1
|
Karaçin P, Özelçi R, Kumcu E, Kaya Kaplanoğlu D, Dilbaz S, Üstün Y. Relationship Between Estradiol Levels Measured on the Initiation Day of GnRH Antagonist Treatment and Pregnancy Outcomes in Patients Receiving the Antagonist Protocol. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:741. [PMID: 40283032 PMCID: PMC12028630 DOI: 10.3390/medicina61040741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 04/06/2025] [Accepted: 04/09/2025] [Indexed: 04/29/2025]
Abstract
Background and Objectives: The aim of this study is to evaluate the relationship between serum estradiol (E2) levels measured on the day of antagonist administration and live birth rates (LBRs) in women undergoing IVF-ET with an antagonist protocol. Materials and Methods: Data from women who underwent IVF-ET with an antagonist protocol between 2011 and 2023 were retrospectively analyzed. Patients were divided into five groups on the basis of serum E2 levels measured on the day of antagonist administration (Group I: E2 < 400 pg/mL, Group II: 400 ≤ E2 < 650 pg/mL, Group III: 650 ≤ E2 < 800 pg/mL, Group IV:800 ≤ E2 < 1000 pg/mL, and Group V: E2 ≥ 1000 pg/mL). The independent effect of serum E2 levels on live birth was analyzed via an adjusted regression model. Results: A total of 1613 patients were included in the study. The overall LBR was 32.1%. The LBRs for Groups I, II, III, IV, and V were 28.9%, 37.8%, 26.4%, 32.2%, and 34.1%, respectively (p = 0.017). In the adjusted regression model, serum E2 levels measured on the day of antagonist administration < 400 pg/mL (OR: 0.752, 95% CI: 0.580-0.999, p = 0.048) and 650 ≤ E2 < 800 pg/mL (OR: 0.595, 95% CI: 0.388-0.911, p = 0.011) were identified as factors that reduce the likelihood of a live birth, adjusting for age, infertility duration, body mass index (BMI), cycle number, quality of embryo, and number of embryos transferred. Conclusions: The serum E2 level associated with the highest LBR in women undergoing IVF-ET with an antagonist protocol was found to be in the range of 400-650. Serum E2 levels < 400 pg/mL or in the range of 650-800 pg/mL were statistically significantly associated with a reduced LBR.
Collapse
Affiliation(s)
- Pınar Karaçin
- Department of Gynecology, Etlik City Hospital, Ankara 06010, Türkiye;
| | - Runa Özelçi
- Department of Gynecology, Etlik Zubeyde Hanim Training and Research Hospital, Ankara 06010, Türkiye; (R.Ö.); (S.D.)
| | - Enes Kumcu
- Department of Gynecology, Etlik City Hospital, Ankara 06010, Türkiye;
| | | | - Serdar Dilbaz
- Department of Gynecology, Etlik Zubeyde Hanim Training and Research Hospital, Ankara 06010, Türkiye; (R.Ö.); (S.D.)
| | - Yaprak Üstün
- Department of Gynecology, Etlik Zubeyde Hanim Training and Research Hospital, Ankara 06010, Türkiye; (R.Ö.); (S.D.)
| |
Collapse
|
2
|
Sun Y, Wang J, Zhang L, Chang Y, Zhu A. Effects of trigger-day progesterone in c-IVF/ICSI cycles on blastocyst culture outcomes. Front Endocrinol (Lausanne) 2025; 16:1496803. [PMID: 40013313 PMCID: PMC11860069 DOI: 10.3389/fendo.2025.1496803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Accepted: 01/27/2025] [Indexed: 02/28/2025] Open
Abstract
Objective To assess whether trigger-day progesterone (P) levels in conventional in vitro fertilization (c-IVF)/intracytoplasmic sperm injection (ICSI) cycles are associated with blastocyst culture outcomes. Methods In this retrospective analysis, 747 eligible patients (747 cycles) who adopted the gonadotropin-releasing hormone (GnRH) antagonist protocol and underwent c-IVF/ICSI between January 2021 to June 2024 were recruited. The P cutoff values were 1.0 and 1.5 ng/ml when trigger-day serum P was measured, and 4177 day3 (D3) embryos for blastocyst culture were grouped according to trigger-day P levels. Furthermore, the effects of trigger-day P on blastocyst culture outcomes were evaluated. Results In total, 747 cycles, 4177 D3 embryos for blastocyst culture were analyzed. After adjustments, multivariate logistic regression analysis revealed that compared with those in the normal level group, available blastocyst rate (adjusted OR, 0.780; 95% CI, 0.645-0.942; P=0.010) and D5 available blastocyst rate (adjusted OR, 0.736; 95% CI, 0.604-0.898; P=0.003) in the high level group were significantly reduced. Subgroup analysis showed that when female age was less than 35 years old, compared with that (36.30%) in the normal level group, the D5 available blastocyst rate (36.92%, adjusted OR, 0.744; 95% CI, 0.602-0.920; P=0.006) in the high level group was significantly reduced. In ICSI cycles, compared with that (28.69%) in the normal level group, the D5 available blastocyst rate (19.13%, adjusted OR, 0.369; 95% CI, 0.194-0.703; P=0.002) in the high level group was significantly decreased. Conclusions This study demonstrated that in the c-IVF/ICSI population, the trigger-day slightly elevated P (1.0-1.5ng/ml) was not related to blastocyst culture outcomes, while the trigger-day elevated P (>1.5ng/ml) was an important factor affecting D5 available blastocyst rate, especially when the woman was younger than 35 years old or insemination type was ICSI.
