Does elevated progesterone on day of oocyte maturation play a role in the racial disparities in IVF outcomes?

Abstract

The aim of this study was to evaluate if premature progesterone elevation on the last day of assisted reproduction technique stimulation contributes to racial disparities. A total of 3289 assisted reproduction technique cycles were evaluated in Latino, Asian, African American, and white women. Live birth was more likely in white women (42.6%) compared with Asian (34.8%) and African American women (36.3%), but was similar to Latino women (40.7%). In all racial groups, progesterone was negatively associated with live birth and the negative effect of progesterone persisted when adjusting for confounders. Although the effect of elevated progesterone was similar in all racial groups, the prevalence of elevated progesterone differed. P > 1.5 ng/ml occurred in only 10.6% of cycles in white women compared with 18.0% in Latino and 20.2% in Asian women. P > 2 ng/ml occurred in only 2.3% of cycles in white women compared with 6.3% in Latino, 5.9% in Asian and 4.4% in African American women. The increased prevalence of premature elevated progesterone persisted when controlling for IVF stimulation parameters. In conclusion, premature progesterone elevation had a negative effect on live birth in all racial groups studied. The prevalence of elevated progesterone was higher in racial minorities.

Adverse effect of prematurely elevated progesterone in in vitro fertilization cycles: a literature review

“…Contrary to this finding, Hill et al demonstrated that the progesterone to oocyte ratio was not protective, indicating a negative effect regardless of ovarian response [42]. Finally, Hill et al demonstrated that the negative effect of premature P elevation persisted among various ethnicities in a similar fashion, although ethnic minorities had a higher prevalence of premature P elevation [43]. Across all of these studies, interaction testing for live birth by P with each variable was statistically nonsignificant.…”

Systematic review of racial and ethnic disparities in reproductive endocrinology and infertility: where do we stand today?

“…However, White women were less likely to exhibit this premature elevation in progesterone (progesterone level > 1.5 ng/mL, 10.6%) than Latino women (18.0%) and Asian women (20.2%). The investigators suggest that this reflects the differences in gene or enzyme polymorphisms that result in differential responses to exogenous gonadotropins (41). However, in an earlier study, examining IVF cycles from both White and Asian patients through the national SART registry as well as from an academic medical center, Asian patients were shown to have lower clinical pregnancy rates after adjustment for estradiol level on the day of trigger and endometrial thickness despite demonstrating significantly decreased embryo fragmentation scores compared with White women (aOR, 0.59; 95% CI, 0.37-0.94) (42).…”

Comparison of the predictive value of progesterone‐related indicators for pregnancy outcomes of women undergoing the short‐acting GnRH agonist long protocol: a retrospective study

“…Excessive P levels may affect the embryo quality and endometrial receptivity, reduce the embryo implantation rate, and thus reduce the clinical pregnancy rate [ 4 ]. Earlier studies did not show any association between P levels and pregnancy rates [ 5 , 6 ], whereas more recent studies have reported a negative impact on pregnancy outcomes when serum P levels are increased [ 4 , 7 ]. In this case, which indicator can we choose to predict pregnancy outcomes and subsequently decide to perform fresh embryo transfer (ET) or the “freeze-all” strategy?…”