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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

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Date 2021 Oct 30
PMID 34716819
Citations 7
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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.

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References
1.
Li R, Qiao J, Wang L, Zhen X, Lu Y . Serum progesterone concentration on day of HCG administration and IVF outcome. Reprod Biomed Online. 2008; 16(5):627-31. DOI: 10.1016/s1472-6483(10)60475-0. View

2.
Wu Z, Li R, Ma Y, Deng B, Zhang X, Meng Y . Effect of HCG-day serum progesterone and oestradiol concentrations on pregnancy outcomes in GnRH agonist cycles. Reprod Biomed Online. 2012; 24(5):511-20. DOI: 10.1016/j.rbmo.2012.02.003. View

3.
Van Vaerenbergh I, Fatemi H, Blockeel C, Van Lommel L, Int Veld P, Schuit F . Progesterone rise on HCG day in GnRH antagonist/rFSH stimulated cycles affects endometrial gene expression. Reprod Biomed Online. 2011; 22(3):263-71. DOI: 10.1016/j.rbmo.2010.11.002. View

4.
Ochsenkuhn R, Arzberger A, von Schonfeldt V, Gallwas J, Rogenhofer N, Crispin A . Subtle progesterone rise on the day of human chorionic gonadotropin administration is associated with lower live birth rates in women undergoing assisted reproductive technology: a retrospective study with 2,555 fresh embryo transfers. Fertil Steril. 2012; 98(2):347-54. DOI: 10.1016/j.fertnstert.2012.04.041. View

5.
Nayak S, Ochalski M, Fu B, Wakim K, Chu T, Dong X . Progesterone level at oocyte retrieval predicts in vitro fertilization success in a short-antagonist protocol: a prospective cohort study. Fertil Steril. 2013; 101(3):676-82. DOI: 10.1016/j.fertnstert.2013.11.022. View