Collapse
Affiliation(s)
| | | | | | | | - Aizhen Zhu
- Department of Reproductive Medicine, Yuncheng Central Hospital affiliated to Shanxi Medical University, Yuncheng, China
| |
Collapse
|
3
|
Lim YC, Hamdan M, Maheshwari A, Cheong Y. Progesterone level in assisted reproductive technology: a systematic review and meta-analysis. Sci Rep 2024; 14:30826. [PMID: 39730597 DOI: 10.1038/s41598-024-81539-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 11/27/2024] [Indexed: 12/29/2024] Open
Abstract
Elevated progesterone (EP) or inadequate progesterone levels during ART cycle monitoring may lead to cycle cancellations or further progesterone supplementation, but practice varies. It remains controversial whether modifying clinical practice in the presence or absence of EP improves clinical outcomes. This systematic review aims to investigate if progesterone levels at different phases of fresh and frozen ART cycles influence pregnancy outcomes, in particular, that pertaining to day 3 versus day 5 embryo transfers. A systematic search of EMBASE, MEDLINE, CINAHL, PubMed, SCOPUS and Web of Science identified studies from the year 2000. We included studies with women undergoing fresh and frozen IVF/ICSI cycles; with extractable per woman data on pregnancy outcomes where serum progesterone measurement was performed. We excluded interventional studies that influence clinical decisions or studies with donor cycles. The Newcastle Ottawa Scale (NOS) was used to determine the risk of bias. The primary outcome was LBR, and the secondary outcomes were OPR, CPR and MR. PICOS study protocol was used to include non-randomized studies of interventions (NRSI). Analysis was done using RevMan5 and the studies were pooled using the DerSimonian and Laird for random effects meta-analysis. The study was registered with PROSPERO (registration ID CRD42022382423). 64 studies (N = 57,988 women) were included. In fresh cycles, there is no evidence that at baseline EP impacts LBR (P > 1.5 ng/ml, OR 0.76 [95% CI 0.39-1.49], 2 studies, N = 309) and CPR (P > 1.5 ng/ml, OR 0.81 [0.38-1.71], 2 studies, N = 309). EP at ovulation trigger is associated with a lower LBR (P > 1.0 ng/ml, OR 0.40 [0.23-0.69], 2 studies, N = 2805) and CPR (P > 1.0 ng/ml, OR 0.49 [0.42-0.58], 3 studies, N = 3323; P > 1.1 ng/ml, OR 0.66 [0.53-0.83], 2 studies, N = 2444; P > 1.2 ng/ml, OR 0.61 [0.39-0.96], 6 studies, N = 844; P > 1.5 ng/ml, OR 0.37 [0.17-0.81], 6 studies, N = 13,870; P > 2.0 ng/ml, OR 0.43 [0.31-0.59], 3 studies, N = 1949) with D3 embryo but not D5 [LBR (P > 1.5 ng/ml, OR 1.02 [0.74-1.39], 3 studies, N = 5174) and CPR (P > 1.5 ng/ml, OR 0.88 [0.67-1.14], 6 studies, N = 5705)]. We could not meaningfully meta-analyse studies on the day of egg collection in fresh cycles, embryo transfer in fresh cycles, at ovulation trigger or before ovulation in natural FET cycles and FET cycles due to significant study heterogeneity. We acknowledged the limitations on including studies post year 2000 and the exclusion of studies with multiple observations, which may result in inherent publication bias and some confounding factors uncontrolled for. In conclusion, in controlled ovarian stimulation, EP at baseline did not impact on LBR; EP at ovulation trigger is associated with a lower LBR for D3 but not for D5 embryo transfer. In FET cycles, as the studies were heterogeneous, we were unable to combine the data in a meaningful way. This review is sponsored by Complete Fertility and the Ministry of Health, Malaysia.
