthermore, Polotsky et al (2009) and Shapiro et al (2010), demonstrated that in cycles with elevated preovulatory progesterone, the probabilities of implantation and ongoing pregnancy are increased if all 2-pronuclear oocytes are cryopreserved and subsequently thawed and cultured to the blastocyst stage before transfer.…”

Why we should transfer frozen instead of fresh embryos: the translational rationale

“…In a retrospective study of 4,032 fresh IVF/intracytoplasmic sperm injection cycles performed by Bosch et al, patients who had a P level >1.5 ng/mL on the day of hCG ovulation trigger had an ongoing pregnancy rate of 19% compared with 31% in patients with a P <1.5 ng/mL ( P <.001; OR 0.53, 95% CI 0.38–0.72) (38). Pregnancy rates were not decreased when these embryos were transferred in a subsequent frozen cycle, demonstrating that the detrimental effect of the elevated P is on the endometrium, not the embryo (43, 44). …”

Overweight Men: clinical pregnancy after ART is decreased in IVF but not in ICSI cycles

“…Standard protocols were followed per routine clinical practice, as previously described in detail [21]. Briefly, suppression of the endogenous luteinizing hormone surge was done with either GnRH agonists or antagonists.…”