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Younis JS, Yakovi S, Perlitz Y, Izhaki I. Proof of concept use of progesterone/estradiol ratio to investigate late follicular progesterone in women with low number of preovulatory follicles. Minerva Endocrinol (Torino) 2024; 49:25-32. [PMID: 33792234 DOI: 10.23736/s2724-6507.21.03328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate late follicular progesterone (P) serum levels in women with a low number of preovulatory follicles in the assisted reproductive technologies (ART) setting. METHODS Fifty-five consecutive women having four or fewer preovulatory follicles of >14 mm on the day of human chorionic gonadotropin (hCG) administration were prospectively evaluated. Spearman correlation tests were performed between serum estradiol (E2) level, serum P level, P/E2 ratio, number of preovulatory follicles, oocytes and embryos. Women enrolled were further divided into two groups in accordance with the P/E2 ratio on the day of hCG administration and compared. RESULTS Serum E2 level correlated positively with P serum level (rs=0.36, P<0.01), number of mature follicles (rs=0.50, P<0.01) and number of oocytes retrieved (rs=0.36, P<0.05), whereas negatively with P/E2 ratio (rs=- 0.68, P<0.01). Likewise, number of preovulatory follicles correlated positively with E2 level (rs=0.50, P<0.01), P level (rs=0.27, P<0.05) and number of oocytes retrieved (rs=0.33, P<0.05), while it correlated negatively with P/E2 ratio (rs=-0.33, P<0.05). Furthermore, women with P/E2 ratio >1 on the day of hCG administration received considerably higher total follicular stimulating hormone (FSH) dosage and achieved significantly lower number of oocytes and embryos as compared to controls. CONCLUSIONS The reverse relationship between number of preovulatory follicles and P/E2 ratio implies that P rise is not only the result of increased steroidogenic activity, but other oocyte-follicle disrupted mechanisms seem to be involved. An exaggerated FSH stimulation appears to disrupt further these mechanisms.
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Affiliation(s)
- Johnny S Younis
- Unit of Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya, Israel -
- Azrieili Faculty of Medicine, University of Bar-Ilan, Safed, Israel -
| | - Shiran Yakovi
- Unit of Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya, Israel
| | - Yuri Perlitz
- Unit of Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya, Israel
- Azrieili Faculty of Medicine, University of Bar-Ilan, Safed, Israel
| | - Ido Izhaki
- Department of Evolutionary and Environmental Biology, University of Haifa, Haifa, Israel
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Woo J, Kwon H, Choi D, Park C, Kim J, Shin J, Kim J, Kang YJ, Koo H. Effects of Elevated Progesterone Levels on the Day of hCG on the Quality of Oocyte and Embryo. J Clin Med 2022; 11:jcm11154319. [PMID: 35893410 PMCID: PMC9331243 DOI: 10.3390/jcm11154319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 01/27/2023] Open
Abstract
This study is designed to investigate the effects of increased progesterone (P4) levels on the quality of retrieved oocytes and embryos during IVF. This retrospective analysis included 982 all-freezing in vitro fertilization (IVF) cycles (conducted between November 2019 and June 2020 at CHA Fertility Center Bundang, South Korea) in which serum P4 levels were measured on the day of human chorionic gonadotropin (hCG) administration. Our study revealed that the serum P4 levels on the day of hCG administration are strongly associated with the rates of oocyte maturation, displaying a positive correlation in patients with serum P4 < 2.25 ng/mL (p = 0.025). Moreover, patients with serum P4 < 1.25 ng/mL showed relatively low fertilization rates (p = 0.037), and the rates of good embryo retrieval were significantly increased with the serum P4 level < 1.5 ng/mL (p = 0.001). Interestingly, serum P4 level on the day of hCG administration affects the rate of good-quality embryo development, especially at the cleavage stage, and is associated with the status of ovarian responses. Our current study suggests that serum P4 level on the day of hCG administration negatively affects the rates of oocyte maturation, fertilization, and the development of good embryos.