Collapse
Affiliation(s)
- Yee Cherng Lim
- Complete Fertility, Princess Anne Hospital, Level F, Coxford Road, Southampton, SO16 5YA, UK
- Department of Obstetrics and Gynaecology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mukhri Hamdan
- Department of Obstetrics and Gynaecology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | | | - Ying Cheong
- Complete Fertility, Princess Anne Hospital, Level F, Coxford Road, Southampton, SO16 5YA, UK.
- Human Development and Health Unit, Institute of Life Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.
| |
Collapse
|
4
|
Baldini D, Bartoli VM, Mastrorocco A, Ferri D, Dellino M, Laganà AS, Hatirnaz S, Baldini GM, Malvasi A, Vimercati A, Trojano G. Progesterone peak influences embryonic developmental morphokinetics on trigger day? A retrospective study. J Ovarian Res 2024; 17:216. [PMID: 39501319 PMCID: PMC11536879 DOI: 10.1186/s13048-024-01548-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 10/28/2024] [Indexed: 11/09/2024] Open
Abstract
OBJECTIVE Premature Progesterone Rise (PPR) is characterized by elevated serum progesterone concentrations either towards the end of the follicular phase or on the trigger day, surpassing a pre-defined threshold value. Aim of the study is to evaluate the impact of PPR exceeding 1.5 ng/ml at the time of hCG-trigger on embryo morphokinetic parameters and to identify predictive biomarkers of in IntraCytoplasmic Sperm Injection (ICSI) cycles outcomes. METHODS It is a retrospective study including patients underwent ICSI cycles in the period 2020-2023. 58 patients were recruited in the study group showing P levels in the trigger day greater than or equal to 1.5 ng/ml. A matching control group of 58 patients with P levels below 1.5 ng/ml was after selected. The general characteristics of these patients, including age, Body Mass Index (BMI), antral follicle count (AFC), anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) levels, the type of infertility and smoking/non-smoking patients, were recorded on the day of their initial visit. Subsequently, data were collected regarding the number of eggs retrieved, mature eggs, successfully fertilized eggs, and embryos reaching the blastocyst stage. Additionally, the timing of embryonic development and the quality of obtained blastocysts, as assessed by the degree of expansion and the characteristics of the inner cell mass (ICM) and trophectoderm (TE), were evaluated using Time-Lapse technology. RESULTS Elevated P levels exceeding 1.5 ng/ml on the trigger day were directly associated with a significantly larger number of antral follicles, consequently leading to a higher count of retrieved eggs, mature eggs, successfully fertilized eggs and embryos reaching the blastocyst stage. Furthermore, the analysis of morphokinetic parameters indicated faster division times and a notably greater number of high-grade blastocysts in the study group compared to the control group. CONCLUSIONS P levels ≥ 1.5 ng/ml on the trigger day did not negatively impact embryonic morphokinetic parameters, instead resulting in faster embryo development in the initial stages.
Collapse
Affiliation(s)
- D Baldini
- MOMO' FertiLIFE, IVF Clinic, Bisceglie, 76011, Italy.
