Top Quality Blastocyst Formation Rates in Relation to Progesterone Levels on the Day of Oocyte Maturation in GnRH Antagonist IVF/ICSI Cycles

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2017 May 19

PMID 28520729

Citations 38

Authors

V S Vanni

E Somigliana

M Reschini

L Pagliardini

E Marotta

S Faulisi

A Paffoni

P Vigano

W Vegetti

M Candiani

E Papaleo

Affiliations

Soon will be listed here.

Abstract

Cycles with progesterone elevation during controlled ovarian stimulation (COS) for IVF/ICSI are commonly managed with a "freeze-all" strategy, due to a well-recognized detrimental effect of high progesterone levels on endometrial receptivity. However, also a detrimental effect of elevated progesterone on day-3 embryo quality has recently been found with regards to top quality embryo formation rate. Because blastocyst culture and cryopreservation are largely adopted, we deemed relevant to determine whether this detrimental effect is also seen on blastocyst quality on day 5-6. This issue was investigated through a large two-center retrospective study including 986 GnRH antagonist IVF/ICSI cycles and using top quality blastocyst formation rate as the main outcome. Results showed that on multivariate analysis sperm motility (p<0.01) and progesterone levels at ovulation triggering (p = 0.01) were the only two variables that significantly predicted top quality blastocyst formation rate after adjusting for relevant factors including female age, BMI, basal AMH and total dose of FSH used for COS. More specifically, progesterone levels at induction showed an inverse relation with top quality blastocyst formation (correlation coefficient B = -1.08, 95% CI -1.9 to -0.02) and ROC curve analysis identified P level >1.49 ng/ml as the best cut-off for identification of patients at risk for the absence of top quality blastocysts (AUC 0.55, p<0.01). Our study is the first to investigate the top quality blastocyst formation rate in relation to progesterone levels in IVF/ICSI cycles, showing that increasing progesterone is associated with lower rates of top quality blastocyst. Hence, the advantages of prolonging COS to maximize the number of collected oocytes might eventually be hindered by a decrease in top quality blastocysts available for transfer, if increasing progesterone levels are observed. This observation extends the results of two recent studies focused on day-3 embryos and deserves further research.

Citing Articles

Effects of trigger-day progesterone in c-IVF/ICSI cycles on blastocyst culture outcomes.

Sun Y, Wang J, Zhang L, Chang Y, Zhu A Front Endocrinol (Lausanne). 2025; 16:1496803.

PMID: 40013313 PMC: 11860069. DOI: 10.3389/fendo.2025.1496803.

Investigating dosage effects of ovulation inhibitors on oocyte maturation in assisted reproductive technology: A retrospective study among patients with normal ovarian reserve.

Handa M, Takiuchi T, Kawaguchi S, Ohara Y, Doshida M, Takeuchi T PLoS One. 2025; 20(1):e0317103.

PMID: 39820188 PMC: 11737757. DOI: 10.1371/journal.pone.0317103.

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.

Progestin-primed ovarian stimulation with letrozole using different doses of medroxyprogesterone acetate per day: a retrospective cohort study.

Li H, Shen B, He Z, Wang H, Sun Z Front Endocrinol (Lausanne). 2024; 15:1429338.

PMID: 39072274 PMC: 11272552. DOI: 10.3389/fendo.2024.1429338.

Premature Progesterone Rise Is Associated with Higher Cumulative Live Birth Rate with Freeze-All Strategy.

Wang Y, Chen M, Guu H, Chen Y, Kung H, Chang J J Clin Med. 2024; 13(12).

PMID: 38929968 PMC: 11204471. DOI: 10.3390/jcm13123439.

References

Fanchin R, Righini C, Olivennes F, De Ziegler D, Selva J, Frydman R . Premature progesterone elevation does not alter oocyte quality in in vitro fertilization. Fertil Steril. 1996; 65(6):1178-83. DOI: 10.1016/s0015-0282(16)58335-6. View

Azem F, Tal G, Lessing J, Malcov M, Ben-Yosef D, Almog B . Does high serum progesterone level on the day of human chorionic gonadotropin administration affect pregnancy rate after intracytoplasmic sperm injection and embryo transfer?. Gynecol Endocrinol. 2008; 24(7):368-72. DOI: 10.1080/09513590802196353. View

Cai Q, Wan F, Huang R, Zhang H . Factors predicting the cumulative outcome of IVF/ICSI treatment: a multivariable analysis of 2450 patients. Hum Reprod. 2011; 26(9):2532-40. DOI: 10.1093/humrep/der228. View

Lahoud R, Kwik M, Ryan J, Al-Jefout M, Foley J, Illingworth P . Elevated progesterone in GnRH agonist down regulated in vitro fertilisation (IVFICSI) cycles reduces live birth rates but not embryo quality. Arch Gynecol Obstet. 2011; 285(2):535-40. DOI: 10.1007/s00404-011-2045-0. View

Papanikolaou E, Kolibianakis E, Pozzobon C, Tank P, Tournaye H, Bourgain C . Progesterone rise on the day of human chorionic gonadotropin administration impairs pregnancy outcome in day 3 single-embryo transfer, while has no effect on day 5 single blastocyst transfer. Fertil Steril. 2007; 91(3):949-52. DOI: 10.1016/j.fertnstert.2006.12.064. View

