The Association Between Elevated Progesterone Level on Day of hCG Trigger and Live Birth Rates in ART Cycles: A Single Centre Observational Study

Robati, Shahin; Saab, Wiam; Durán-Retamal, Montserrat; Saab, Wael; Theodorou, Efstathios; Cawood, Suzanne; Serhal, Paul; Seshadri, Srividya

doi:10.18502/jri.v21i4.4333

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…So far, many studies have evaluated the effect of elevated progesterone level on the trigger day on the clinical outcomes after IVF/ICSI cycles [ 11 – 14 ]. But few studies analysed whether slight elevation of progesterone level (1.0–1.5 ng/ml) has detrimental effect on the outcomes, especially in GnRH-ant protocol.…”

Section: Discussionmentioning

confidence: 99%

Effect of slightly elevated progesterone on hCG trigger day on clinical pregnancy rate in GnRH-ant IVF/ICSI cycles

Zhao

Hao

et al. 2022

Reprod Health

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Background It was been agreed that significantly elevated progesterone level on the hCG trigger day have detrimental effect on clinical outcomes in IVF/ICSI cycles. However, few studies explored whether slightly elevated progesterone level also same impact on clinical outcomes. Methods We retrospectively studies the effect of slightly elevated progesterone level on outcomes of IVF/ICSI in GnRH-ant cycles. Propensity score matching was used to confounding variables. The women were divided into two groups according to the progesterone level: Group 1: < 1.0 ng/ml; Group 2: 1.0 ng/ml–1.5 ng/ml. Then compare the clinical pregnancy rate (CPR) between the two groups. Result A total of 847 IVF/ICSI cycles were included in the present study. The average CPR per transfer cycle was 51.7%. CPR of group 1 was 55.22%, significantly higher than that of group 2 (40.66%, P = 0.013). Progesterone level on the day of hCG injection was further evaluated at threshold increments of 0.1 ng/ml, and the CPR was decreased dramatically once the progesterone level higher than 1.4 ng/ml. Conclusion The slight elevation progesterone level on the hCG trigger day may have a negative effect on the clinical pregnancy in GnRH-ant cycles. In the case of progesterone > 1.4 ng/ml on the hCG injection day, freeze-all strategy was recommended. Summary The present retrospective study aimed to evaluate the effect of slightly elevated progesterone (1.0 ng/ml ~ 1.5 ng/ml) on outcomes of IVF/ICSI in GnRH-ant cycles. Slightly elevated progesterone level leaded to significant lower clinical pregnancy rate (CPR) that that of group with normal progesterone level (40.66% vs. 55.22%, P = 0.013). The CPR was decreased dramatically once the progesterone level higher than 1.4 ng/ml. So slightly elevated progesterone level on the trigger day may have a negative effect on the clinical pregnancy in GnRH-ant cycles. In the case of progesterone > 1.4 ng/ml on the hCG injection day, freeze-all strategy was recommended.

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Section: Discussionmentioning

confidence: 99%

Effect of slightly elevated progesterone on hCG trigger day on clinical pregnancy rate in GnRH-ant IVF/ICSI cycles

Zhao

Hao

et al. 2022

Reprod Health

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“…It is also known that the number of collected oocytes is also related to the frequency of PL. Thus, several researchers recommended considering the ratio of P4 to E2, or P4 to the number of collected oocytes, as good predictors, rather than the use of the absolute value of P4 [ 35 , 36 , 37 , 38 , 39 ]. Correspondingly, our study evaluated the effect of P4/oocyte ratios on oocytes’ and embryos’ quality.…”

Section: Discussionmentioning

confidence: 99%

Effects of Elevated Progesterone Levels on the Day of hCG on the Quality of Oocyte and Embryo

Woo

Kwon

Choi

et al. 2022

JCM

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This study is designed to investigate the effects of increased progesterone (P4) levels on the quality of retrieved oocytes and embryos during IVF. This retrospective analysis included 982 all-freezing in vitro fertilization (IVF) cycles (conducted between November 2019 and June 2020 at CHA Fertility Center Bundang, South Korea) in which serum P4 levels were measured on the day of human chorionic gonadotropin (hCG) administration. Our study revealed that the serum P4 levels on the day of hCG administration are strongly associated with the rates of oocyte maturation, displaying a positive correlation in patients with serum P4 < 2.25 ng/mL (p = 0.025). Moreover, patients with serum P4 < 1.25 ng/mL showed relatively low fertilization rates (p = 0.037), and the rates of good embryo retrieval were significantly increased with the serum P4 level < 1.5 ng/mL (p = 0.001). Interestingly, serum P4 level on the day of hCG administration affects the rate of good-quality embryo development, especially at the cleavage stage, and is associated with the status of ovarian responses. Our current study suggests that serum P4 level on the day of hCG administration negatively affects the rates of oocyte maturation, fertilization, and the development of good embryos.

