The value of the progesterone-to-estradiol ratio on the day of hCG administration in predicting ongoing pregnancy and live birth rates in normoresponders undergoing GnRH antagonist cycles

Çetinkaya, Şerife Esra; Berker, Bülent; Aytaç, Ruşen; Sönmezer, Murat; Özmen, Batuhan

doi:10.1016/j.ejogrb.2013.07.033

Cited by 24 publications

(24 citation statements)

References 30 publications

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“…It has been suggested that a patient's hormone profile during COS is related to ovarian response and that the P level increases as the number of follicles and E 2 level increase [18]. Some studies have suggested that the progesterone-toestradiol ratio (P/E 2 ) reflects premature luteinization and that it could be a more accurate predictor of IVF outcome than the isolated P level [19,20]. However, these studies that have correlated the P/E 2 to IVF outcome have reported unsatisfactory values for sensitivity, specificity, and AUC [19,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have suggested that the progesterone-toestradiol ratio (P/E 2 ) reflects premature luteinization and that it could be a more accurate predictor of IVF outcome than the isolated P level [19,20]. However, these studies that have correlated the P/E 2 to IVF outcome have reported unsatisfactory values for sensitivity, specificity, and AUC [19,21,22]. Conversely, our test showed a moderate level of accuracy with AUC=0.756, and it exhibited good sensitivity and specificity of 71 % and 71.1 %, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The ovarian response, number of retrieved oocytes, number of mature oocytes retrieved, and number of fertilized eggs were significantly lower in the patients with a P/F ratio>.075. Some studies using the P/E 2 ratio have found similar results after establishing a cut-off value for P/E 2 , suggesting that this ratio is associated with lower fertility [19,26]. Studies attempting to establish cut-off levels or ratios using hormonal measurements may be influenced by the different measurement techniques used or by the lab at which they are measured.…”

Section: Discussionmentioning

confidence: 99%

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Ratio of progesterone-to-number of follicles as a prognostic tool for in vitro fertilization cycles

Roque

Valle

Sampaio

et al. 2015

J Assist Reprod Genet

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Purpose To establish a ratio of the P level to the number of follicles (P/F ratio) on the day of human chorionic gonadotropin (hCG) administration and to evaluate whether this ratio is associated with in vitro fertilization (IVF) outcome. Methods This study was conducted between January 2012 and June 2013. A total of 337 patients with cleavage-stage day-3 fresh embryo transfer with P levels ≤1.5 ng/mL on the day of hCG administration were included in the study. The main outcome was ongoing pregnancy rate. Result(s) The P/F ratio was calculated according to the equation (P[ng/mL]/number of follicles) on the day of final oocyte maturation. Using ROC, we established a cut-off level of 0.075 for the P/F ratio. The area under the curve (AUC) (0.756; 95 % confidence interval [CI]: 0.704-0.807) indicated that it was a good prognostic test. In group 1 (patients under 36 years old), the ongoing pregnancy rates were 57 and 30 % for patients with P/F ratios≤.075 and>.075, respectively, (p= 0.003). In group 2 (patients between 36 and 39 years old), the ongoing pregnancy rates were 58 % and 17 % (p=0.001) for patients with P/F ratios ≤.075 and>.075, respectively. In group 3 (patients≥40 years old), the ongoing pregnancy rates were 41.7 and 10.9 % (p=0.001) for patients with P/F ratios≤.075 and>.075, respectively. Conclusions The P/F ratio is a good prognostic test for predicting IVF outcome that can correlate the P level with ovarian response.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ratio of progesterone-to-number of follicles as a prognostic tool for in vitro fertilization cycles

Roque

Valle

Sampaio

et al. 2015

J Assist Reprod Genet

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“…In a recent systemic review [11], he expanded and further confirmed his findings. It seemed that a ratio of progesterone-to-estradiol > 0.48 reduced pregnancy rates in antagonist cycles and that this ratio was found to be an independent predictor of pregnancy [12]. The effect of elevated progesterone levels was higher in patients with a rather low ovarian response [11].…”

Section: Discussionmentioning

confidence: 99%

Delaying the oocyte maturation trigger by one day leads to a higher metaphase II oocyte yield in IVF/ICSI: a randomised controlled trial