| | - V M Bartoli
- Department of Biosciences, Biotechnologies and Environment, University of Bari "Aldo Moro", Bari, 70125, Italy
| | - A Mastrorocco
- Department of Biosciences, Biotechnologies and Environment, University of Bari "Aldo Moro", Bari, 70125, Italy
| | - D Ferri
- MOMO' FertiLIFE, IVF Clinic, Bisceglie, 76011, Italy
| | - M Dellino
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, 70124, Italy
| | - A S Laganà
- Unit of Obstetrics and Gynecology, Department of Health Promotion, Mother and Childcare, Internal Medicine and Medical Specialties (PROMISE), "Paolo Giaccone" Hospital, University of Palermo, Palermo, 90127, Italy
| | - S Hatirnaz
- Mediliv Medical Center, Ilkadim, Samsun, Turkey
| | - G M Baldini
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, 70124, Italy
| | - A Malvasi
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, 70124, Italy
| | - A Vimercati
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, 70124, Italy
| | - G Trojano
- Madonna Delle Grazie Hospital ASM, Matera, 75100, Italy
| |
Collapse
|
5
|
Bila J, Makhadiyeva D, Dotlic J, Andjic M, Aimagambetova G, Terzic S, Bapayeva G, Laganà AS, Sarria-Santamera A, Terzic M. Predictive Role of Progesterone Levels for IVF Outcome in Different Phases of Controlled Ovarian Stimulation for Patients With and Without Endometriosis: Expert View. Reprod Sci 2024; 31:1819-1827. [PMID: 38388924 DOI: 10.1007/s43032-024-01490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
The study aimed to review the role of basal, trigger, and aspiration day progesterone levels (PLs) as predictors of in vitro fertilization (IVF) success for patients with and without endometriosis. A non-systematic review was conducted by searching papers published in English during the period of 1990-2023 in MEDLINE and PubMed, Embase, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), and Web of Science. The most widely used IVF predictor success was the trigger day progesterone serum level. Many studies utilize the threshold level of 1.5-2.0 ng/ml. However, the predictive power of only progesterone level failed to show high sensitivity and specificity. Contrary, progesterone level on the trigger day combined with the number of mature retrieved oocytes had the highest predictive power. High baseline progesterone level was associated with poor IVF outcomes. Research on progesterone and IVF success in patients with endometriosis is limited but indicates that endometriosis patients seem to benefit from higher progesterone concentrations (≥ 37.1 ng/ml) in IVF cycles. Currently, there is limited data for a definitive insight into the mportance of progesterone in the estimation of IVF success. Nonetheless, this summarized evidence could serve as up-to-date guidance for the role of progesterone in the prediction of IVF outcomes, both in patients with and without endometriosis.
Collapse
Affiliation(s)
- Jovan Bila
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000, Belgrade, Serbia
| | - Dinara Makhadiyeva
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana, 010000, Kazakhstan
| | - Jelena Dotlic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000, Belgrade, Serbia
| | - Mladen Andjic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000, Belgrade, Serbia
| | - Gulzhanat Aimagambetova
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana, 010000, Kazakhstan.
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana, 010000, Kazakhstan
| | - Gauri Bapayeva
- Clinical Academic Department of Women's Health, Corporate Fund "University Medical Center", Turan Ave. 32, Astana, 010000, Kazakhstan
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133, Palermo, Italy
| | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana, 010000, Kazakhstan
| | - Milan Terzic
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana, 010000, Kazakhstan
- Clinical Academic Department of Women's Health, Corporate Fund "University Medical Center", Turan Ave. 32, Astana, 010000, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, School of Medicine, 300 Halket Street, Pittsburgh, PA, 15213, USA
| |
Collapse
|
6
|
Jiang J, Kong N, Shi Q, Yan Y, Shen X, Mei J, Sun H, Huang C. Effect of Elevated Progesterone Levels on hCG Trigger Day on Clinical Pregnancy Outcome in Short-Acting GnRHa Downregulated Cycles. Int J Womens Health 2023; 15:1971-1979. [PMID: 38146586 PMCID: PMC10749555 DOI: 10.2147/ijwh.s437794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/14/2023] [Indexed: 12/27/2023] Open
Abstract
Background Previous studies suggested higher serum progesterone (P) levels were strongly associated with a lower clinical pregnancy rate (CPR) for in vitro fertilization-embryo transfer (IVF-ET). However, the effect of increased serum P levels on the day of human chorionic gonadotropin (hCG) administration on clinical outcomes in short-acting gonadotropin-releasing hormone agonist (GnRHa) downregulated IVF-ET cycles remains unclear. Methods We conducted a retrospective cohort study from January 2017 to December 2021, which included a total of 1664 patients receiving their first short-acting GnRHa IVF-ET cycles at our reproductive medicine centre of Nanjing Drum Tower Hospital. The smooth curve fitting and interaction analysis were employed to analyse the association between the CPR and the serum P levels with different embryo types (cleavage-stage embryo or blastocyst). In addition, total cycles were grouped according to different P levels on the trigger day of hCG administration for further analysis. Results The CPR of patients with increased serum P level (higher than 1.5 ng/mL) on the hCG day did not decrease. A smoothing curve fitting showed that the CPR did not change obviously with the increase in serum P levels. Subgroup analysis of different types of embryos transferred showed that no correlation was observed between the CPR and serum P levels on the day of hCG administration in cleavage-stage embryo transfer cycles. However, the CPR of patients receiving blastocyst transfer showed a downward trend with the increase in serum P levels. At the same time, an interaction analysis also confirmed that the CPR of blastocyst transfer was more likely to be affected by elevated serum P levels on the hCG day. Conclusion In the luteal phase short-acting GnRHa downregulated IVF-ET cycles, the elevated serum P levels on the hCG day did not affect the CPR of cleavage-stage embryo transfer but reduced the CPR of blastocyst transfer.
