Clinical Value of Basal Serum Progesterone Prior to Initiate Ovarian Hyper-Stimulation with GnRH Antagonists: A Retrospective Cohort Study

Abstract

Background: The routine assessment of day 3 serum progesterone prior to initiation of ovarian hyper-stimulation with the use of GnRH antagonists is under debate. In this study, we evaluated the clinical utility of this policy. Methods: Retrospective cohort study of women undergoing in vitro fertilization (IVF) with the use of GnRH antagonists aimed at determining the frequency of cases with progesterone levels exceeding the recommended threshold of 1,660 pg/ml and at evaluating whether this assessment may be predictive of pregnancy. Results: Serum progesterone exceeded the recommended threshold in one case (0.3%, 95% CI 0.01-1.5). The median (interquartile range) basal progesterone in women who did (n = 95) and did not (n = 217) become pregnant were 351 (234-476) and 380 (237-531) pg/ml, respectively (p = 0.28). The 90th percentile of the basal progesterone distribution in women who became pregnant was 660 pg/ml. Cases with serum progesterone exceeding this threshold in successful and unsuccessful cycles were 10 (10%) and 30 (14%), respectively (p = 0.47). The capacity of basal progesterone to predict pregnancy was evaluated using receiver operating characteristic curve (area under the curve = 0.54, 95% CI 0.47-0.61, p = 0.28). No graphically evident threshold emerged. Conclusion: Routine day 3 serum progesterone assessment in IVF cycles with the use of GnRH antagonists is not justified. Further evidence is warranted prior to claiming its systematic use.

Top quality blastocyst formation rates in relation to progesterone levels on the day of oocyte maturation in GnRH antagonist IVF/ICSI cycles

“…All patients were treated with a GnRH antagonist protocol as previously described [ 21 – 22 ]. Briefly, both initial dose of FSH and dose adjustments during treatment were chosen on a case-by-case basis according to patients’ characteristics.…”

The curious case of premature luteinization

“…Mutlu et al [53] showed an association of basal progesterone above 0.65 ng/ml with preovulatory progesterone rise above 1.5 ng/ml; in this study, cycles with basal progesterone above 1.6 ng/ml were canceled. However, Faulisi et al [158] did not confirm the clinical value of basal progesterone value before the onset of stimulation with GnRH antagonist (day 3).…”

Effect of vitamin D supplementation on assisted reproduction technology (ART) outcomes and underlying biological mechanisms: protocol of a randomized clinical controlled trial. The “supplementation of vitamin D and reproductive outcome” (SUNDRO) study

“…Patients will be treated according to standard IVF protocols as described elsewhere [12, 13]: since neither the clinicians nor the recruited women will be aware about vitamin D dosage, clinical management of ovarian stimulation will not be conditioned by the study.…”