Jsmc-10256

ASSOCIATION BETWEEN PRE-TRIGGER SERUM PROGESTERONE LEVEL AND CONCEPTION RATE AFTER A FRESH EMBRYO TRANSFER IN IVF-ICSI CYCLES

Zhiyan Ahmad Abdullah a

a Maternity Teaching Hospital, Sulaimani, Kurdistan Region, Iraq.

Submitted: 20/9/2019; Accepted: 13/9/2020; Published: 21/9/2020

DOI Link: https://doi.org/10.17656/jsmc.10256

ABSTRACT

Background

High progesterone (P4) level in the late follicular phase during in vitro fertilization (IVF) - intracytoplasmic sperm injection (ICSI) cycles had been claimed to have associations with decreased pregnancy rate; however, the evidence is still not clear.

Objectives

The aim was to determine the effect of serum P4 on pregnancy outcomes among IVF-ICSI cycles.

Patients and Methods

The prospective observational study was conducted on 997 patients who underwent IVF-ICSI cycles in the International Private IVF Center in Sulaimani from January 1st, 2017 to January 1st, 2019. Blood samples were collected for serum P4 on the day of the ovulation trigger. Ovum pickup was done 36 hours later, and serum P4 was correlated with IVF-ICSI outcome in terms of positive conception rate. The patients were subdivided into four subgroups depending on different age groups, conception rates and serum P4 were studied in each age group.

Results

The average serum P4 for positive and negative pregnancy groups among patients was 0.766 ng/ml and 0.803 ng/ml, respectively, with a statistically significant difference (P-value=0.035). Also, P4 for positive and negative groups was 0.852 ng/ml and 0.804 ng/ml, respectively, for the age group of 35-39 years (P-value=0.014).

Conclusion

Pregnancy may still occur with high P4, and the need to identify the subgroup of cycles with elevated P4 does not signify implantation failure or reduction, is still in question. Therefore, more studies are needed before making decisions like freezing all embryo or cycle cancelation based on the level of serum P4 alone.

KEYWORDS

Intracytoplasmic sperm injection (ICSI); In vitro fertilization (IVF); Kurdistan; Pregnancy; Progesterone (P4); Sulaimani.

References

1- Ubaldi F, Camus M, Smitz J, Bennink HC, Van Steirteghem A, Devroey P. Premature luteinization in vitro fertilization cycles using gonadotropin-releasing hormone agonist (GnRH-a) and recombinant follicle-stimulating hormone (FSH) and GnRH-a and urinary FSH. Fertil Steril. 1996;66(2):275-80.

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

3- Bu Z, Zhao F, Wang K, Guo Y, Su Y, Zhai J, et al. 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.

4- Huang Y, Wang EY, Du QY, Xiong YJ, Guo XY, Yu YP, et al. Progesterone elevation on the day of human chorionic gonadotropin administration adversely affects the outcome of IVF with transferred embryos at different developmental stages. Reprod Biol Endocrinol. 2015;13:82.

5- Demir B, Kahyaoglu I, Guvenir A, Yerebasmaz N, Altinbas S, Dilbaz B, et al. Progesterone change in the late follicular phase affects pregnancy rates both agonist and antagonist protocols in normoresponders: a case-controlled study in ICSI cycles. Gynecol Endocrinol. 2016;32(5):361-5.

6- Fanchin R, Righini C, Olivennes F, Ferreira AL, de Ziegler D, Frydman R. Consequences of premature progesterone elevation on the outcome of in vitro fertilization: insights into a controversy. Fertil Steril. 1997;68(5):799-805.

7- Bourgain C, Devroey P. The endometrium in stimulated cycles for IVF. Hum Reprod Update. 2003;9(6):515-22.

8- Papanikolaou EG, Kolibianakis EM, Pozzobon C, Tank P, Tournaye H, Bourgain C, et al. Progesterone rise on the day of human chorionic gonadotropin administration impairs pregnancy outcome in day 3 single-embryo transfer, while does not affect day 5 single blastocyst transfer. Fertil Steril. 2009;91(3):949-52.

9- Huang B, Ren X, Wu L, Zhu L, Xu B, Li Y, et al. Elevated progesterone levels on the day of oocyte maturation may affect top quality embryo IVF cycles. PLoS One. 2016;11(1):e0145895.

10- Bosch E, Labarta E, Crespo J, Simón C, Remohí J, Jenkins J, et al. Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: analysis of over 4000 cycles. Hum Reprod. 2010;25(8):2092-100.

11- Lee VC, Li RH, Chai J, Yeung TW, Yeung WS, Ho PC, et al. Effect of preovulatory progesterone elevation and duration of progesterone elevation on the pregnancy rate of frozen-thawed embryo transfer in natural cycles. Fertil Steril. 2014;101(5):1288-93.

12- Lee VCY, Li RH, Ng EH, Yeung WS, Ho PC. Luteal phase support does not improve the clinical pregnancy rate of natural cycle frozen-thawed embryo transfer: a retrospective analysis. Eur J Obstet Gynecol Reprod Biol. 2013;169(1):50-3.

13- 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.

14- Miller KF, Behnke EJ, Arciaga RL, Goldberg JM, Chin NW, Awadalla SG. The significance of elevated progesterone at the time of administration of human chorionic gonadotropin may be related to luteal support. J Assist Reprod Genet. 1996;13(9):698-701.

15- Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C, Thomas S, et al. Evidence of impaired endometrial receptivity after ovarian stimulation for in vitro fertilization: a prospective randomized trial comparing fresh and frozen-thawed embryo transfer in normal responders. Fertil Steril. 2011;96(2):344-8.

16- Griesinger G, Mannaerts B, Andersen CY, Witjes H, Kolibianakis EM, Gordon K, et al. Progesterone elevation does not compromise pregnancy rates in high responders: a pooled analysis of in vitro fertilization patients treated with recombinant follicle-stimulating hormone/gonadotropin-releasing hormone antagonist in six trials. Fertil Steril. 2013 Dec;100(6):1622-8.e1-3.

Full Text

This work is licensed under a Creative Commons Attribution 4.0 International License.