Serum progesterone (P4) levels greater than 2.86 nmol/L (0.9 ng/mL) on the day of hCG administration are reportedly associated with decreased pregnancy rates in in vitro fertilization/embryo transfer (IVF/ET) cycles. To further assess this phenomenon we measured serial serum P4, LH, and estradiol levels in 115 consecutive patients undergoing stimulation for IVF/ET with midluteal leuprolide acetate and human menopausal gonadotropins. IVF/ET cycle outcome was retrospectively correlated with P4 levels on the day of hCG administration. Two critical breakpoints were identified, 1.27 nmol/L (0.4 ng/mL) and 286 nmol/L (0.9 ng/mL). Clinical pregnancies occurred in 9 of 18 patients in group I (P4, less than 1.27 nmol/L) compared to 11 of 81 patients in group II (1.27 less than P4 less than 2.86 nmol/L; P = 0.001) and 0 of 14 patients in group III (P4, less than or equal to 2.86 nmol/L) (P = 0.001). Eleven patients in group III had cryopreservation of embryos during that cycle. Six subsequently underwent frozen embryo transfer, and clinical pregnancies occurred in 2, both of whom have delivered. These findings demonstrate that even modest increases in serum P4 levels (greater than 1.27 nmol/L) are associated with reduced pregnancy rates in IVF/ET cycles. In addition, it appears that the mechanism may not exclusively involve poor oocyte quality.

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An association between endometriosis and infertility has long been noted. Endometriosis affects approximately 5% of the general population. In infertile women, the prevalence may be as high as 30%. Multiple studies, the majority of which are retrospective, indicate that the monthly fecundity of patients with endometriosis may be decreased by half compared to women without the disease. The precise cause-effect relationship between endometriosis and infertility remains controversial. In advanced cases of endometriosis, with distorted pelvic anatomy, the mechanism of infertility is more easily explained. Recent evidence suggests that treatment of early-stage endometriosis may increase pregnancy rates. Many etiologies of infertility in early-stage endometriosis have been proposed. These include endocrine dysfunctions such as luteal phase defect and luteinized unruptured follicle syndrome. In the last 15 years, alterations in the local pelvic immune environment have been the subject of multiple basic science investigations. Unfortunately, there is no satisfactory hypothesis that unequivocally explains the association of early stages of endometriosis with infertility.

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