Are Extremely High Progesterone Levels Still an Issue in IVF?

Overview

Journal J Endocrinol Invest

Publisher Springer

Specialty Endocrinology

Date 2016 Aug 29

PMID 27568185

Citations 8

Authors

V S Vanni

P Vigano

L Quaranta

L Pagliardini

P Giardina

M Molgora

M Munaretto

M Candiani

E Papaleo

Affiliations

Soon will be listed here.

Abstract

Background: Premature luteinization of one or more developing follicles complicates 1-2 % of controlled ovarian stimulation cycles for assisted reproduction. The management of this complication is controversial, with cycle cancellation likely representing the most commonly used strategy. The aim of this study was to evaluate the efficacy of the "freeze-all" policy-where the entire cohort of blastocysts is cryopreserved for subsequent frozen-thawed embryo transfer-in treating cases of premature luteinization.

Methods: Patients experiencing premature luteinization during controlled ovarian stimulation-identified by extremely high progesterone levels at induction (P levels ≥3.0 ng/ml and/or P/estradiol ratio ≥1, n = 42)-were included in a "freeze-all" program and compared to controls undergoing a "freeze-all" program with normal progesterone levels at induction (P < 1.5 ng/ml, n = 67).

Results: Blastulation rate was comparable between patients with premature luteinization and controls (48.1 ± 20.5 % in Cases vs. 52.3 ± 24.9 % in Controls, p = 0.36). Ongoing pregnancy rates after the first frozen-thawed embryo transfer (38.1 % in Cases and 41.0 % in Controls, p = 0.83) and cumulative ongoing pregnancy rates after three frozen-thawed embryo transfer cycles (40.5 % in Cases vs. 47.8 % in Controls, p = 0.55) were also similar.

Conclusions: These results show that extremely marked progesterone elevation throughout controlled ovarian stimulation does not impair blastocyst development and implantation potential in the context of a "freeze-all" strategy. Based on this, adoption of the "freeze-all" strategy represents a valuable tool in treating premature luteinization. In contrast, cycle cancellation-likely the most frequently used method for management of this complication-currently represents a misconduct.

Citing Articles

The Effect of Progesterone Elevation on the Day of Trigger Administration: A Review of the Literature.

Jreij C, Halimeh R, Fadel D, Chamoun P, Nassar J, Saab W J Reprod Infertil. 2024; 25(2):102-109.

PMID: 39157800 PMC: 11327421. DOI: 10.18502/jri.v25i2.16005.

Correlation between controlled ovarian stimulation protocols and euploid blastocyst rate in pre-implantation genetic testing for aneuploidy cycles.

Huang B, Li H, Xu B, Li N, Wang X, Li Y Reprod Biol Endocrinol. 2023; 21(1):118.

PMID: 38057895 PMC: 10698966. DOI: 10.1186/s12958-023-01166-7.

Delayed blastocyst development is influenced by the level of progesterone on the day of trigger.

Villanacci R, Buzzaccarini G, Marzanati D, Vanni V, De Santis L, Alteri A J Assist Reprod Genet. 2022; 40(2):361-370.

PMID: 36542311 PMC: 9935760. DOI: 10.1007/s10815-022-02682-y.

Significant Serum Progesterone Variations on the Day of Final Oocyte Maturation in Stimulated IVF Cycles.

Shanker U, Lawrenz B, Bungum L, Bixio L, Ruiz F, Coughlan C Front Endocrinol (Lausanne). 2019; 10:806.

PMID: 31824423 PMC: 6880656. DOI: 10.3389/fendo.2019.00806.

Progesterone elevation on the day of hCG trigger has detrimental effect on live birth rate in low and intermediate ovarian responders, but not in high responders.

Wu Z, Dong Y, Ma Y, Li Y, Li L, Lin N Sci Rep. 2019; 9(1):5127.

PMID: 30914679 PMC: 6435811. DOI: 10.1038/s41598-019-41499-1.

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