Collapse
Affiliation(s)
- Jingwen Jiang
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, People’s Republic of China
- Reproductive Medicine Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, People’s Republic of China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People’s Republic of China
| | - Na Kong
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, People’s Republic of China
- Reproductive Medicine Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, People’s Republic of China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People’s Republic of China
| | - Qingqing Shi
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, People’s Republic of China
- Reproductive Medicine Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, People’s Republic of China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People’s Republic of China
| | - Yuan Yan
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, People’s Republic of China
- Reproductive Medicine Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, People’s Republic of China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People’s Republic of China
| | - Xiaoyue Shen
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, People’s Republic of China
- Reproductive Medicine Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, People’s Republic of China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People’s Republic of China
| | - Jie Mei
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, People’s Republic of China
- Reproductive Medicine Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, People’s Republic of China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People’s Republic of China
| | - Haixiang Sun
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, People’s Republic of China
- Reproductive Medicine Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, People’s Republic of China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People’s Republic of China
| | - Chenyang Huang
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, People’s Republic of China
- Reproductive Medicine Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, People’s Republic of China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People’s Republic of China
| |
Collapse
|
7
|
George JS, Keefe KW, Lanes A, Yanushpolsky E. Premature progesterone elevation during the early and mid-follicular phases in fresh in vitro fertilization (IVF) cycles is associated with lower live birth, clinical pregnancy, and implantation rates. J Assist Reprod Genet 2023; 40:1029-1035. [PMID: 37012450 PMCID: PMC10239424 DOI: 10.1007/s10815-023-02786-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Abstract
PURPOSE Evaluate follicular phase progesterone elevation (≥ 1.5 ng/mL) prior to trigger during IVF stimulation and its effects on live birth rate (LBR), clinical pregnancy rate (CPR), and implantation rate (IR) in fresh IVF cycles. METHODS This was a retrospective cohort study within an academic clinic. A total of 6961 fresh IVF and IVF/ICSI cycles from October 1, 2015 to June 30, 2021 were included and grouped by progesterone (PR) prior to trigger: PR < 1.5 ng/mL (low PR group) and PR ≥ 1.5 ng/mL (high PR group). Main outcome measures included LBR, CPR, and IR. RESULTS Among all cycle starts, 1568 (22.5%) were in the high PR group and 5393 (77.5%) were in the low PR group. Of the cycles which proceeded to an embryo transfer, 416 (11.1%) were in the high PR group and 3341 (88.9%) were in the low PR group. The high PR group had significantly lower IR (RR 0.75; 95% CI 0.64-0.88), CPR (aRR 0.74; 95% CI 0.64-0.87), and LBR (aRR 0.71; 95% CI 0.59-0.85) compared to the low PR group. When stratified by progesterone on the day of trigger (TPR), there was a clinically notable decrease in IR (16.8% vs 23.3%), CPR (28.1% vs 36.0%), and LBR (22.8% vs 28.9%) in the high PR group compared to the low PR group even when TPR < 1.5 ng/mL. CONCLUSIONS In fresh IVF cycles in which TPR < 1.5 ng/mL, progesterone elevation ≥ 1.5 ng/mL at any point in time prior to trigger negatively impacts IR, CPR, and LBR. This data supports testing of serum progesterone in the follicular phase prior to trigger, as these patients may benefit from a freeze-all approach.
Collapse
Affiliation(s)
- Jenny S George
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
| | - Kimberly W Keefe
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrea Lanes
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Elena Yanushpolsky
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| |
Collapse
|