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. 2023 Dec 21:15:1971-1979.
doi: 10.2147/IJWH.S437794. eCollection 2023.

Effect of Elevated Progesterone Levels on hCG Trigger Day on Clinical Pregnancy Outcome in Short-Acting GnRHa Downregulated Cycles

Jingwen Jiang #  1   2   3 , Na Kong #  1   2   3 , Qingqing Shi #  1   2   3 , Yuan Yan  1   2   3 , Xiaoyue Shen  1   2   3 , Jie Mei  1   2   3 , Haixiang Sun  1   2   3 , Chenyang Huang  1   2   3
Affiliations

Effect of Elevated Progesterone Levels on hCG Trigger Day on Clinical Pregnancy Outcome in Short-Acting GnRHa Downregulated Cycles

Jingwen Jiang et al. Int J Womens Health. .

Abstract

Background: Previous studies suggested higher serum progesterone (P) levels were strongly associated with a lower clinical pregnancy rate (CPR) for in vitro fertilization-embryo transfer (IVF-ET). However, the effect of increased serum P levels on the day of human chorionic gonadotropin (hCG) administration on clinical outcomes in short-acting gonadotropin-releasing hormone agonist (GnRHa) downregulated IVF-ET cycles remains unclear.

Methods: We conducted a retrospective cohort study from January 2017 to December 2021, which included a total of 1664 patients receiving their first short-acting GnRHa IVF-ET cycles at our reproductive medicine centre of Nanjing Drum Tower Hospital. The smooth curve fitting and interaction analysis were employed to analyse the association between the CPR and the serum P levels with different embryo types (cleavage-stage embryo or blastocyst). In addition, total cycles were grouped according to different P levels on the trigger day of hCG administration for further analysis.

Results: The CPR of patients with increased serum P level (higher than 1.5 ng/mL) on the hCG day did not decrease. A smoothing curve fitting showed that the CPR did not change obviously with the increase in serum P levels. Subgroup analysis of different types of embryos transferred showed that no correlation was observed between the CPR and serum P levels on the day of hCG administration in cleavage-stage embryo transfer cycles. However, the CPR of patients receiving blastocyst transfer showed a downward trend with the increase in serum P levels. At the same time, an interaction analysis also confirmed that the CPR of blastocyst transfer was more likely to be affected by elevated serum P levels on the hCG day.

Conclusion: In the luteal phase short-acting GnRHa downregulated IVF-ET cycles, the elevated serum P levels on the hCG day did not affect the CPR of cleavage-stage embryo transfer but reduced the CPR of blastocyst transfer.

Keywords: blastocyst transfer; clinical pregnancy rate; elevated progesterone level; hCG trigger day; short-acting GnRHa.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
A smooth fitting curve analysis of the relationship between serum P levels on the hCG day and the CPR. The CPR kept stable as the P level increased. The area between two dotted lines is expressed as the 95% CI.
Figure 2
Figure 2
A smooth fitting curve analysis of the relationship between serum P levels on the hCG day and the CPR of different types of embryos transferred. The CPR of blastocyst transfer decreased as the P level on the hCG day gradually increased. The area between two dotted lines is expressed as the 95% CI.
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