The effect of weight and body mass index on serum progesterone values and live birth rate in cryopreserved in vitro fertilization cycles

Abstract

Objective: To determine if weight or body mass index (BMI) affects the serum progesterone level at the time of the pregnancy test in cryopreserved blastocyst transfer cycles and to determine if those serum progesterone levels affect live births. Design: Retrospective cohort study. Setting: US academic medical center. Patient(s): Six hundred thirty-three patients undergoing their first cryopreserved embryo transfer cycle. Intervention(s): None. Main Outcome Measure(s): The primary outcome was the serum progesterone level on the day of the pregnancy test by patient weight and BMI. Our secondary analysis assessed the serum progesterone effect on live birth rate (LBR) in a clinic where progesterone supplementation was increased if the progesterone level was <15 ng/mL on the day of the pregnancy test. Results(s): There was a strong negative correlation between serum progesterone level and both BMI and weight, with BMI accounting for 27% and weight accounting for 29% of the variance in progesterone level. Serum progesterone level on the day of the pregnancy test was <15 ng/mL in 3% of women weighing <68 kg compared with 29% of women weighing R90.7 kg. Among women weighing R90.7 kg, live birth occurred in 47% whose serum progesterone level was <15 ng/mL on the day of the pregnancy test compared with 49% in those with serum progesterone level of 15-19 ng/mL and 44% in those with serum progesterone level of R20 ng/mL. Conclusion(s): Body weight was a significant factor in serum progesterone level at the time of the pregnancy test, with nearly 30% of patients weighing R90.7 kg having serum progesterone level of <15 ng/mL, a value associated with lower LBRs in prior studies. However, we found no effect of low progesterone levels on LBR after cryopreserved embryo transfer cycles in a clinic where progesterone dosing was increased if serum progesterone levels were <15 ng/mL. (Fertil Steril Rep Ò 2021;2:195-200. Ó2021 by American Society for Reproductive Medicine.

T cells in obesity‐associated inflammation: The devil is in the details

“…Several studies showed that as BMI in women increases, the level of serum progesterone decreases. [48][49][50][51] Lowering progesterone through use of oral contraceptives drastically reduced Tregs in women, 52 consistent with the suggestion that BMI-associated decreases in progesterone lower Tregs in obesity and thus potentiate shifts in inflammatory profiles. Data that complement effects on Tregs showed that progesterone (at specific concentrations) activates CD4 + cells and downregulates numerous T cell cytokines including those associated with Th1, Th2, and Th17 subsets.…”

Effect of BMI on the value of serum progesterone to predict clinical pregnancy outcome in IVF/ICSI cycles: a retrospective cohort study

“…Most importantly, baseline E2, FSH level, and E2 and P level on triggering day were significantly lower in the overweight/obese group compared to the normal weight group, consistent with findings from several prior studies ( 12 , 31 – 34 ). For instance, previous research has reported that in cryopreserved blastocyst transfer cycles, serum P levels on the day of pregnancy testing were <15 ng/mL in 29% of women weighing >90.7 kg, versus 3% in those weighing <68 kg ( 32 ). In addition, in intrauterine insemination cycles for patients <35 years old, serum E2, LH, and P levels were negatively correlated with BMI on hCG day ( 33 ).…”

The effect of frozen embryo transfer regimen on the association between serum progesterone and live birth: a multicentre prospective cohort study (ProFET)

“…Systemically, progesterone exerts a regulatory role upon the innate and acquired immune responses, resulting in an inhibition of cytotoxicity and the induction of immune tolerance required for successful implantation ( Szekeres-Bartho, 2018 ; Shah et al , 2019 ). The bioavailability of progesterone administered vaginally varies according to many factors including dose, frequency of administration, the woman’s age and BMI, the saturability of vaginal and uterine progesterone receptors, and the ability of the epithelial lining to absorb the drug into the systemic circulation ( MacLaughlin and Richardson, 1976 ; Levy et al , 1980 ; Archer et al , 1995 ; González-Foruria et al , 2020 ; Whynott et al , 2021 ). There is, hence, biological plausibility to the hypothesis that in women with a low level of circulating progesterone, the addition of a systemic route of exogenous progesterone administration may compensate, at least partly, for low absorption rates where there is impaired local absorption.…”