The duration of pre-ovulatory serum progesterone elevation before hCG administration affects the outcome of IVF/ICSI cycles

Huang, Chien-Hua; Lien, Yih-Ron; Chen, Shee‐Uan; Chen, Mei-Jou; Shieh, Chia-Jen; Yao, Yilin; Chang, Chin‐Hao; Yang, Yu Shih

doi:10.1093/humrep/des141

Cited by 72 publications

(53 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Many studies have reported that a premature rise in progesterone is unfavorable on live birth outcome [17][18][19][20][21][22] following transfer of embryos in fresh IVF cycles. This phenomenon (premature luteinization) is unique to fresh cycles when the ovaries are driven by exogenously administered gonadotropins.…”

Section: Discussionmentioning

confidence: 99%

Serum progesterone levels greater than 20 ng/dl on day of embryo transfer are associated with lower live birth and higher pregnancy loss rates

Kofinas

Blakemore

McCulloh

et al. 2015

J Assist Reprod Genet

View full text Add to dashboard Cite

Background Progesterone (P4) is essential for support of the endometrium and implantation of an embryo in the normal menstrual cycle. In programed frozen embryo transfer cycles using exogenous P4 is necessary, as the endogenous production of P4 requires a functioning corpus luteum that is not present in programed cycles. To date, there is continuing debate about ideal serum estradiol and P4 values in frozen embryo transfer cycles. Methods Patients underwent single euploid embryo frozen transfer cycles from 2010 to 2013 at a single large academic center. Patients using donor oocytes and patients with changes in progesterone dose during the cycles in question were excluded. All cycles were programed and intramuscular P4 was used exclusively. Only patients administering the same daily dose of P4 throughout the cycle were included (N=213 patients). Main outcomes were ongoing pregnancy/live birth rates (OPR/LBR), clinical pregnancy rates (CPR), and spontaneous abortions/biochemical pregnancies. CPR was defined by the presence of a sac on 1st trimester ultrasound. Missed abortions were calculated per pregnancy with a sac. Receiver operator characteristic curves (ROC curves) and chi-squared tests were performed for statistical analysis. Results Two groups based on day 19 P4 levels were compared (group A, P4<20 ng/ml; group B, P4>20 ng/ml). OPR/LBRs were 65 vs. 49 %, group A vs. B, p value=0.02, RR=1.33 (1.1-1.7). Missed abortion and biochemical rates were higher in group B as opposed to group A, 27 vs. 12 %, p=0.01, RR=0.45(0.24-0.86). When P4 was stratified into five groups based on nanogram per milliliter of progesterone on day 19 (10-15, 15-20, 20-30, 30-40, and >40), there was a trend downward in OPR/LBR (70, 62, 52, 50, and 33 %, respectively). There was also an increase in missed abortion/biochemical rates (7, 15, 27, 32, and 20 %, respectively). Multiple logistic regression showed an increase in OPR/LBR when accounting for age, day 2 FSH, weight, number of embryos biopsied, and number of euploid embryos. Conclusion P4 levels >20 ng/ml on the day of transfer (during frozen single euploid embryo transfer cycles) were associated with decreased OPR/LBR.

show abstract

Section: Discussionmentioning

confidence: 99%

Serum progesterone levels greater than 20 ng/dl on day of embryo transfer are associated with lower live birth and higher pregnancy loss rates

Kofinas

Blakemore

McCulloh

et al. 2015

J Assist Reprod Genet

View full text Add to dashboard Cite

show abstract

“…Interestingly, the duration of P elevation could have a stronger impact on cycle outcome than the absolute serum P concentration on the day of hCG. Th e clinical pregnancy rate is signifi cantly inversely correlated with the duration of premature serum P elevation above the cut-off value of 1.0 ng/mL, whatever the protocol used and the intensity of the ovarian response 19 . It seems that the use of a multivariable analysis is the proper way of assessing the adverse eff ect of preovulatory P elevation on live birth rates, when compared with the bivariate analysis that was used in most of the studies that failed to identify the detrimental eff ect in fresh IVF cycles 20 .…”

Section: Introductionmentioning

confidence: 97%

Current Preventive Strategies for Preovulatory Progesterone Elevation During Ovarian Stimulation for in Vitro Fertilization

Ejubović

Kasum

Stanić

et al. 2016

acc

View full text Add to dashboard Cite

SUMMARY -Th e purpose of this review is to present contemporary measures for preventing the increase in preovulatory progesterone (P) and its adverse eff ects on ovarian stimulation in in vitro fertilization (IVF). For the last 20 years, the increase of preovulatory P has been a topic of numerous discussions because its role is not fully understood in terms of its impact on pregnancy outcome after IVF. Some studies failed to establish a connection between the preovulatory P increase and successful IVF outcome regardless of the level of P, while, conversely, most other studies have reported on adverse eff ects of elevated P concentrations. Current strategies to prevent the increase in preovulatory P include an individualized approach with the use of mild stimulation protocols and early application of human chorionic gonadotropin for ovulation induction among good responders, delay in the transfer of fresh embryos from 3 rd to 5 th day, and cryopreservation of all embryos with the thawed embryo transfer in the natural cycle. Nevertheless, further studies are needed to confi rm the current preventive methods or enable the application of new strategies in order to lower or eliminate the detrimental eff ects of preovulatory P rise during ovarian stimulation in IVF.

