The impact of preovulatory versus midluteal serum progesterone level on live birth rates during fresh embryo transfer

Abstract

Background Conflicting evidence still prevails concerning the effect of preovulatory elevated progesterone (EP4) on reproductive outcomes in fresh embryo transfer (ET). However, few studies have analyzed the effect of EP4 on the likelihood of pregnancy using multivariate regression approach. The potential confounding factors tested in these studies were limited to either patient’s characteristics or to stimulation related parameters. Yet, several studies have shown that postovulatory parameters such as midluteal progesterone (P4) level may be considered as a proxy variable of endometrial receptivity as well. Objective The aim of the present study was to estimate the independent effect of preovulatory P4 effect, if any, on the probability of live birth (LB) by considering the midluteal endocrine profile when controlling for the potential confounding factors. Methods This is a secondary data analysis of a cohort of fresh IVF/ICSI cycles triggered with GnRH agonist (n = 328) performed in a single IVF center during the period 2014–2016. Patients contributed only one cycle and were stratified into four groups according to preovulatory P4 quartiles. We assessed the association between preovulatory P4 and the odds of LB calculated by logistic regression analysis after controlling for the most clinically relevant confounders. The primary outcome measure: Live birth rates (LBR). Results Both preovulatory and midluteal P4 were significantly correlated with the ovarian response. Logistic regression analysis showed that preovulatory serum P4 did not have a significant impact on LBR. In contrast, midluteal serum P4 level was an important independent factor associated with LBR. The optimal chance of LBR was achieved with midluteal serum P4 levels of 41–60 ng/ml, [OR: 2.73 (1.29–5.78); p< 0.008]. Conclusion The multivariate analysis suggests that the midluteal P4 level seems to impact LBR more than the preovulatory P4 level in women undergoing IVF treatment followed by fresh ET.

Progesterone level in assisted reproductive technology - a Systematic Review and Meta- analysis

“…The progesterone threshold ranged from 0.9ng/ml to 2.0ng/ml. Twenty-one studies reported using D3 embryos [14][15][16][17][18][19][20]22,23,27,30,32,34,36,40,[45][46][47][48]50,56 , four studies reported using D5 embryos 31,33,37,54 , eighteen studies reported using both D3 and D5 embryos 21,24,25,29,38,39,[41][42][43][44]49,[51][52][53]55 and three studies did not specify the stages of embryo used 26,28,35 (Table 1).…”

Low Luteal Serum Progesterone Levels Are Associated With Lower Ongoing Pregnancy and Live Birth Rates in ART: Systematic Review and Meta-Analyses

“…The main characteristics of the included studies are reported in Supplementary Table 1. The included women were recruited during their first or second cycle (19)(20)(21)(22)(23), all of them (24)(25)(26)(27)(28)(29)(30) or not specified (11,14,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46). Studies concerned either autologous cycles (13, 14, 19, 21, 22, 25, 27, 29-32, 36, 38-43, 45, 47), oocyte donation (20,44) or not specified (11, 21, 23, 26, 28, 33-35, 37, 46).…”

“…Studies concerned either autologous cycles (13, 14, 19, 21, 22, 25, 27, 29-32, 36, 38-43, 45, 47), oocyte donation (20,44) or not specified (11, 21, 23, 26, 28, 33-35, 37, 46). Studies included single-embryo transfers (11,13,22,28,33,35,40,41), single-or double-embryo transfers (19,20,26,27,30,31,34,37,46), transfers of two to three embryos (24), transfers of three to four embryos (38,39,44) and not reported (14,21,23,25,29,36,43,45,47). Transferred embryos were cleaved embryos (21,24,27,29,34,39), blastocyst embryos (11,13,14,19,20,22,23,26,…”

“…Studies included single-embryo transfers (11,13,22,28,33,35,40,41), single-or double-embryo transfers (19,20,26,27,30,31,34,37,46), transfers of two to three embryos (24), transfers of three to four embryos (38,39,44) and not reported (14,21,23,25,29,36,43,45,47). Transferred embryos were cleaved embryos (21,24,27,29,34,39), blastocyst embryos (11,13,14,19,20,22,23,26,31,35,40,41,46), both (28,30,…”

The late-follicular-phase progesterone to retrieved oocytes ratio in normal ovarian responders treated with an antagonist protocol can be used as an index for selecting an embryo transfer strategy and predicting the success rate: a retrospective large-scale study

“…Some studies have shown that LFPE can reduce the pregnancy rate after embryo transfer in fresh cycles by affecting the quality of oocytes/embryos and endometrial receptivity (4)(5)(6). Conversely, another study revealed no correlation between LFPE length and pregnancy outcomes (7,8).…”