Subtle progesterone rise on the day of hCG administration is associated with lower live birth rates in women undergoing assisted reproductive technology: a retrospective study with 2,555 fresh embryo transfers

Capsule:
In this retrospective, observational, cohort study with 2,555 women, a rise of serum P levels on the day of hCG administration was associated with a reduced live birth rate after day-5 fresh ET.

Authors:
Robert Ochsenkühn, M.D., Andrea Arzberger, M.D., Viktoria von Schönfeldt, Ph.D., Julia Gallwas, M.D., Nina Rogenhofer, M.D., Alexander Crispin, M.D., Christian J. Thaler, M.D., Ulrich Noss, M.D.

Volume 98, Issue 2 , Pages 347-354, August 2012

Abstract:

Objective:
To evaluate the association between serum P levels on the day of hCG administration and pregnancy outcome in women undergoing controlled ovarian hyperstimulation, prevention of premature ovulation by GnRH analogues, and fresh ET after 5 days of embryo culture.

Design:
Retrospective, observational, cohort study.

Setting:
Private IVF center.

Patient(s):
A total of 2,555 women undergoing fresh ET on day 5 in 2,062 GnRH agonist and 493 GnRH antagonist cycles.

Intervention(s):
None.

Main Outcome Measure(s):
Live birth rate.

Result(s):
Live birth rate in cycles with GnRH agonists was significantly lower in women with P levels ≥2.0 ng/mL (17.4%) on the day of hCG administration as compared with women with P levels

Conclusion(s):
A rise of serum P levels ≥2.0 ng/mL on the day of hCG administration is associated with impaired early embryo implantation and reduced live birth rate in cycles with GnRH agonists after day-5 fresh ET.

Clinical Trial Registration Number:
NCT01426152.

  • Micah Hill

    Most of the recent large studies showing a negative impact of
    elevated progesterone on the day of hCG have been in cleavage stage embryo
    transfers. This large retrospective
    study shows a similar negative impact on blastocyst stage transfers. This is in contrast to a study from
    Papanikolaou et al (FS 2009) which demonstated the negative effect of elevated
    progesterone in cleavage stage, but not blastocyst, embryo transfers. It remains to be demonstrated in a RCT that
    cryopreservation of embryos with subsequent thawed transfer in cycles with
    elevated progesterone is superior to transferring the embryo in the fresh
    cycle.

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