show abstract

“…1 Ovülasyonun tetiklendiği gün yani insan koryonik gonadotropin [human chorionic gonadotropin (hCG)] günü, P yükselmesinin İVF sikluslarında gebelik sonuçları üzerine etkisi son 20 yıldır araştırılmaktadır. [2][3][4][5] Preovülatuar P yüksekliği endometriyal reseptiviteye zarar vererek devam eden gebelik oranlarını düşürmektedir. Ancak daha güncel çalışmalarda, GnRH antagonist sikluslarında P yüksekliğinin overyan yanıt düştükçe gebelik üzerine olumsuz etkisinin arttığı ortaya konmuştur.…”

unclassified

Effect of Trigger Day Progesterone-to-Follicle Number Ratio on Pregnancy Outcomes in Patients with High Trigger Day Progesterone Levels in GnRH Antagonist in-Vitro Fertilization Cycles

Aytac¹,

Güleç²,

İnce³

et al. 2017

Turkiye Klinikleri J Gynecol Obst

View full text Add to dashboard Cite

Ö ÖZ ZE ET T A Am ma aç ç: : Ovülasyonun tetiklendiği gün [insan koryonik gonadotropin (hCG) günü] serum progesteron seviyesi ≥1,5 ng/mL olan gonadotropin salıcı hormon (GnRH) antagonist protokolü ve intrasitoplazmik sperm enjeksiyonu uygulanan sikluslarda serum progesteron seviyesinin yine aynı gün transvajinal ultrasonografide ölçülen ≥12 mm folikül sayısına oranının (progesteron) / (≥12 mm folikül sayısı) (progesteron/folikül oranı) canlı doğum oranını ön-görmedeki yerini araştırmaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Mart 2010-Temmuz 2015 tarihleri arasında, İzmir Tepecik Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği Tüp Bebek Merkezine başvuran hastaların kayıtlarından oluşan 2.111 siklustan dâhil edilme kriterlerine uygun ve hCG günü progesteron seviyesi ≥1,5 ng/mL olan toplam 203 siklus bu retrospektif kohort çalışmasına dâhil edilmiştir. Kontrollü overyan stimülasyon sonrası ICSI ve taze embriyo transferi uygulanan GnRH antagonist sikluslarda hCG günü serum progesteron düzeyi ve ultrasonografi ile folikülometri yapılarak folikül çapları ölçülmüş ve sayıları kaydedilmiştir. Ayrıca hastaların bazal demografik ve hormonal verileri, yumurta toplama işlemi sonrası embriyo gelişim verileri ve gebelik sonuçları veri analizine alın-mıştır. B Bu ul lg gu ul la ar r: : Çalışmamızın sonucunda progesteron/folikül oranı için alıcı işlem karakteristikleri eğrisi altında kalan alan 0,617, kestirim değeri 0,307, sensitivite 0,97 ve spesifisite ise 0,24 olarak saptanmıştır (p=0,023). Bunun yanı sıra çalışmamızda kestirim değerinin altındaki hastalarda (progesteron/folikül≤0,307), üzerindekilere oranla; kullanılan total folikül uyarıcı hormon miktarı ve hCG günü progesteron düzeyi anlamlı olarak düşük iken (p<0,01, p<0,001), hCG günü ≥12 mm ve ≥17 mm folikül sayısı, hCG günü endometriyum kalınlığı, hCG günü estradiol dü-zeyi, total ve metafaz II oosit sayısı anlamlı şekilde yüksek saptanmıştır. Diğer taraftan genel (kimyasal), klinik, devam eden gebelik ve canlı doğum oranları kestirim değerinin altındaki hastalarda istatistiksel açıdan anlamlı olarak yüksek bulunmuştur. S So on nu uç ç: : hCG günü serum progesteron seviyesi ≥1,5 ng/mL olan, taze embriyo transferi yapılan ve antagonist protokol uygulanan sikluslarda, serum progesteron düzeyinin aynı gün ölçülen ≥12 mm folikül sayısına oranı (progesteron/folikül) canlı doğum oranını öngörmede önemli bir parametredir.A An na ah ht ta ar r K Ke el li im me el le er r: : İnfertilite; overyan folikül; in vitro fertilizasyon; sperm enjeksiyonu, intrasitoplazmik; progesteron A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The purpose of this retrospective cohort study was to establish a ratio of the progesterone level to the number of follicles (having diameter larger than 12 mm) on ovulation trigger day [human chorionic gonadotropin (hCG)-day] and to demonstrate if this ratio is associated with pregnancy outcome in gonadotropin releasing hormone (GnRH) antagonist/intracytoplasmic sperm injection cycles with high hCG-day serum pr...

show abstract

The duration of pre-ovulatory serum progesterone elevation before hCG administration affects the outcome of IVF/ICSI cycles

Abstract: Older patients (>42 years) are excluded from our study.

Cited by 72 publications

References 49 publications

Serum progesterone levels greater than 20 ng/dl on day of embryo transfer are associated with lower live birth and higher pregnancy loss rates

Serum progesterone levels greater than 20 ng/dl on day of embryo transfer are associated with lower live birth and higher pregnancy loss rates

Current Preventive Strategies for Preovulatory Progesterone Elevation During Ovarian Stimulation for in Vitro Fertilization

Effect of Trigger Day Progesterone-to-Follicle Number Ratio on Pregnancy Outcomes in Patients with High Trigger Day Progesterone Levels in GnRH Antagonist in-Vitro Fertilization Cycles

Contact Info

Product

Resources

About