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Pitner I, Mikuš M, Šprem Goldštajn M, Laganà AS, Chiantera V, Ferrari F, Shah M, D'Alterio MN, Vitale SG, Angioni S. Effects of different progesterone levels on reproductive outcomes in assisted reproductive technologies: from molecular basis to treatment strategies. Gynecol Endocrinol 2023; 39:2190806. [PMID: 36963420 DOI: 10.1080/09513590.2023.2190806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
PURPOSE The aim of this narrative review is to offer an overview about the role of progesterone levels on pregnancy outcome in patients undergoing assisted reproductive technologies (ARTs). METHODS A detailed computerized search of the literature was performed in the main electronic databases (MEDLINE, EMBASE, Web of Science) to determine the importance of elevated progesterone levels at different stages of the cycle for pregnancy rates in the in vitro fertilization (IVF) cycle. Our review also provides information on the differences between elevated progesterone levels and their interpretation in normal and in poorly responding women. RESULTS After careful evaluation, our search strategy yielded a total of 15 included articles, showing the possible factors that may have had an impact on the increased progesterone level before human chorionic gonadotropin (HCG) injection and the different thresholds above which the pregnancy rate was lower. Furthermore, increased progesterone on cycle day 2 or 3 could serve as a marker for increased progesterone in the late follicular phase, which is associated with a lower pregnancy rate. CONCLUSION Despite the literature data that support the negative effect of elevated progesterone on fresh cycles, due to lack of randomized controlled trials, the value of measuring progesterone in daily practice is questionable. Available evidence supports the detrimental effect of elevated progesterone in different subgroups of women, although there is still the need for defining different thresholds and durations of high progesterone exposure. The need for various thresholds for different cohorts of women, the inter-assay variability is making this decision harder.
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Affiliation(s)
- Iva Pitner
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Marina Šprem Goldštajn
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Mohsin Shah
- Department of Physiology, Khyber Medical University, Peshawar, Pakistan
| | - Maurizio Nicola D'Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Sayed GA, Al-Sawaf HA, Al-Sawaf AH, Saeid M, Maged A, Ibrahim IH. Mitochondrial DNA in Fresh versus Frozen Embryo Culture Media of Polycystic Ovarian Syndrome Patients Undergoing Invitro Fertilization: A Possible Predictive Marker of a Successful Pregnancy. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:27-38. [PMID: 33469340 PMCID: PMC7810675 DOI: 10.2147/pgpm.s284064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
Purpose Frozen embryos transfer (ET) may improve the live-birth and reduce rates of ovarian hyperstimulation in polycystic ovary syndrome (PCOS) patients. Morphological criteria are the classical way for embryo selection, yet recently, many biochemical and genetic markers have been developed. This study aimed to compare fresh and frozen ET using the mtDNA/gDNA ratio of embryo secretome and the possibility of using this ratio as a predictive marker of PCOS pregnancy rate. Subjects and Methods One hundred PCOS patients undergoing IVF were chosen according to Rotterdam criteria and divided into two groups. Group I (50 with fresh ET), group II (50 with frozen ET), and otherwise 33 apparently healthy women as a control group with fresh ET. We then carried out absolute quantification of embryo culture media mtDNA and gDNA by real-time PCR. Results mtDNA/gDNA ratio was significantly low in PCOS embryo culture media in comparison with control. Additionally, while the mtDNA/gDNA ratio was significantly high in pregnant PCOS embryo culture media, it was high, though not statistically significant, in the fresh ET than frozen ET group. mtDNA/gDNA ratio sensitivity and specificity in PCOS embryo culture media as a predictive value of pregnancy rate were (86% and 96%, respectively). Conclusion mtDNA/gDNA ratio measurement in PCOS embryo culture media is a novel marker that can be clinically applied as a predictive value of the quality of the morphologically good embryo. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/uqKkQgRrql4
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Affiliation(s)
- Ghadir A Sayed
- Department of Biochemistry, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
| | - Hussein A Al-Sawaf
- Department of Biochemistry, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
| | - Ahmed H Al-Sawaf
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Ahmed Maged
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iman Hassan Ibrahim
- Department of Biochemistry, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
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Mitra S, Patil M, Patil M, Nayak P. Pre-ovulatory hormones on day of human chorionic gonadotropin trigger and assisted reproductive technique outcomes in different ovarian response groups. J Hum Reprod Sci 2021; 14:406-414. [PMID: 35197687 PMCID: PMC8812392 DOI: 10.4103/jhrs.jhrs_91_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Aims: Setting and Design: Materials and Methods: Statistical Analysis: Results: Conclusion:
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Wu Z, Dong Y, Ma Y, Li Y, Li L, Lin N, Li Y, Zhuan L, Bai Y, Luo X, Kang X. Progesterone elevation on the day of hCG trigger has detrimental effect on live birth rate in low and intermediate ovarian responders, but not in high responders. Sci Rep 2019; 9:5127. [PMID: 30914679 PMCID: PMC6435811 DOI: 10.1038/s41598-019-41499-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/11/2019] [Indexed: 02/04/2023] Open
Abstract
Progesterone elevation (PE) on the day of hCG trigger is associated with decreased pregnancy outcome in fresh cycles. Evidence for this comes from overall patient estimates that mostly ignore different ovarian responses. To compare the impacts of PE on the day of hCG trigger on live birth rates (LBs) in low, intermediate and high ovarian responders and to explore the cut-off value for PE in different populations according to the ovarian response, we retrospectively analyzed a total of 2,351 patients receiving fresh assisted reproduction technology (ART) transfer cycles with GnRH agonist using a long or short protocol. Trend and multivariate logistic regression analyses were performed to identify the cutoff values of PE and to evaluate the effects of PE on LB rates (LBRs) in different ovarian responders. The study found that PE has a detrimental effect on LBRs in low to intermediate ovarian responders rather than in high responders. The cut-off values for PE were 1.0 ng/mL and 2.0 ng/mL for low and intermediate ovarian responders, respectively. The different associations between PE and LBRs according to ovarian response could more accurately predict the prognosis of the IVF cycle and could be used to optimize the treatment of patients undergoing In Vitro Fertilization (IVF)/ Intracytoplasmic Sperm Injection (ICSI).