Li P, Zhu H, Tan L, Zhao D, Ma L, Xiang Y . Effects of high progesterone on outcomes of in vitro fertilization-embryo transfer in patients with different ovarian responses. Syst Biol Reprod Med. 2015; 61(3):161-7. DOI: 10.3109/19396368.2015.1033779. View

Huang B, Ren X, Wu L, Zhu L, Xu B, Li Y . Elevated Progesterone Levels on the Day of Oocyte Maturation May Affect Top Quality Embryo IVF Cycles. PLoS One. 2016; 11(1):e0145895. PMC: 4706317. DOI: 10.1371/journal.pone.0145895. View

Restelli L, Paffoni A, Corti L, Rabellotti E, Mangiarini A, Vigano P . The strategy of group embryo culture based on pronuclear pattern on blastocyst development: a two center analysis. J Assist Reprod Genet. 2014; 31(12):1629-34. PMC: 4250467. DOI: 10.1007/s10815-014-0350-9. View

Intra G, Alteri A, Corti L, Rabellotti E, Papaleo E, Restelli L . Application of failure mode and effect analysis in an assisted reproduction technology laboratory. Reprod Biomed Online. 2016; 33(2):132-9. DOI: 10.1016/j.rbmo.2016.05.008. View

10.

Silverberg K, Martin M, Olive D, Burns W, Schenken R . Elevated serum progesterone levels on the day of human chorionic gonadotropin administration in in vitro fertilization cycles do not adversely affect embryo quality. Fertil Steril. 1994; 61(3):508-13. DOI: 10.1016/s0015-0282(16)56584-4. View

11.

Faulisi S, Reschini M, Borroni R, Paffoni A, Busnelli A, Somigliana E . Clinical Value of Basal Serum Progesterone Prior to Initiate Ovarian Hyper-Stimulation with GnRH Antagonists: A Retrospective Cohort Study. Gynecol Obstet Invest. 2016; 82(2):175-180. DOI: 10.1159/000446952. View

12.

Hofmann G, Bentzien F, Bergh P, Garrisi G, Williams M, Guzman I . Premature luteinization in controlled ovarian hyperstimulation has no adverse effect on oocyte and embryo quality. Fertil Steril. 1993; 60(4):675-9. DOI: 10.1016/s0015-0282(16)56221-9. View

13.

Shapiro B, Daneshmand S, Garner F, Aguirre M, Hudson C, Thomas S . Embryo cryopreservation rescues cycles with premature luteinization. Fertil Steril. 2009; 93(2):636-41. DOI: 10.1016/j.fertnstert.2009.01.134. View

14.

Bu Z, Zhao F, Wang K, Guo Y, Su Y, Zhai J . Serum progesterone elevation adversely affects cumulative live birth rate in different ovarian responders during in vitro fertilization and embryo transfer: a large retrospective study. PLoS One. 2014; 9(6):e100011. PMC: 4057273. DOI: 10.1371/journal.pone.0100011. View

15.

Kofinas J, Mehr H, Ganguly N, Biley Y, Bochkovsky S, McCulloh D . Is it the egg or the endometrium? Elevated progesterone on day of trigger is not associated with embryo ploidy nor decreased success rates in subsequent embryo transfer cycles. J Assist Reprod Genet. 2016; 33(9):1169-74. PMC: 5010810. DOI: 10.1007/s10815-016-0752-y. View

16.

Hill M, Royster 4th G, Healy M, Richter K, Levy G, DeCherney A . Are good patient and embryo characteristics protective against the negative effect of elevated progesterone level on the day of oocyte maturation?. Fertil Steril. 2015; 103(6):1477-84.e1-5. PMC: 6499929. DOI: 10.1016/j.fertnstert.2015.02.038. View

17.

Fanchin R, Hourvitz A, Olivennes F, Taieb J, Hazout A, Frydman R . Premature progesterone elevation spares blastulation but not pregnancy rates in in vitro fertilization with coculture. Fertil Steril. 1997; 68(4):648-52. DOI: 10.1016/s0015-0282(97)80464-5. View

18.

Venetis C, Kolibianakis E, Bosdou J, Tarlatzis B . Progesterone elevation and probability of pregnancy after IVF: a systematic review and meta-analysis of over 60 000 cycles. Hum Reprod Update. 2013; 19(5):433-57. DOI: 10.1093/humupd/dmt014. View

19.

Roque M, Lattes K, Serra S, Sola I, Geber S, Carreras R . Fresh embryo transfer versus frozen embryo transfer in in vitro fertilization cycles: a systematic review and meta-analysis. Fertil Steril. 2012; 99(1):156-162. DOI: 10.1016/j.fertnstert.2012.09.003. View

20.

Cai Q, Wan F, Appleby D, Hu L, Zhang H . Quality of embryos transferred and progesterone levels are the most important predictors of live birth after fresh embryo transfer: a retrospective cohort study. J Assist Reprod Genet. 2013; 31(2):185-94. PMC: 3933599. DOI: 10.1007/s10815-013-0129-4. View