Relation of progesterone and luteinizing hormone serum levels and Ultrasound endometrium criteria with intracytoplasmatic sperm injection outcome

Abstract

Background: Hormone levels (progesterone "P" and luteinizing hormone "LH) are vitally important to the proper functioning of the female reproductive cycle and together with Ultrasound assessment of endometrial receptivity may predict success of in vitro fertilization/ intracytoplasmatic sperm injection (IVF/ICSI). Objective: to study the effects of serum P and LH levels together with Ultrasound assessment of endometrial receptivity at the day of human chorionic gonadotrophin administration on fertilization and pregnancy rates. Patients and Methods: Thirty patients age ranged 22-38 years underwent ovarian stimulation using a gonadotrophinreleasing hormone (GnRH) agonist for pituitary down-regulation, and then ovarian hyperstimulation was initiated with highly purified human menopausal gonadotrophin (HMG). Final oocyte maturation was triggered 36 hours after human chorionic gonadotrophin (hCG) injection. On the day of hCG administration (Day 0), serum progesterone, LH levels together with Ultrasound assessment of endometrial receptivity (thickness, morphology and the spiral artery resistance index "RI") were evaluated. Fertilization and pregnancy rates were recorded. Results: There was no significant difference between the pregnant and non pregnant women, in respect to age. The pregnancy rate was not affected by the serum LH level but was only 18.75% in cycles in which serum P was more than 1.2 ng/ml on day 0, which was significantly lower than that in cycles in which serum P was less than 1.2 ng/ml on day 0 (64.28%) (P = 0.001). The fertilization rate was lower in the cycles with higher levels of serum P and/or LH than in cycles in which serum P was less than 1.2 ng/ml and serum LH was normal (51.66 vs. 68.85%). Failed cases had altered endometrium and a higher spiral artery RI (resistance index), meaning lower peri-implantation blood flow. Conclusion: This study concluded that the progesterone levels on the day of hCG administration (Day 0) can affect the success of in vitro fertilization, as higher progesterone levels were associated with lower rates of pregnancy and fertilization. Increase serum P level caused advanced endometrial maturation and impaired endometrial receptivity to embryo implantation. The embryo transfer (ET) in such cases can be canceled and freezing all embryos for future transfer must be considered, to increase acceptance of the endometrium and thus increase the success rate.