Progesterone elevation does not compromise pregnancy rates in high responders a pooled analysis of in vitro fertilization patients treated with recombinant FSH GnRH antagonist in six trials

Capsule:
Incidence of elevated P increases with ovarian response, and elevated P (>1.5 ng/mL) is independently associated with a decreased chance of pregnancy in low to normal, but not high, responders.

Authors:
Georg Griesinger, M.D., Bernadette Mannaerts, Ph.D., Claus Yding Andersen, D.M.Sc., Han Witjes, Ph.D., Efstratios M. Kolibianakis, M.D., Keith Gordon, Ph.D.

Volume 100, Issue 6, Pages 1622-1628.e3, December 2013

Abstract:

Objective:
To compare the impact of elevated P during the late follicular phase on the chance of pregnancy in low, normal, and high responders.

Design:
Retrospective combined analysis from six clinical trials.

Setting:
IVF centers.

Patient(s):
Women up to 39 years of age with a regular menstrual cycle and an indication for ovarian stimulation before IVF/intracytoplasmic sperm injection.

Intervention(s):
Ovarian stimulation with recombinant (r) FSH in a GnRH antagonist protocol.

Main Outcome Measure(s):
Ongoing pregnancy rates (OPRs) assessed with the use of univariate and multivariate analyses according to serum P levels ≤1.5 ng/mL versus >1.5 ng/mL on the day of hCG administration and compared among low (1–5 oocytes), normal (6–18 oocytes), and high (>18 oocytes) responders.

Result(s):
A total of 157/1,866 women (8.4%; 95% confidence interval [CI] 7.2%–9.8%) had elevated P. Incidence of elevated P increased from 4.5% in low responders to 19.0% in high responders. Overall, OPRs were significantly lower in women with elevated P. Per started cycle, the >1.5 to ≤1.5 ng/mL adjusted odds ratio was 0.55 (95% CI 0.37–0.81). OPRs were not impaired in high responders with P elevation and were significantly higher compared with normal responders with P elevation.

Conclusion(s):
The incidence of elevated P increases with ovarian response, and elevated P at a threshold of 1.5 ng/mL is independently associated with a decreased chance of pregnancy in low to normal responders, but not in high responders, when using an rFSH/GnRH antagonist protocol.

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