Novel insights on premature progesterone elevation: a mini-review

Abstract

In vitro fertilization (IVF) success involves ovarian stimulation with conventional or mild stimulation protocols aimed to yield an adequate number of mature oocytes. These oocytes can be further fertilized and generate good quality embryos to be transferred, ideally in the same cycle. Since 2013, following the results of a metaanalysis including more than 60,000 IVF cycles, the negative effects of premature progesterone elevation on reproductive outcomes have been demonstrated. Nowadays, evidence is emerging on the limited regulation on serum progesterone values, demonstrating significantly lower live birth rates in patients with either low (<0.5ng/ ml) late follicular phase progesterone or higher levels decreasing sharply. This review discusses and summarizes the different mechanisms of progesterone elevation and its impact on IVF treatments. Different approaches to diminish the impact of progesterone on fertility outcomes are also addressed.

The usefulness of peri-trigger female reproductive hormones (delta-FRH) in predicting oocyte maturation in normal ovarian reserve patients who received in vitro fertilization-embryo transfer: a retrospective study

“…Delaying oocyte retrieval may allow for further progesterone rise and improved oocyte maturation. However, the optimal progesterone threshold and timing adjustments require further investigation, as excessive delays could compromise oocyte quality ( Cortes-Vazquez et al, 2022 ).…”

Endometriosis and IVF treatment outcomes: unpacking the process

“…First, the low ovarian reserve reduces the rate of optimal embryos to transfer. In addition, poor responders are at higher risk of early progesterone elevation [ 52 , 53 ], a condition that displace the window of implantation, therefore interfering with embryo implantation [ 54 ]. Second, endometriosis is associated with conditions that per se interfere with implantation, including adenomyosis, polyps and endometritis [ 3 , 55 – 57 ].…”

Low ovarian responders produce more progesterone per follicle than normal and high responders

“…Oocytes were retrieved transvaginally under ultrasound guidance 34-36 hours after hCG administration. The oocytes were graded for maturity based on the morphological characteristics, as previously described (Cortés-Vazquez et al, 2022).…”

“…This phenomenon has been shown to occur in 20.8 to 38.3% of all IVF/ICSI cycles, irrespective of the COS protocol employed (Bosch et al, 2003;Ubaldi et al, 1996). Some authors believe premature progesterone elevation may have different etiologies in accordance with the ovarian response; in high responders, multiple ovarian developments may cause progesterone accumulation, while in low responders, follicular aging may lead to progesterone elevation in contrasted mechanisms (Cortés-Vazquez et al, 2022).…”