Exploration of the value of progesterone and progesterone/estradiol ratio on the hCG trigger day in predicting pregnancy outcomes of PCOS patients undergoing IVF/ICSI: a retrospective cohort study

Abstract

Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder with the disorders of estrogen(E2) and progesterone(P) secretion. The purpose of this study was to evaluate the association between the progesterone level or progesterone/estradiol(P/E2) ratio on human chorionic gonadotropin (hCG) trigger day and the outcome of in vitro fertilization in PCOS patients and explore the value of progesterone and P/E2 ratio for predicting the clinical pregnancy. Methods The clinical data of 1254 PCOS patients who satisfied the inclusion criteria were retrospectively analyzed, including baseline characteristics such as age, body mass index, basal sex hormone levels, et al., as well as ovarian stimulation data and clinic outcome. Results The number of follicles larger than 14 mm in diameter (P < 0.001) and retrieved oocytes (P < 0.001) was greater in the high progesterone group (progesterone ≥ 0.92 ng/mL). In the high P/E2 group(P/E2 ratio ≥ 0.3), the number of follicles larger than 14 mm in diameter (P < 0.001) and retrieved oocytes (P < 0.001), as well as the rate of high-quality embryos (P = 0.040) were significantly decreased. In ultralong GnRH agonist protocol, the implantation rate(P < 0.001), hCG positive rate (P < 0.001), clinical pregnancy rate (P < 0.001) and live birth rate (P < 0.001) were all significantly higher than long GnRH agonist protocol and GnRH antagonist protocol. The clinical pregnancy rate of high progesterone group was significantly lower than that of low progesterone group in ultralong GnRH agonist (P = 0.008). The progesterone level could be used as an indicator to predict the positive clinical pregnancy (long GnRH agonist: P = 0.001; ultralong GnRH agonist: P < 0.001) except in cycles using GnRH antagonist (P = 0.169). In the ultralong GnRH agonist, the value of progesterone level in the prediction of clinical pregnancy was significantly higher than that of the P/E2 ratio (P = 0.021). Conclusions In PCOS patients, the progesterone level is associated with clinical pregnancy rate while P/E2 ratio is not. In subgroup analysis using three different COS protocols, a significant association between progesterone level and clinical pregnancy rate can be observed in the long GnRH agonist protocol and ultralong GnRH agonist protocol. The progesterone level is significantly better than the P/E2 ratio in predicting the pregnancy outcome of PCOS patients, especially in ultralong GnRH agonist cycles.

Effects of trigger-day progesterone in the preimplantation genetic testing cycle on the embryo quality and pregnancy outcomes of the subsequent first frozen-thawed blastocyst transfer

“…Several clinical studies using PGT-A have found that elevated P during the late follicular period is irrelevant to the embryo euploidy rate and pregnancy outcomes ( 9 , 10 ). However, these findings contradict previously reported studies that high P affects embryo quality, possibly due to the use of different thresholds ( 12 , 15 ). Additionally, there are limited data assessing the correlation between P on the day of HCG injection and embryo quality, euploidy rates, and pregnancy outcomes in subsequent FET cycles.…”

“…( 29 ) discovered that on the trigger day, the mean number of top-quality blastocysts was lower in the P≥1.5 ng/ml group than in the P<1.5 ng/ml group. Two large retrospective studies ( 14 , 15 ) also indicated that high P was relevant to a reduced rate of top-quality blastocysts. Furthermore, Vanni et al.…”

“…Racca et al (29) discovered that on the trigger day, the mean number of top-quality blastocysts was lower in the P≥1.5 ng/ml group than in the P<1.5 ng/ml group. Two large retrospective studies (14,15) also indicated that high P was relevant to a reduced rate of top-quality blastocysts. Furthermore, Vanni et al (13) believed that when P levels reached or approached 1.5 ng/ml (>1.49), they could be considered an early warning sign of a decline in the top-quality blastocyst rate.…”

“…Conversely, some scholars have proposed that top-quality blastocysts represented by morphological grade are affected by high P ( 12 , 13 ). Furthermore, two large retrospective studies have shown that patients with high P have lower rates of top-quality blastocysts, cumulative live birth, and implantation ( 14 , 15 ). Clearly, patients with high P on the trigger day may lack top-quality blastocysts.…”

Effect of BMI on the value of serum progesterone to predict clinical pregnancy outcome in IVF/ICSI cycles: a retrospective cohort study

“…Increased P may be a significant negative factor for pregnancy outcomes. At present, in published reports, the debate over the influence of PE on hCG day on pregnancy outcomes has primarily focus on different ovarian stimulation protocols (GnRH antagonist or agonist protocols) ( 21 ), stages of embryos transferred (cleavage stage embryo or blastocyst) ( 22 ) and different ovarian responses (low, intermediate and high responses) ( 23 ). The relationship of P level on hCG day to clinical pregnancy outcomes in IVF/ICSI cycles for patients based on BMI is still unknown.…”