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“…This is also the most widely accepted threshold. [6][7][8][13][14][15] However, few studies have analyzed whether just a slight elevation in progesterone level (1.0-1.5ng/mL) has a detrimental effect on the outcomes. In clinical practice, we observed that progesterone levels between 1.0 and 1.5 seem to have an adverse effect on pregnancy outcome, and we determined these two thresholds according to the literature and clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…2 Although the cut-off values for the possible adverse effects of progesterone level on pregnancy outcomes range from 0.8 to 2.5ng/mL, according to the literature, [2][3][4][5] most studies suggest that the clinical pregnancy rate is reduced and a "freeze-all" strategy is recommend when the progesterone level is above 1.5ng/mL. [6][7][8][9] More refined studies are urgently needed regarding possible progesterone thresholds. These should include several identification parameters (eg, patient characteristics, type of ovarian response, stimulation protocol).…”

Section: Introductionmentioning

confidence: 99%

Slightly Elevated Progesterone on HCG Trigger Day Has an Impact on Pregnancy Outcomes of Fresh Single Blastocyst Transfer Cycles Under an Early Follicular Phase Prolonged Protocol Cycle

Wei¹,

Yan²,

Xu³

et al. 2022

IJWH

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Background:The effect of premature progesterone elevation on assisted reproductive technology has been debated. In different ovarian stimulation protocols, ovarian responses, and embryos transferred, conflicting results reside regarding the impact of elevated progesterone on pregnancy outcomes, according to previous studies. In addition, most studies have focused on significantly elevated progesterone levels, eg, above 1.5ng/mL, 1.75ng/mL, 2ng/mL. However, studies focusing on levels that are just slightly elevated are lacking, and some have concluded that such levels have no adverse effects on pregnancy outcomes. Methods: Clinical data of patients who underwent early follicular phase prolonged protocol cycle in vitro fertilization/intracytoplasmic sperm injection treatment were collected. Patients were divided into two groups according to progesterone level on the trigger day of human chorionic gonadotropin (HCG): Group 1: < 1.0ng/mL and Group 2: 1.0-1.5ng/mL. Differences in baseline characteristics, ovulation promotion, and embryo culture, along with clinical pregnancy outcomes, were compared between the two cohorts. Results: A total of 743 participants were included in this study, of which 587 were included in Group 1 and 156 were included in Group 2. In terms of pregnancy outcomes, Group 2 had a significantly lower clinical pregnancy rate and live birth rate per cycle than Group 1 (64.1% vs 75.7%, p < 0.05; 63.5% vs 72.7%, p < 0.05). After correction for maternal age, maternal body mass index, infertility duration, basal follicle-stimulating hormone, anti-Müllerian hormone, antral follicle count, total dose of gonadotropin, days of stimulation, and estradiol level on HCG trigger day, slightly elevated progesterone levels (P > 1.0ng/mL) remained a risk factor for pregnancy failure in fresh single D5 blastocyst transfer under an early follicular phase prolonged protocol cycle. Conclusion: Slightly elevated progesterone levels on HCG trigger day may negatively affect pregnancy outcomes in early follicular phase prolonged protocol cycles.

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The Association Between Elevated Progesterone Level on Day of hCG Trigger and Live Birth Rates in ART Cycles: A Single Centre Observational Study

Cited by 5 publications

References 19 publications

Effect of slightly elevated progesterone on hCG trigger day on clinical pregnancy rate in GnRH-ant IVF/ICSI cycles

Effect of slightly elevated progesterone on hCG trigger day on clinical pregnancy rate in GnRH-ant IVF/ICSI cycles

Effects of Elevated Progesterone Levels on the Day of hCG on the Quality of Oocyte and Embryo

Slightly Elevated Progesterone on HCG Trigger Day Has an Impact on Pregnancy Outcomes of Fresh Single Blastocyst Transfer Cycles Under an Early Follicular Phase Prolonged Protocol Cycle

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