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. 2015 Jun;103(6):1477-84.e1-5.
doi: 10.1016/j.fertnstert.2015.02.038. Epub 2015 Apr 14.

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

Micah J Hill  1 , Greene Donald Royster 4th  2 , Mae Wu Healy  2 , Kevin S Richter  3 , Gary Levy  2 , Alan H DeCherney  4 , Eric D Levens  3 , Geeta Suthar  3 , Eric Widra  3 , Michael J Levy  3
Affiliations

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

Micah J Hill et al. Fertil Steril. 2015 Jun.

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.

Keywords: Elevated progesterone; IVF; implantation; premature luteinization.

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Conflict of interest statement

M.J.H. has nothing to disclose. G.D.R. has nothing to disclose. M.W.H. has nothing to disclose. K.S.R. has nothing to disclose. G.L. has nothing to disclose. A.H.D. has nothing to disclose. E.D.L. has nothing to disclose. G.S. has nothing to disclose. E.W. has nothing to disclose. M.J.L. has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Graphic representation of the effect of serum P values on implantation and live birth in cleavage and blastocyst embryo transfers. Progesterone values (ng/ml) are plotted on the x-axis, and implantation (A and B) and live birth (C and D) are on the y-axis. Actual implantation (A) and live birth (C) are shown per serum P value. Linear trend lines for implantation (B) and live birth (D) are shown per serum P value. hCG = human chorionic gonadotropin; P = progesterone.
FIGURE 2
FIGURE 2
Graphic representation of the effect of serum P values on implantation and live birth in good blastocyst and fair or poor blastocyst embryo transfers. Progesterone values (ng/ml) are plotted on the x-axis, and implantation (A and B) and live birth (C and D) are indicated on the y-axis. Actual implantation (A) and live birth (C) are shown per serum P value. Linear trend lines for implantation (B) and live birth (D) are shown per serum P value. hCG = human chorionic gonadotropin; P = progesterone.
FIGURE 3
FIGURE 3
Graphic representation of the effect of serum P values on implantation and live birth based on ovarian response. Progesterone values (ng/ml) are plotted on the x-axis, and implantation (A and B) and live birth (C and D) are indicated on the y-axis. Actual implantation (A) and live birth (C) are shown per serum P value. Linear trend lines for implantation (B) and live birth (D) are shown per serum P value. hCG = human chorionic gonadotropin; P = progesterone.
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Comment in

References

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