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Affiliation(s)
- Ze Wu
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yunhua Dong
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yanping Ma
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yonggang Li
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Lei Li
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Na Lin
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yunxiu Li
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Li Zhuan
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yun Bai
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xi Luo
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China. .,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China.
| | - Xiaomin Kang
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China. .,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China.
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Kaponis A, Chronopoulou E, Decavalas G. The curious case of premature luteinization. J Assist Reprod Genet 2018; 35:1723-1740. [PMID: 30051348 DOI: 10.1007/s10815-018-1264-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/11/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Premature luteinization (PL) affects 12.3-46.7% of fresh in vitro fertilization cycles, and there is accumulating evidence confirming its negative effect on success rates. However, despite its clinical significance, PL is poorly understood and defined. This narrative review aims to provide a fresh look at the phenomenon of PL by summarizing the existing evidence and re-evaluating fundamental issues. METHODS A thorough electronic search was conducted covering the period from 1978 until January 2018 in PubMed, Embase, and Medline databases, and references of relevant studies were cross-checked. Meeting proceedings of the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine were also hand searched. RESULTS In the curious case of PL, one should go back to the beginning and re-consider every step of the way. The pathogenesis, definition, measurement methods, clinical implications, and management strategies are discussed in detail, highlighting controversies and offering "food for thought" for future directions. CONCLUSIONS Authors need to speak the same language when studying PL in order to facilitate comparisons. The terminology, progesterone cut-off, measurement methods and days of measurement should be standardized and globally accepted; otherwise, there can be no scientific dialog. Future research should focus on specific patient profiles that may require a tailored approach. Progesterone measurements throughout the follicular phase possibly depict the progesterone exposure better than an isolated measurement on the day of hCG. Adequately powered randomized controlled trials should confirm which the best prevention and management plan of PL is, before introducing any strategy into clinical practice.
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Affiliation(s)
- Apostolos Kaponis
- Department of Obstetrics and Gynaecology, Patras University School of Medicine, General University Hospital of Patras, Rio, 26504, Patras, Greece
| | - Elpiniki Chronopoulou
- Department of Obstetrics and Gynaecology, Patras University School of Medicine, General University Hospital of Patras, Rio, 26504, Patras, Greece.
| | - George Decavalas
- Department of Obstetrics and Gynaecology, Patras University School of Medicine, General University Hospital of Patras, Rio, 26504, Patras, Greece
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Evans MB, Healy MW, DeCherney AH, Hill MJ. Adverse effect of prematurely elevated progesterone in in vitro fertilization cycles: a literature review. Biol Reprod 2018; 99:45-51. [PMID: 29741591 PMCID: PMC6279063 DOI: 10.1093/biolre/ioy082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 11/12/2022] Open
Abstract
Premature progesterone (P) elevation was commonly seen in IVF prior to the utilization of GnRH analogues for suppression of endogenous gonadotropin release. The cause and effect of premature P elevation has finally been better elucidated in the past decade. Although still occurring in 5-38% of all IVF cycles, the adverse effects of premature P elevation on pregnancy outcomes are now well known.
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Affiliation(s)
- Michael B Evans
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver
National Institute of Child Health and Human Development, National Institutes of Health.
Bethesda, MD, USA
| | - Mae W Healy
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver
National Institute of Child Health and Human Development, National Institutes of Health.
Bethesda, MD, USA
| | - Alan H DeCherney
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver
National Institute of Child Health and Human Development, National Institutes of Health.
Bethesda, MD, USA
| | - Micah J Hill
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver
National Institute of Child Health and Human Development, National Institutes of Health.
