There is a cycle to cycle variation in ovarian response and pre-hCG serum progesterone level: an analysis of 244 consecutive IVF cycles

Abstract

We aimed to answer one key question, that was not previously addressed as to whether serum progesterone (P4-hCG day) and its co-variates (estradiol (E2-hCG day) and the number of retrieved oocytes) of a given cycle can be predictive of the subsequent cycle when both cycles are consecutive and comparable for the stimulation protocol, gonadotropin dose and duration of stimulation. We analyzed such 244 consecutive (< 6 months) IVF cycles in 122 patients with GnRH agonist long protocol and found that P4, E2 and the number of retrieved oocytes significantly vary between the two cycles. Although P4 increased (ranging from 4.7 to 266.7%) in the 2nd cycle in 61 patients, E2 and the number of retrieved oocytes, which are normally positively correlated with P4 paradoxically decreased in the 41% and 37.7% respectively, of these same 61 patients. When a similar analysis was done in the 54 out of 122 patients (44.3%) in whom serum P4 was decreased in the 2nd cycle, the mean decrease in P4 was − 34.1 ± 23.3% ranging from − 5.26 to − 90.1%. E2 and the number of retrieved oocytes paradoxically increased in the 42.3% and 40.7% of these 54 patients respectively. P4 remained the same only in the 7 (5.7%) of these 122 patients. These findings indicate that late follicular phase serum P4 may change unpredictably in the subsequent IVF cycle. The changes are not always necessarily proportional with ovarian response of previous cycle suggesting that growth characteristics and steroidogenic activities of antral cohorts may exhibit considerable cycle to cycle variations.

GnRH agonist early follicular challenge test as a predictor of ovarian response in antagonist cycles for fertility preservation

“…The authors observed certain GAST response cycle variability in some of the patients and argued that the fluctuation can only be attributed to chance variation. However, in contrast to their conclusion, it was shown that there is some cycle to cycle variation of hormonal variables and oocyte yield 20 not explained by baseline AFC and AMH 21 which may attribute to GAST individual cycle results.…”

“Short agonist stop” protocol, an ovarian stimulation for poor responders in in vitro fertilization (IVF): A pilot study

“…We must point out that cycle-to-cycle variation in ovarian response exists and that the growth and steroidogenic characteristics of antral cohorts in response to exogenous FSH may vary from one cycle to another (e.g. expression and sensitivity of FSH receptors of granulosa cells ( 49 )). However, the cycle-to-cycle heterogeneity would probably be similar in both groups.…”

An interpretable machine learning model for individualized gonadotrophin starting dose selection during ovarian stimulation

“…Lastly, for the subset of patients with prior retrievals, we tried using prior outcomes as an input to our nearest-neighbor model but found that this did not meaningfully change the dose curves or expected benefit analysis. This is possibly due to the cycle-to-cycle variation in outcomes that exists even when using the same dose of gonadotropins (Yildiz et al, 2020).…”