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. 2024 Mar;49(1):25-32.
doi: 10.23736/S2724-6507.21.03328-9. Epub 2021 Apr 1.

Proof of concept use of progesterone/estradiol ratio to investigate late follicular progesterone in women with low number of preovulatory follicles

Johnny S Younis  1   2 , Shiran Yakovi  3 , Yuri Perlitz  3   4 , Ido Izhaki  5
Affiliations

Proof of concept use of progesterone/estradiol ratio to investigate late follicular progesterone in women with low number of preovulatory follicles

Johnny S Younis et al. Minerva Endocrinol (Torino). 2024 Mar.

Abstract

Background: The aim of this study was to investigate late follicular progesterone (P) serum levels in women with a low number of preovulatory follicles in the assisted reproductive technologies (ART) setting.

Methods: Fifty-five consecutive women having four or fewer preovulatory follicles of >14 mm on the day of human chorionic gonadotropin (hCG) administration were prospectively evaluated. Spearman correlation tests were performed between serum estradiol (E<inf>2</inf>) level, serum P level, P/E<inf>2</inf> ratio, number of preovulatory follicles, oocytes and embryos. Women enrolled were further divided into two groups in accordance with the P/E<inf>2</inf> ratio on the day of hCG administration and compared.

Results: Serum E<inf>2</inf> level correlated positively with P serum level (r<inf>s</inf>=0.36, P<0.01), number of mature follicles (r<inf>s</inf>=0.50, P<0.01) and number of oocytes retrieved (r<inf>s</inf>=0.36, P<0.05), whereas negatively with P/E<inf>2</inf> ratio (r<inf>s</inf>=- 0.68, P<0.01). Likewise, number of preovulatory follicles correlated positively with E<inf>2</inf> level (r<inf>s</inf>=0.50, P<0.01), P level (r<inf>s</inf>=0.27, P<0.05) and number of oocytes retrieved (r<inf>s</inf>=0.33, P<0.05), while it correlated negatively with P/E<inf>2</inf> ratio (r<inf>s</inf>=-0.33, P<0.05). Furthermore, women with P/E<inf>2</inf> ratio >1 on the day of hCG administration received considerably higher total follicular stimulating hormone (FSH) dosage and achieved significantly lower number of oocytes and embryos as compared to controls.

Conclusions: The reverse relationship between number of preovulatory follicles and P/E<inf>2</inf> ratio implies that P rise is not only the result of increased steroidogenic activity, but other oocyte-follicle disrupted mechanisms seem to be involved. An exaggerated FSH stimulation appears to disrupt further these mechanisms.

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