Progesterone elevation on the day of hCG trigger has detrimental effect on live birth rate in low and intermediate ovarian responders, but not in high responders

Abstract

Progesterone elevation (PE) on the day of hCG trigger is associated with decreased pregnancy outcome in fresh cycles. Evidence for this comes from overall patient estimates that mostly ignore different ovarian responses. To compare the impacts of PE on the day of hCG trigger on live birth rates (LBs) in low, intermediate and high ovarian responders and to explore the cut-off value for PE in different populations according to the ovarian response, we retrospectively analyzed a total of 2,351 patients receiving fresh assisted reproduction technology (ART) transfer cycles with GnRH agonist using a long or short protocol. Trend and multivariate logistic regression analyses were performed to identify the cutoff values of PE and to evaluate the effects of PE on LB rates (LBRs) in different ovarian responders. The study found that PE has a detrimental effect on LBRs in low to intermediate ovarian responders rather than in high responders. The cut-off values for PE were 1.0 ng/mL and 2.0 ng/mL for low and intermediate ovarian responders, respectively. The different associations between PE and LBRs according to ovarian response could more accurately predict the prognosis of the IVF cycle and could be used to optimize the treatment of patients undergoing In Vitro Fertilization (IVF)/ Intracytoplasmic Sperm Injection (ICSI).

Evaluation of Serum Progesterone Level on the Day of hCG Injection on Clinical Outcome of Antagonist Protocol in ICSI Cycles

“…The observations were contrary to the study by (Al-Obaidi, et al [11] ) which showed that triggering day were markedly high with progesterone elevation than in the nonprogesterone elevation groups (Wu, et al [14] ). The explanation is that, when FSH is used in stimulation, it induces bearing of LH receptors in granulosa cells, which leads to increase sensitivity to the same LH, which in turn could conduct to create the rise of progesterone prematurely, even with low level of serum LH (Glamoclija, et al [15] ).…”

Pre-ovulatory hormones on day of human chorionic gonadotropin trigger and assisted reproductive technique outcomes in different ovarian response groups

“…This supports the hypothesis that increasing P4 levels is a simple mass effect due to excess number of follicles, and therefore, PE is more likely in hyper-responders. [ 1 2 3 4 5 6 7 9 10 11 13 14 15 16 17 18 19 23 24 25 27 28 29 30 31 32 ] We noted higher pre-ovulatory P4 levels in hyper-responders but not higher PE rates, probably because the mean values were lower than the chosen cut-off to define PE. In addition, we did not find higher CPR in hyper-responders despite better COS characteristics and hormonal profiles, in contrast to the findings of previous studies.…”

The value of serum progesterone level on day of human chorionic gonadotrophin administration / metaphase II oocyte ratio in predicting IVF/ICSI outcome in patients with normal ovarian reserve

“…It should be noted however that the clinical utility of P/MII ratio may be less in patients with low ovarian reserve who would have higher ratio mainly because of low number of available oocytes (denominator) and not necessarily high level of progesterone. It would therefore seem that high progesterone level alone as denoted by previous studies may be clinically relevant [33]. On the other hand a beneficial effect of adoption of freeze all policy in patients with low number of available embryos has not been proven by randomized clinical trials.…”