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Affiliation(s)
- Jeesoo Woo
- Research Competency Milestones Program of School of Medicine, CHA University, 335 Pangyo-ro, Bundang-gu, Gyeonggi-do, Seongnam-si 13488, Korea;
| | - Hwang Kwon
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, 335 Pangyo-ro, Bundang-gu, Gyeonggi-do, Seongnam-si 13488, Korea; (H.K.); (D.C.); (C.P.); (J.K.); (J.S.); (J.K.)
| | - Donghee Choi
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, 335 Pangyo-ro, Bundang-gu, Gyeonggi-do, Seongnam-si 13488, Korea; (H.K.); (D.C.); (C.P.); (J.K.); (J.S.); (J.K.)
| | - Chan Park
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, 335 Pangyo-ro, Bundang-gu, Gyeonggi-do, Seongnam-si 13488, Korea; (H.K.); (D.C.); (C.P.); (J.K.); (J.S.); (J.K.)
| | - Jihyang Kim
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, 335 Pangyo-ro, Bundang-gu, Gyeonggi-do, Seongnam-si 13488, Korea; (H.K.); (D.C.); (C.P.); (J.K.); (J.S.); (J.K.)
| | - Jieun Shin
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, 335 Pangyo-ro, Bundang-gu, Gyeonggi-do, Seongnam-si 13488, Korea; (H.K.); (D.C.); (C.P.); (J.K.); (J.S.); (J.K.)
| | - Jeehyun Kim
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, 335 Pangyo-ro, Bundang-gu, Gyeonggi-do, Seongnam-si 13488, Korea; (H.K.); (D.C.); (C.P.); (J.K.); (J.S.); (J.K.)
| | - Youn-Jung Kang
- Department of Biochemistry, Research Institute for Basic Medical Science, School of Medicine, CHA University, 335 Pangyo-ro, Bundang-gu, Gyeonggi-do, Seongnam-si 13488, Korea
- Correspondence: (Y.-J.K.); (H.K.)
| | - Hwaseon Koo
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, 335 Pangyo-ro, Bundang-gu, Gyeonggi-do, Seongnam-si 13488, Korea; (H.K.); (D.C.); (C.P.); (J.K.); (J.S.); (J.K.)
- Correspondence: (Y.-J.K.); (H.K.)
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Berger M, Patel H, Buyalos R, Hubert G, Wang C, Shamonki M, Quinn M. Estradiol to progesterone ratio is not a predictor of oocyte maturity at time of ovulation trigger. J Assist Reprod Genet 2022; 39:1667-1672. [PMID: 35672539 PMCID: PMC9365892 DOI: 10.1007/s10815-022-02491-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the relationship between progesterone and oocyte maturity rate via estradiol to progesterone ratio (E/P) at the time of ovulatory trigger. Methods This is a retrospective cohort study of first autologous IVF cycles from January to December 2018 from a private practice fertility center. Serum estradiol and progesterone levels were measured on the day of ovulatory trigger. E/P was calculated to control for degree of response. Embryos were cultured to the blastocyst stage for trophectoderm biopsy. Preimplantation genetic testing for aneuploidy (PGT-A) was performed using next-generation sequencing (NGS). Oocyte retrieval rate (oocytes retrieved/follicles ≥ 13 mm), maturity rate (MII/oocytes retrieved), and euploid rate (euploid/total biopsied embryos) were calculated. Clinical pregnancy, ongoing pregnancy (> 10 weeks), and live births following frozen embryo transfer (FET) were examined in relation to E/P. Regression analyses were performed to analyze E/P as a categorical value (defined by quartile) on oocyte maturity. Results Two hundred eleven women underwent controlled ovarian hyperstimulation and had steroid levels at trigger available. Mean E at trigger was 3449 ± 2040 pg/mL while mean P was 1.13 ± 0.58 ng/mL, with mean E/P of 3.36 + 2.04. There were no differences between quartiles of E/P with respect to retrieval, maturity rate, or euploid rate. Two hundred eleven IVF cycles resulted in 138 euploid frozen embryo transfers. There were no differences between quartiles of E/P with respect to clinical pregnancy, ongoing pregnancy, or live birth rate. Conclusion E/P ratio at the time of trigger does not impact oocyte retrieval rate, maturity rate, or euploid rate. Pregnancy and live birth outcomes were also not impacted.
