Serum Progesterone Level Above 0.85 ng/mL and Progesterone/estradiol Ratio May Be Useful Predictors for Replacing Cleavage-stage with Blastocyst-stage Embryo Transfer in Fresh IVF/ICSI Cycles Without Premature Progesterone Elevation

Overview

Journal Arch Gynecol Obstet

Specialty Gynecology & Obstetrics

Date 2021 Oct 30

PMID 34716819

Citations 7

Authors

Vehbi Yavuz Tokgoz

Ahmet Basar Tekin

Affiliations

Soon will be listed here.

Abstract

Purpose: To assess the impact of serum progesterone level and the progesterone/estradiol ratio on determining the appropriate day of embryo transfer in fresh IVF/ICSI cycles without premature progesterone elevation.

Methods: This was a retrospective cohort study in a university teaching hospital. Only fresh embryo transfer cycles in the GnRH-antagonist protocol without elevated trigger-day progesterone levels (n = 508) were analyzed after taking into consideration the exclusion criteria. The main outcome measure was to determine the association between below and above of the cut-off values of serum progesterone level and P/E ratio regarding clinical pregnancy, ongoing pregnancy and live birth rates. These rates were assessed with the use of percentile and logistic regression analyses according to the threshold levels of serum progesterone levels < 0.85 ng/mL versus ≥ 0.85 ng/mL on the day of hCG administration.

Results: The clinical pregnancy rates were significantly lower in fresh cycles with P levels ≥ 0.85 ng/mL on the day of hCG administration than in cycles with P levels < 0.85 ng/mL for the cleavage-stage embryo transfers (26.7% vs. 47.5%, p = 0.001). Blastocyst-stage embryo transfer improved pregnancy results although the P levels were ≥ 0.85 ng/mL (53.8% vs. 51.4%, p > 0.05). The adjusted odds ratio of P levels < 0.85 ng/mL revealed significant differences in only cleavage-stage embryo transfer cycles (aOR = 0.424, p = 0.016).

Conclusion: Although serum progesterone levels are below the accepted cut-off level of 1.5 ng/mL, there may be reduced pregnancy outcomes in fresh embryo transfer cycles. A threshold level such as 0.85 ng/mL may ensure the decision to replace the cleavage stage with the blastocyst-stage embryo transfer in fresh cycles without premature progesterone elevation.

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.

Effect of progesterone concentration on hCG trigger day on clinical outcomes after high-quality single blastocyst transfer in GnRH antagonist cycles.

Jia N, Xu J, Song B, Hao H, Li M, Zhang C Front Med (Lausanne). 2024; 11:1443624.

PMID: 39469143 PMC: 11514136. DOI: 10.3389/fmed.2024.1443624.

Impact of progesterone concentration on human chorionic gonadotropin trigger day on clinical outcomes with one top-quality cleavage-stage embryo or blastocyst transfer in fresh fertilization cycles.

Xu J, Zhang C, Wang S, Zhang S Front Endocrinol (Lausanne). 2023; 14:1085287.

PMID: 37409225 PMC: 10319152. DOI: 10.3389/fendo.2023.1085287.

Nomogram for Predicting Live Birth after the First Fresh Embryo Transfer in Patients with PCOS Undergoing IVF/ICSI Treatment with the GnRH-Ant Protocol.

Si M, Jiang H, Zhao Y, Qi X, Li R, Long X Diagnostics (Basel). 2023; 13(11).

PMID: 37296779 PMC: 10252873. DOI: 10.3390/diagnostics13111927.

Effects of trigger-day progesterone in the preimplantation genetic testing cycle on the embryo quality and pregnancy outcomes of the subsequent first frozen-thawed blastocyst transfer.

Li J, Cui Y, Shi H, Bu Z, Wang F, Sun B Front Endocrinol (Lausanne). 2023; 14:990971.

PMID: 36950680 PMC: 10025458. DOI: 10.3389/fendo.2023.990971.

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