Is the effect of premature elevated progesterone augmented by human chorionic gonadotropin versus gonadotropin releasing hormone agonist trigger

Authors:
Matthew T. Connell, D.O., George Patounakis, M.D., Ph.D., Mae Wu Healy, D.O., Alan H. DeCherney, M.D., Kate Devine, M.D., Eric Widra, M.D., Michael J. Levy, M.D., Micah J. Hill, D.O.

Abstract:

Objective:
To compare the effect of P on live birth rate between hCG and GnRH agonist (GnRH-a) trigger cycles.

Design:
Retrospective cohort study.

Setting:
Large private assisted reproductive technology (ART) practice.

Patient(s):
A total of 3,326 fresh autologous ART cycles.

Intervention(s):
None.

Main Outcome Measure(s):
Live birth.

Result(s):
A total of 647 GnRH-a trigger cycles were compared with 2,679 hCG trigger cycles. Live birth was negatively associated with P in both the hCG trigger (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.52–0.76) and the agonist trigger cohorts (OR 0.56, 95% CI 0.45–0.69). Interaction testing evaluating P and trigger medication was not significant, indicating that P had a similar negative effect on live birth rates in both cohorts. Progesterone ≥2 ng/mL occurred more commonly in GnRH-a trigger cycles compared with hCG trigger cycles (5.5% vs. 3.1%) and was negatively associated with live birth in both the hCG trigger (OR 0.28, 95% CI 0.11–0.73) and agonist trigger cohorts (OR 0.35, 95% CI 0.14–0.90). When P ≥2 ng/mL, the live birth rates were poor and similar in the hCG and GnRH-a cohorts (5.9% vs. 14.2%), indicating that P ≥2 ng/mL had a similar negative effect on live birth in both cohorts.

Conclusion(s):
Elevated serum P on the day of hCG was negatively associated with live birth rates in both hCG and GnRH-a trigger cycles.

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