Midluteal Progesterone: A Marker of Treatment Outcomes in Couples With Unexplained Infertility

Hansen, Karl R.; Eisenberg, Esther; Baker, Valerie L.; Hill, Micah J.; Chen, Sixia; Talken, Sara; Diamond, Michael P.; Legro, Richard S.; Coutifaris, Christos; Alvero, Ruben; Robinson, Randal D.; Casson, Peter R.; Christman, Gregory M.; Santoro, Nanette; Zhang, Heping; Wild, Robert A.

doi:10.1210/jc.2018-00642

Cited by 20 publications

(16 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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).…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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

Ranisavljevic

Huberlant

Montagut³

et al. 2022

Front. Endocrinol.

View full text Add to dashboard Cite

Progesterone plays a key role in implantation. Several studies reported that lower luteal progesterone levels might be related to decreased chances of pregnancy. This systematic review was conducted using appropriate key words, on MEDLINE, EMBASE, and the Cochrane Library, from 1990 up to March 2021 to assess if luteal serum progesterone levels are associated with ongoing pregnancy (OP) and live birth (LB) rates (primary outcomes) and miscarriage rate (secondary outcome), according to the number of corpora lutea (CLs). Overall 2,632 non-duplicate records were identified, of which 32 relevant studies were available for quantitative analysis. In artificial cycles with no CL, OP and LB rates were significantly decreased when the luteal progesterone level falls below a certain threshold (risk ratio [RR] 0.72; 95% confidence interval [CI] 0.62–0.84 and 0.73; 95% CI 0.59–0.90, respectively), while the miscarriage rate was increased (RR 1.48; 95% CI 1.17–1.86). In stimulated cycles with several CLs, the mean luteal progesterone level in the no OP and no LB groups was significantly lower than in the OP and LB groups [difference in means 68.8 (95% CI 45.6–92.0) and 272.4 (95% CI 10.8–533.9), ng/ml, respectively]. Monitoring luteal serum progesterone levels could help in individualizing progesterone administration to enhance OP and LB rates, especially in cycles without corpus luteum.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=139019, identifier 139019.

show abstract

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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

Ranisavljevic

Huberlant

Montagut³

et al. 2022

Front. Endocrinol.

View full text Add to dashboard Cite

show abstract

“…The etiology of LPD associated with ART treatments has two components: the effect of ART procedures themselves and the individually variable inborn predisposition of each patient. Data show that virtually all women undergoing an ART attempt are prone to LPD (57,58). It was hypothesized that women who experience LPD in natural cycles are exposed to a more severe LPD after ART treatment than women with normal spontaneous LP (9,10).…”

Section: Management Of Luteal Phase Deficiency In Assisted Reproductimentioning

confidence: 99%

Luteal Phase in Assisted Reproductive Technology

Conde-López¹,

Galán-Lázaro²,

Mendoza-Tesarik³

2020

Front. Reprod. Health

View full text Add to dashboard Cite

Luteal phase (LP) is the period of time beginning shortly after ovulation and ending either with luteolysis, shortly before menstrual bleeding, or with the establishment of pregnancy. During the LP, the corpus luteum (CL) secretes progesterone and some other hormones that are essential to prepare the uterus for implantation and further development of the embryo, the function known as uterine receptivity. LP deficiency (LPD) can occur when the secretory activity of the CL is deficient, but also in cases of normal CL function, where it is caused by a defective endometrial response to normal levels of progesterone. LPD is particularly frequent in treatments using assisted reproductive technology (ART). Controlled ovarian stimulation usually aims to obtain the highest number possible of good-quality oocytes and requires the use of gonadotropin-releasing hormone (GnRH) analogs, to prevent premature ovulation, as well as an ovulation trigger to achieve timed final oocyte maturation. Altogether, these treatments suppress pituitary secretion of luteinizing hormone (LH), required for the formation and early activity of the CL. In addition to problems of endometrial receptivity for embryos, LPD also leads to dysfunction of the local uterine immune system, with an increased risk of embryo rejection, abnormally high uterine contractility, and restriction of uterine blood flow. There are two alternatives of LPD prevention: a direct administration of exogenous progesterone to restore the physiological progesterone serum concentration independently of the CL function, on the one hand, and treatments aimed to stimulate the CL activity so as to increase endogenous progesterone production, on the other hand. In case of pregnancy, some kind of LP support is often needed until the luteal–placental shift occurs. If LPD is caused by defective response of the endometrium and uterine immune cells to normal concentrations of progesterone, a still poorly defined condition, symptomatic treatments are the only available solution currently available.

show abstract

“…One in six couples is affected by fertility disorders and approximately 30% of the patients in reproduction physicians experience unexplained infertility [1]. Ovulation induction (OI) followed by intrauterine insemination (IUI) is the first choice treatment of idiopathic infertility due to its low risk and cost-effectiveness [2].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, plasma P4 concentration is a low cost and reliable indicator of ovulation in humans. The level of P4 remains under 1 ng/mL during the follicular phase and progressively increases following the luteinising hormone (LH) surge, reaching maximum values between days seven and eight post-ovulation [1].…”

Section: Introductionmentioning

confidence: 99%

The utility of detecting ovulation to predict success in ovulation induction and intrauterine insemination cycles — a prospective observational study

et al. 2021

View full text Add to dashboard Cite

Objectives:The success of ovulation induction-intrauterine insemination (OI-IUI) procedures may be limited by the absence of ovulation detection. The aim of this study was to evaluate the empirical use of ultrasonography and luteal phase progesterone (P4) as ovulation indicators and determine its effect on pregnancy outcome in OI-IUI cycles.Material and methods: This prospective observational study, which was performed in a university setting, included 107 women with unexplained infertility. Following OI, IUI was performed 36 hours after human chorionic gonadotropin (hCG). P4 was measured 72-96 hours after hCG. At the same time, the appearance of ovaries and signs indicative of ovulation, which are decreased follicle dimensions, irregularity of follicular walls, and the presence of free fluid in the Douglas pouch, were noted. Results:In 58 patients (54.2%), ovulation was detected at the P4 level of > 10 ng/mL. Eighty-nine patients had ultrasound images suggestive of ovulation. However, only 50 of these were confirmed ovulation as indicated using P4. Implantation was observed in a total of 13 patients (12.1%). All patients were in the ovulation detected group with P4 > 10 ng/mL (AUC: 0.750; p = 0.004). P4 of > 21.5 ng/mL detected successful ovulation and was strongly associated with implantation with 77% sensitivity and 61% specificity (OR: 9.9; 95% CI: 2.4-41.2). Body mass index (BMI) > 23.9 kg/m 2 was a reliable anovulation indicator as a secondary outcome (AUC: 0.696; p = 0.02). Conclusions:In 45.8% of the patients, ovulation did not occur even with OI treatment. The association of progesterone measurement and ovarian ultrasound scanning between 72 and 96 hours after hCG treatment can be used to detect ovulation. In doing so, we can find the optimal treatment for patients with infertility in their next cycle.

show abstract

Midluteal Progesterone: A Marker of Treatment Outcomes in Couples With Unexplained Infertility

Cited by 20 publications

References 29 publications

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

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

Luteal Phase in Assisted Reproductive Technology

The utility of detecting ovulation to predict success in ovulation induction and intrauterine insemination cycles — a prospective observational study

Contact Info

Product

Resources

About