Progesterone elevation on the day of human chorionic gonadotropin administration is not the only factor determining outcomes of in vitro fertilization

Capsule:
The elevated progesterone on the day of human chorionic gonadotropin triggering has an obvious negative impact on pregnancy outcome only at extremely high progesterone concentrations.

Authors:
Yi-Ru Tsai, M.D., Fu-Jen Huang, M.D., Pin-Yao Lin, M.D., Fu-Tsai Kung, M.D., Yu-Ju Lin, M.D., Yi-Chi Lin, B.Sc., Kuo-Chung Lan, M.D., Ph.D.

Volume 103, Issue 1, Pages 106-111

Abstract:

Objective:
To assess whether progesterone elevation is the only factor in determining outcomes of in vitro fertilization (IVF).

Design:
Retrospective cohort study.

Setting:
Infertility clinic at Kaohsiung Chang Gung Memorial Hospital, Taiwan.

Patient(s):
One thousand five hundred eight women undergoing a total of 1,508 IVF cycles.

Intervention(s):
None.

Main Outcome Measure(s):
Clinical pregnancy and live-birth rates.

Result(s):
Patients were classified into four subgroups according to their progesterone concentration on the day of human chorionic gonadotropin (hCG) triggering. The clinical pregnancy and live-birth rates were statistically significantly associated with the age of the woman, the day of embryo transfer, the progesterone concentration on the day of hCG administration, the number of transferred embryos, and the number of top-quality embryos transferred. However, after omitting the women with the highest progesterone concentration (≥1.94 ng/mL), only four factors—patient age, day of embryo transfer, number of transferred embryos, and number of top-quality embryos transferred—were statistically significantly associated with the clinical pregnancy and live-birth rates.

Conclusion(s):
Progesterone concentration on the day of hCG administration is not the only factor determining the clinical pregnancy and live-birth rates. Fresh embryos from women should be frozen with extremely high progesterone concentrations. Each patient’s general condition and the capacity for frozen-thawed embryo transfer should be considered before implantation.

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