[Relation between the outcome of IVF-ET and subtle rise in serum progesterone during the follicular phase stimulated with a combination of gonadotropin-releasing hormone analog and gonadotropin]

Abstract

This study was designed to investigate whether the rise in the serum progesterone concentration (1.0 to 2.0ng/ml) (P rise) during the follicular phase occurs in cycles stimulated with gonadotropin-releasing hormone analog (GnRHa) and gonadotropins (hMG and pure FSH), and whether the P rise affects the outcome of IVF-ET. Three hyperstimulation regimens were used for IVF-ET; short regimen (SR): 64 cycles of 44 patients, long regimen (LR): 78 cycles of 46 patients, and pure FSH regimen (PR): 16 cycles of 16 patients. Although serum LH levels did not significantly change during the follicular phase in any of the regimens, a P rise was observed frequently in all the three regimens (26.6% per cycle in SR, 15.4% per cycle in LR, and 18.8% per cycle in PR, respectively). Significantly higher serum E2 levels (p < 0.05) and a greater number of collected oocytes (p < 0.05) but significantly lower rates of mature oocytes (p < 0.05) and fertilization (p < 0.05) were observed in P rise cycles compared to no P rise cycles. Ten of 12 ongoing pregnancies in this study occurred in no P rise cycles. These results suggest that the increasing number of developing follicles related to a high concentration of serum E2 is responsible for the occurrence of P rise irrespective of whether LH is endogenous or exogenous, and that the P rise affects the outcome of IVF-ET.