Premature progesterone rise on day of hCG negatively correlated with live birth rate in IVF cycles: An analysis of 1022 cycles

Abstract

Objective: To investigate the relationship between serum P levels on the day of hCG administration and pregnancy outcomes in patients undergoing IVF.

Design: Retrospective study.

Setting: Teaching hospital.

Patients: A total of 1022 IVF-ICSI cycles, frozen embryo transfer excluded.

Intervention(s): Patients-all types of responder - underwent IVF with agonist or antagonist protocols. Clinical outcomes of IVF were analyzed according to plasma P levels.

Main outcome measure(s): Ongoing pregnancy rates.

Results: We proposed a serum P level of 1.57ng/ml on day of hCG as a threshold for all types of responders and all protocols combined. Ongoing implantation rates were not affected by elevated progesterone. Live birth rate was inversely associated with serum P levels on day of hCG and more miscarriages were associated with P>1.57ng/ml. We have not found the progesterone>1.57ng/ml on the day of hCG as a prognostic factor for pregnancy.

Conclusion(s): Elevated P level on the day of hCG administration negatively influence live birth rate and is correlated to an increase of miscarriage. The detrimental effect of P elevation on pregnancy seems not to be related substantially to endometrium receptivity. Thus, despite a comparable clinical pregnancy rate and an initial implantation rate, we demonstrate more spontaneous abortion and it would seem that the effect of progesterone is later.

Keywords: IVF; Implantation; Live birth rates; Pregnancy; Progesterone.