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Yang Y, Liu B, Wu G, Yang J. Exploration of the value of progesterone and progesterone/estradiol ratio on the hCG trigger day in predicting pregnancy outcomes of PCOS patients undergoing IVF/ICSI: a retrospective cohort study. Reprod Biol Endocrinol 2021; 19:184. [PMID: 34893087 PMCID: PMC8665570 DOI: 10.1186/s12958-021-00862-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/21/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common endocrine disorder with the disorders of estrogen(E2) and progesterone(P) secretion. The purpose of this study was to evaluate the association between the progesterone level or progesterone/estradiol(P/E2) ratio on human chorionic gonadotropin (hCG) trigger day and the outcome of in vitro fertilization in PCOS patients and explore the value of progesterone and P/E2 ratio for predicting the clinical pregnancy. METHODS The clinical data of 1254 PCOS patients who satisfied the inclusion criteria were retrospectively analyzed, including baseline characteristics such as age, body mass index, basal sex hormone levels, et al., as well as ovarian stimulation data and clinic outcome. RESULTS The number of follicles larger than 14 mm in diameter (P < 0.001) and retrieved oocytes (P < 0.001) was greater in the high progesterone group (progesterone ≥ 0.92 ng/mL). In the high P/E2 group(P/E2 ratio ≥ 0.3), the number of follicles larger than 14 mm in diameter (P < 0.001) and retrieved oocytes (P < 0.001), as well as the rate of high-quality embryos (P = 0.040) were significantly decreased. In ultralong GnRH agonist protocol, the implantation rate(P < 0.001), hCG positive rate (P < 0.001), clinical pregnancy rate (P < 0.001) and live birth rate (P < 0.001) were all significantly higher than long GnRH agonist protocol and GnRH antagonist protocol. The clinical pregnancy rate of high progesterone group was significantly lower than that of low progesterone group in ultralong GnRH agonist (P = 0.008). The progesterone level could be used as an indicator to predict the positive clinical pregnancy (long GnRH agonist: P = 0.001; ultralong GnRH agonist: P < 0.001) except in cycles using GnRH antagonist (P = 0.169). In the ultralong GnRH agonist, the value of progesterone level in the prediction of clinical pregnancy was significantly higher than that of the P/E2 ratio (P = 0.021). CONCLUSIONS In PCOS patients, the progesterone level is associated with clinical pregnancy rate while P/E2 ratio is not. In subgroup analysis using three different COS protocols, a significant association between progesterone level and clinical pregnancy rate can be observed in the long GnRH agonist protocol and ultralong GnRH agonist protocol. The progesterone level is significantly better than the P/E2 ratio in predicting the pregnancy outcome of PCOS patients, especially in ultralong GnRH agonist cycles.
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Affiliation(s)
- Yiqing Yang
- Reproductive Medical Centre, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
- Hubei Clinical Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, 430060, People's Republic of China
| | - Bowen Liu
- Reproductive Medical Centre, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
- Hubei Clinical Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, 430060, People's Republic of China
| | - Gengxiang Wu
- Reproductive Medical Centre, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.
- Hubei Clinical Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, 430060, People's Republic of China.
| | - Jing Yang
- Reproductive Medical Centre, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.
- Hubei Clinical Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, 430060, People's Republic of China.
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Tokgoz VY, Tekin AB. 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. Arch Gynecol Obstet 2021; 305:1011-1019. [DOI: 10.1007/s00404-021-06304-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/18/2021] [Indexed: 12/01/2022]
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Wang Y, Li T, Zhang L, Li J, Zou B, Singh BK. The Clinical Value of 3D Ultrasonic Measurement of the Ratio of Gestational Sac Volume to Embryo Volume in IoT-Based Prediction of Pregnancy Outcome. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6421025. [PMID: 34484654 PMCID: PMC8410420 DOI: 10.1155/2021/6421025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022]
Abstract
The objective of the research study is to investigate the use of three-dimensional ultrasonic measurement technology, to determine the size of gestational sac and embryo volume, and to use the ratio of gestational sac volume to embryo volume in IoT-based prediction of pregnancy outcome. The abnormal and normal pregnancy identifiers are there, which assists in prediction of pregnancy outcomes: whether the pregnancy is normal or may suffer pregnancy loss during first trimester. For the observational study, 500 singleton pregnant women who made an appointment for delivery in Qiqihar Hospital from January 2015 to June 2019 were considered. The 500 pregnant women received transvaginal ultrasound at 6+0 ∼ 8+0 weeks of gestational age to measure gestational sac volume (GSV), yolk sac volume (YSV), and germ volume (GV). According to pregnancy outcome, they were divided into fine group (n = 435) and abortion group (n = 65). Among the 500 cases, 435 had normal delivery and 65 had abortions. According to the results of gestational age (GA) analysis, the pregnancy success rates at 6 (n = 268), 7 (n = 184), and 8 weeks (n = 48) were 85.8%, 87.5%, and 91.7%, respectively. Comparison of pregnancy failure rate among the three groups shows statistically significant difference. The morphology of germ, yolk sac, and gestational sac cannot be used as a predictor of pregnancy outcome in various degrees. The results of multivariate Cox proportional regression analysis show the following: the ratio of germ volume (GV) to gestational sac volume (GSV) (P=0.008) has an impact on the prediction of spontaneous abortion prognosis, showing statistically significant difference; yolk sac volume (YSV), germ volume (GV), and gestational sac volume (GSV) have no effect on the prediction of spontaneous abortion prognosis (P > 0.05). The ratio of GSV to germ volume has a strong prognostic value for pregnancy results. To a certain extent, the ratio of gestational sac volume to germ volume can predict spontaneous pregnancy abortion at 6th week of gestation, providing a theoretical basis for clinical ultrasound pregnancy examination indicators.