Bethesda, MD, USA
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Bushaqer N, Mohawash W, Alrakaf F, Algaffli M, Rawah H, Dayoub N, Ayoub H, Alasmari N. Progesterone level significance in agonist versus antagonist protocols. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2017.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Follicle growth and endocrine dynamics in women with spontaneous luteinized unruptured follicles versus ovulation. Hum Reprod 2018; 33:1130-1140. [DOI: 10.1093/humrep/dey082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/18/2018] [Indexed: 01/11/2023] Open
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Dieamant FC, Petersen CG, Mauri AL, Comar V, Mattila M, Vagnini LD, Renzi A, Petersen B, Nicoletti A, Oliveira JBA, Baruffi RL, Franco JG. Fresh embryos versus freeze-all embryos - transfer strategies: Nuances of a meta-analysis. JBRA Assist Reprod 2017; 21:260-272. [PMID: 28837037 PMCID: PMC5574650 DOI: 10.5935/1518-0557.20170048] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective The present meta-analysis aimed to evaluate whether the freeze-all strategy
(Freeze/All-ET) could bring about improvements in the clinical assisted
reproductive technique (ART) outcomes when compared with the fresh embryo
transfer strategy (Fresh-ET) in patients undergoing an ART cycle in
accordance with the mean number of oocytes collected. Methods A systematic review based on electronic searches in databases (PubMed,
EMBASE, Web of Science, SCOPUS, and Cochrane Central Register of Controlled
Trials) was carried out to identify randomized controlled trails (RCTs)
comparing ART outcomes between fresh-embryo transfers versus elective
frozen-embryo transfers up to February of 2017. Four reviewers independently
evaluated abstracts, validity assessment and data extraction. Odds Ratio
(OR) values with a 95% confidence interval (CI), and heterogeneity were
evaluated. Results Five RCTs were included as targets for data extraction and meta-analysis
purposes. The results of this meta-analysis were divided into two parts
(Freeze/All-ET versus Fresh-ET): Part I- All trials in which the mean number
of collected oocytes was >12 and <21 for ongoing pregnancy rate
(OR=1.24; 95%CI=1.06-1.44), clinical pregnancy rate (OR=1.19;
95%CI=0.98-1.43), live birth rate (OR= 1.39; 95%CI=0.99-1.95), and
miscarriage rate (OR=0.68; 95%CI=0.46-1.00); Part II- Three studies where
the mean number of oocytes retrieved was >12 and <15 for ongoing
pregnancy rate (OR=1.17; 95%CI=1.00-1.38), clinical pregnancy rate (OR=1.34;
95%CI=0.79-2.28), live birth rate (OR= 1.24; 95%CI=1.00-1.55), and
miscarriage rate (RR=0.68; 95%CI=0.46-1.02). Conclusions The freeze-all strategy could be favorable when high numbers of oocytes are
collected, signaling an association between higher ovarian stimulation and
consequent impairment of endometrial receptivity. However, when the mean
number of oocytes collected is <15, the freeze-all strategy does not
appear to be advantageous.
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Affiliation(s)
- Felipe C Dieamant
- Center for Human Reproduction Prof. Franco Jr., Ribeirão Preto, Brazil.,Paulista Center for Diagnosis, Research and Training, Ribeirão Preto, SP, Brazil
| | - Claudia G Petersen
- Center for Human Reproduction Prof. Franco Jr., Ribeirão Preto, Brazil.,Paulista Center for Diagnosis, Research and Training, Ribeirão Preto, SP, Brazil
| | - Ana L Mauri
- Center for Human Reproduction Prof. Franco Jr., Ribeirão Preto, Brazil.,Paulista Center for Diagnosis, Research and Training, Ribeirão Preto, SP, Brazil
| | - V Comar
- Center for Human Reproduction Prof. Franco Jr., Ribeirão Preto, Brazil
| | - Mariana Mattila
- Center for Human Reproduction Prof. Franco Jr., Ribeirão Preto, Brazil
| | - Laura D Vagnini
- Paulista Center for Diagnosis, Research and Training, Ribeirão Preto, SP, Brazil
| | - Adriana Renzi
- Paulista Center for Diagnosis, Research and Training, Ribeirão Preto, SP, Brazil
| | - Bruna Petersen
- Paulista Center for Diagnosis, Research and Training, Ribeirão Preto, SP, Brazil
| | - Andreia Nicoletti
- Center for Human Reproduction Prof. Franco Jr., Ribeirão Preto, Brazil
| | - João Batista A Oliveira
- Center for Human Reproduction Prof. Franco Jr., Ribeirão Preto, Brazil.,Paulista Center for Diagnosis, Research and Training, Ribeirão Preto, SP, Brazil
| | - Ricardo Lr Baruffi
- Center for Human Reproduction Prof. Franco Jr., Ribeirão Preto, Brazil.,Paulista Center for Diagnosis, Research and Training, Ribeirão Preto, SP, Brazil
| | - Jose G Franco
- Center for Human Reproduction Prof. Franco Jr., Ribeirão Preto, Brazil.,Paulista Center for Diagnosis, Research and Training, Ribeirão Preto, SP, Brazil
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