Serum Progesterone Elevation Adversely Affects Cumulative Live Birth Rate in Different Ovarian Responders during In Vitro Fertilization and Embryo Transfer: A Large Retrospective Study

Abstract

In order to explore the relationship between serum progesterone (P) level on the day of human chorionic gonadotrophin (HCG) administration and cumulative live birth rate in patients with different ovarian response during in vitro fertilization (IVF), we carried out this retrospective cohort study including a total of 4,651 patients undergoing their first IVF cycles from January 2011 to December 2012. All patients with a final live birth outcome (4,332 patients) were divided into three groups according to ovarian response: poor ovarian responder (≤5 oocytes, 785 patients), intermediate ovarian responder (6–19 oocytes, 3065 patients) and high ovarian responder (≥20 oocytes, 482 patients). The thresholds for serum P elevation were 1.60 ng/ml, 2.24 ng/ml, and 2.50 ng/ml for poor, intermediate, and high ovarian responders, respectively. Cumulative live birth rate per oocyte retrieval cycle was calculated in each group. The relationship between serum P level and cumulative live birth rate was evaluated by both univariate and multivariate logistic regression analysis. Cumulative live birth rate per oocyte retrieval cycle was inversely associated with serum P level in patients with different ovarian response. For all responders, patients with elevated P level had significantly higher number of oocytes retrieved, but lower high quality embryo rate, and lower cumulative live birth rate compared with patients with normal serum P level. In addition, serum P level adversely affected cumulative live birth rate by both univariate and multivariate logistic regression analysis, independent of ovarian response. Serum P elevation on the day of HCG administration adversely affects cumulative live birth rate per oocyte retrieval cycle in patients with different ovarian response.

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

“…Our results thus extend the observation of two recent studies focused on Day 3 embryos [15–16] and deserve further research.…”

Serum progesterone trend after day of transfer predicts live birth in fresh IVF cycles

“…Interestingly, parallel research has also shown that high serum P4 at trigger has a positive or direct correlation on the number of oocytes retrieved, without an obvious effect on quality [3, 6, Fig. 2 Receiver operator characteristic curve for live birth and ongoing pregnancy rate when compared to any negative %ΔP4 with AUC 0.692 [15][16][17]. A study of the cumulative effects of fresh and FET cycles has shown that elevated serum P4, previously repeatedly reported to have a negative impact on LBR, may actually depend on ovarian response [15].…”

Impact of Serum Progesterone Levels in GnRH Antagonist Assisted Reproduction Cycles on Pregnancy Outcomes: A Prospective Cohort Study

“…The lower clinical pregnancy and live birth rates in group with high basal or late follicular progesterone may be explained by its effect on endometrium (altered receptivity) or its effect on oocyte/embryo quality or the synchrony between the two (advancement of implantation window)[19].The present literature presents conflicting evidence on its effect on oocyte and embryo quality. While some studies demonstrated an adverse effect on oocyte and top quality embryos rates[20] [21][22] [23], others showed comparable oocyte quality, fertilization, cleavage rates and embryo quality between high and normal progesterone groups[9] [24]-[29]. When it comes to clinical pregnancy and live birth rates, the dilemma continues.…”