Serum progesterone level effects on the outcome of in vitro fertilization in patients with different ovarian response: an analysis of more than 10,000 cycles
Elevated serum P levels are associated with reduced ongoing pregnancy rates regardless of different ovarian responses. Increased P threshold concentration is associated with better ovarian responses.
Bei Xu, Ph.D., Zhou Li, Ph.D., Hanwang Zhang, Ph.D., Lei Jin, Ph.D., Yufeng Li, Ph.D., Jihui Ai, Ph.D., Guijin Zhu, M.D.
Volume 97, Issue 6 , Pages 1321-1327.e4, June 2012
To investigate the relationship between serum P levels on the day of hCG administration and pregnancy outcomes in different responders undergoing IVF.
A total of 11,055 women who underwent their first IVF/intracytoplasmic sperm injection cycles and a subgroup of 4,021 women undergoing frozen-embryo transfer (FET) cycles.
Patients underwent IVF-ET with the long GnRH agonist protocol. The ovarian response was classified as high (≥20 oocytes; n = 2,023), poor (≤4 oocytes; n = 827), or intermediate (remaining cases; n = 8,205) according to the number of oocytes retrieved. Clinical outcomes of IVF-ET and FET cycles were analyzed according to plasma P levels.
Main Outcome Measure(s):
Ongoing pregnancy rates (PRs).
Ongoing PRs in fresh cycle were inversely associated with serum P levels on the day of hCG administration for all patients. Different P threshold concentrations were determined according to different ovarian response: We proposed a serum P level of 1.5 ng/mL as the threshold for poor responders, 1.75 ng/mL for intermediate responders, and 2.25 ng/mL for high responders. Our study does not show negative results for elevated P levels on oocyte performance in terms of fertilization, cleavage rate, or PR of FET cycles within different ovarian responses, offering no evidence for a detrimental effect of high P on oocyte quality.
Elevated P levels on the day of hCG administration negatively influence PR regardless of different ovarian responses, although increased P threshold concentration is associated with better ovarian responses. The detrimental effect of P elevation on PR seems to be unrelated to oocyte quality in all responders.