The Role of hCG Triggering Progesterone Levels: A Real-World Retrospective Cohort Study of More Than 8000 IVF/ICSI Cycles

Abstract

To assess the association between serum ovulation trigger progesterone (P) levels and the outcome of in vitro fertilization cycles. Design Setting: Real world single-center retrospective cohort study. Patient Intervention(s): All fresh cleavage and blastocyst-stage embryo transfers (ETs) performed from January 2012 to December 2016. Main outcome Measure(s): The impact of premature high serum P levels cycles in terms of clinical pregnancy rates (CPRs) and live birth rates (LBRs). Results: 8,034 ETs were performed: 7,597 cleavage-stage transfers and 437 blastocyst transfers. Serum P levels demonstrated to be inversely related to CPR (OR 0.72, p < 0.001) and LBR (OR 0.73, p < 0.001). The progressive decrease of LBR and CPR started when P levels were >1 ng/ml in a good prognosis cleavage ET subgroup, whereas in patients with worse prognosis only for P ≥ 1.75 ng/ml. In the blastocyst ET subgroup, the negative effect of P elevation was reported only if P was >1.75 ng/ml. CPR (OR 0.71 (0.62-0.80), p < 0.001) and LBR (OR 0.73 (0.63-0.84), p < 0.001) in thawed cycles resulted statistically significantly higher than in fresh cycles in the cleavage-stage subgroup. In the blastocyst group, no significant difference resulted between thawed and fresh cycles, independently of P levels [CPR OR 0. 37 (0.49-1.09), p = 0.123; LBR OR 0.71 (0.46-1.10), p = 0.126]. Conclusion: High P levels decrease CPR as well as LBR in both cleavage and blastocyst ET. In the cleavage group, for P levels below 1.75 ng/ml, our data suggest the possibility to wait until day 5 for ET, and if P level is ≥1.75 ng/ml, it should be considered to freeze all embryos and postpone the ET. Clinical Trial Registration: ClinicalTrials.gov, ID: NCT04253470.

Is the lack of prior exposure to sperm antigens associated with worse neonatal and maternal outcomes? A 10‐year single‐center experience comparing ICSI–TESE pregnancies to ICSI pregnancies

“…This retrospective analysis, however, includes a small number of cases, and it registered a higher incidence of PE in women conceiving by intrauterine insemination with washed donor spermatozoa compared with intrauterine insemination with washed partner spermatozoa. 30 Probably the sexual intercourse in our couple during a spontaneous search of pregnancy with the same partner allowed sensitization to the partner's sperm antigens as well as in couples who performed ICSI from ejaculated semen. This hypothesis could be on the basis of the absence of increased risk of preclampsia in couples who perform ICSI by TESE.…”

“…This supports, indirectly, an immunologic basis for PE. This retrospective analysis, however, includes a small number of cases, and it registered a higher incidence of PE in women conceiving by intrauterine insemination with washed donor spermatozoa compared with intrauterine insemination with washed partner spermatozoa 30 …”

“…In frozen embryo transfers, endometrial synchronization was established before the transfer procedure through three different protocols: natural cycles, modified natural cycles with urinary hCG triggering, and artificial replacement cycles, as already described by De Cesare et al 30 …”

“…natural cycles, modified natural cycles with urinary hCG triggering, and artificial replacement cycles, as already described by De Cesare et al 30…”

Ectopic pregnancy risk factors in infertile patients: a 10-year single center experience

“…Ovarian stimulation (OS) was performed using four different protocols: GnRH agonist long protocol; GnRH agonist short protocol; GnRH antagonist protocol; flare-up GnRH agonist protocol 31 . As previously described by the same research group 32 , most of antagonist OS started with the use of combined oral contraceptives pretreatment. Long GnRH agonist protocol was based on the administration of daily leuprorelin (Enantone die, Takeda, Italy) or Leuprolin acetate 20 IU/day (Fertipeptyl, Abbott Pharmaceutical Products, USA) on day 21 of the previous luteal phase of the stimulation cycle.…”