Vandekerckhove

Gerris

Vansteelandt

et al. 2014

Reprod Biol Endocrinol

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BackgroundThe negative impact of rising progesterone levels on pregnancy rates is well known, but data on mature oocyte yield are conflicting. We examined whether delaying the oocyte maturation trigger in IVF/ICSI affected the number of mature oocytes and investigated the potential influence of serum progesterone levels in this process.MethodsBetween January 31, 2011, and December 31, 2011, 262 consecutive patients were monitored using ultrasound plus hormonal evaluation. Those with > =3 follicles with a mean diameter of > =18 mm were divided into 2 groups depending on their serum progesterone levels. In cases with a progesterone level < = 1 ng/ml, which was observed in 59 patients, 30-50% of their total number of follicles (only counting those larger than 10 mm) were at least 18 mm in diameter. These patients were randomised into 2 groups: in one group, final oocyte maturation was triggered the same day; for the other, maturation was triggered 24 hours later. Seventy-two patients with progesterone levels > 1 ng/ml were randomised in the same manner, irrespective of the percentage of larger follicles (> = 18 mm). The number of metaphase II oocytes was our primary outcome variable. Because some patients were included more than once, correction for duplicate patients was performed.ResultsIn the study arm with low progesterone (<= 1 ng/ml), the mean number of metaphase II oocytes (+/-SD) was 10.29 (+/-6.35) in the group with delayed administration of the oocyte maturation trigger versus 7.64 (+/-3.26) in the control group. After adjusting for age, the mean difference was 2.41 (95% CI: 0.22-4.61; p = 0.031). In the study arm with elevated progesterone (>1 ng/ml), the mean numbers of metaphase II oocytes (+/-SD) were 11.81 (+/-9.91) and 12.03 (+/-7.09) for the delayed and control groups, respectively. After adjusting for PCOS (polycystic ovary syndrome) and female pathology, the mean difference was -0.44 (95% CI: -3.65-2.78; p = 0.79).ConclusionsDelaying oocyte maturation in patients with low progesterone levels yields greater numbers of mature oocytes.Trial registrationB67020108975 (Belgian registration) and NCT01980563 (ClinicalTrials.gov).

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“…Several studies have reported that elevated progesterone levels in the late follicular phase decrease pregnancy/live birth rates [37–40], which is considered to be due to advancement of the endometrium [41,42], without affecting oocyte/embryo quality [43–45]. Also, an elevated progesterone/estradiol ratio on the day of hCG has been suggested to better reflect “premature luteinisation” [46] and to be associated with lower pregnancy rates in both agonist [47] and antagonist protocols [48]. It should be noted that the progesterone/estradiol ratio was significantly lower after HP-hMG treatment in both protocols in the present study due to the more estrogenic microenvironment induced by the HP-hMG preparation [35].…”

Section: Discussionmentioning

confidence: 99%

The rate of high ovarian response in women identified at risk by a high serum AMH level is influenced by the type of gonadotropin

Arce

Klein

Marca

2014

Gynecological Endocrinology

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The aim was to compare ovarian response and clinical outcome of potential high-responders after stimulation with highly purified menotropin (HP-hMG) or recombinant follicle-stimulating hormone (rFSH) for in vitro fertilisation/intracytoplasmic sperm injection. Retrospective analysis was performed on data collected in two randomized controlled trials, one conducted following a long GnRH agonist protocol and the other with an antagonist protocol. Potential high-responders (n = 155 and n = 188 in the agonist and antagonist protocol, respectively) were defined as having an initial anti-Müllerian hormone (AMH) value >75th percentile (5.2 ng/ml). In both protocols, HP-hMG stimulation in women in the high AMH category was associated with a significantly lower occurrence of high response (≥15 oocytes retrieved) than rFSH stimulation; 33% versus 51% (p = 0.025) and 31% versus 49% (p = 0.015) in the long agonist and antagonist protocol, respectively. In the potential high-responder women, trends for improved live birth rate were observed with HP-hMG compared with rFSH (long agonist protocol: 33% versus 20%, p = 0.074; antagonist protocol: 34% versus 23%, p = 0.075; overall population: 34% versus 22%, p = 0.012). In conclusion, the type of gonadotropin used for ovarian stimulation influences high-response rates and potentially clinical outcome in women identified as potential high-responders.

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The value of the progesterone-to-estradiol ratio on the day of hCG administration in predicting ongoing pregnancy and live birth rates in normoresponders undergoing GnRH antagonist cycles

Cited by 24 publications

References 30 publications

Ratio of progesterone-to-number of follicles as a prognostic tool for in vitro fertilization cycles

Ratio of progesterone-to-number of follicles as a prognostic tool for in vitro fertilization cycles

Delaying the oocyte maturation trigger by one day leads to a higher metaphase II oocyte yield in IVF/ICSI: a randomised controlled trial

The rate of high ovarian response in women identified at risk by a high serum AMH level is influenced by the type of gonadotropin

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