Are good patient and embryo characteristics protective against the negative effect of elevated progesterone level on the day of oocyte maturation

Capsule:
Elevated P level on the day of human chorionic gonadotropin administration negatively affects live-birth rate, regardless of embryo stage, embryo quality, patient age, or ovarian response.

Authors:
Micah J. Hill, D.O., Greene Donald Royster IV, M.D., Mae Wu Healy, D.O., Kevin S. Richter, Ph.D., Gary Levy, M.D., Alan H. DeCherney, M.D., Eric D. Levens, M.D., Geeta Suthar, B.S.M.T., C.L.C.P., Eric Widra, M.D., Michael J. Levy, M.D.

Volume 103, Issue 6, Pages 1477-1484

Abstract:

Objective:
To evaluate if an elevated progesterone (P) level on the day of human chorionic gonadotropin (hCG) administration is associated with a decrease in live-birth rate in patients with a good prognosis.

Design:
Retrospective cohort study.

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

Patient(s):
One thousand six hundred twenty fresh autologous ART cycles.

Intervention(s):
None.

Main Outcome Measure(s):
Live-birth rate.

Result(s):
A total of 934 blastocyst and 686 cleavage-stage embryo transfer (ET) cycles were evaluated. Serum P levels were not associated with markers of oocyte or embryo quality, including fertilization, embryo stage at transfer, and embryos available for cryopreservation. Patient age, stage of ET, embryo quality, the number of embryos transferred, and P level on the day of hCG administration were all significantly associated with live birth. Higher P levels were associated with decreased odds of live birth for cleavage- and blastocyst-stage embryos, poor-fair and good-quality embryos, and poor- and high-responder patients. The nonsignificance of interaction tests of P levels with embryo stage, embryo quality, patient age, and ovarian response indicated that the relationship between P level and live birth was similar regardless of these factors.

Conclusion(s):
An elevated serum P level on the day of hCG administration was negatively associated with live birth, even in ETs with a good prognosis.

  • Micah Hill

    Thanks for the comment Alex. We generally recommend freezing with values 2ng/ml or higher. We do see decreases in pregnancy with values over 1.5, but the drop in pregnancy becomes profoundly significant over 2. However, I think when to freeze is an individual patient and program decision. P assays lack accuracy at low values and may differ from lab to lab. Programs with good vitrification outcomes might do better freezing at lower thresholds than programs with poorer vitrification outcomes. Patient characteristics (like supranumerary embryos to freeze) and pricing structure would also come into play. So in my opinion, when to freeze is a more complex decision than just a single threshold value. But that being said, 2ng/ml is the general threshold we use.

  • This is a timely article on the important topic of P levels on the day of hCG administration and the effect on pregnancy outcomes. Can the authors comment on whether a cut-off P level on the day of hCG should be routinely used to recommend freezing of embryos? If yes, what is the cutoff value that you would recommend?

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