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Affiliation(s)
- Yong Wang
- Ultrasonic Department, The First Hospital of Qiqihar, Southern Medical University, Qiqihar 161000, China
| | - Tiantian Li
- Ultrasonic Department, The First Hospital of Qiqihar, Southern Medical University, Qiqihar 161000, China
| | - Lichun Zhang
- Ultrasonic Department, The First Hospital of Qiqihar, Southern Medical University, Qiqihar 161000, China
| | - Jing Li
- Ultrasonic Department, The First Hospital of Qiqihar, Southern Medical University, Qiqihar 161000, China
| | - Bo Zou
- Ultrasonic Department, The First Hospital of Qiqihar, Southern Medical University, Qiqihar 161000, China
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Hussein RS, Elnashar I, Abou-Taleb HA, Zhao Y, Abdelmagied AM, Abbas AM, Abdalmageed OS, Abdelaleem AA, Farghaly TA, Youssef AA, Badran E, Ibrahim MN, Amin AF. Progesterone/Oestradiol ratio can Better Predict Intracytoplasmic Sperm Injection Outcomes than Absolute Progesterone Level. J Hum Reprod Sci 2021; 14:28-35. [PMID: 34083989 PMCID: PMC8057156 DOI: 10.4103/jhrs.jhrs_57_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/10/2020] [Accepted: 01/12/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Several parameters were proposed to predict the impact of premature luteinization on intracytoplasmic sperm injection (ICSI) outcomes such as isolated progesterone (P) level, progesterone to oocyte ratio, and progesterone/estradiol ratio (P/E2). Aim: The aim of this study is to compare the predictive value of P/E2 ratio and isolated P level on the ovulation triggering day for pregnancy outcomes in fresh GnRH antagonist ICSI cycles. Settings and Design: A retrospective cohort study conducted in a university-affiliated in vitro fertilization center between January 2017 and April 2019. Methods: The study included women who underwent their first- or second-ranked GnRH antagonist ICSI cycles with day-3 embryo transfer. P/E2 ratio was calculated as (P [ng/mL] × 1000)/E2 (pg/mL). Cutoff values of ≥1.5 ng/ml for high P (HP) and ≥0.55 for HP/E2 ratio were chosen based on the literature. Statistical Analysis: A receiver operating curve was performed to detect the predictability of serum P/E2 and P for the ongoing pregnancy rate. First, patients were divided according to either P level (low P < 1.5 ng/mL and HP ≥1.5 ng/mL) or P/E2 ratio (low P/E2 <0.55 and HP/E2 ≥ 0.55). Patients were further divided into four subgroups: (Group A: HP and HP/E2 ratio, Group B: low P and low P/E2 ratio, Group C: HP only, and Group D: HP/E2 only). A multivariate regression analysis models were used to account for the effect of the cycle confounders on the likelihood of pregnancy. Results: A total of 402 ICSI cycles were analyzed. The area under the curve was 0.67 and 0.59 for P/E2 and P, respectively. P/E2 showed a significant association with ongoing pregnancy (adjusted odds ratios [aOR]: 0.409, 95% confidence interval [CI] 0.222–0.753, P = 0.004) while HP revealed no significant predictive value (aOR: 0.542, 95% CI 0.284–1.036, P = 0.064) after the multivariate analysis. Conclusions: P elevation may not present as an independent predictor for cycle outcomes. P/E2 ratio has a better prognostic value than P alone in predicting pregnancy of GnRH antagonist cycles.
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Affiliation(s)
- Reda S Hussein
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ihab Elnashar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hisham A Abou-Taleb
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Yulian Zhao
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed M Abdelmagied
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Obstetrics and Gynecology, Taibah University, Medina, KSA
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Osama S Abdalmageed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Abdelaleem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Tarek A Farghaly
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Youssef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa Badran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mostafa N Ibrahim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed F Amin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Jia Q, Fang L, Wang Z, Wu Z, Yan Y, Liu B, Cheng JC, Sun YP. Ovarian Hyperstimulation Syndrome Is Associated with a High Secondary Sex Ratio in Fresh IVF Cycles with Cleavage-Stage Embryo Transfer: Results for a Cohort Study. Reprod Sci 2021; 28:3341-3351. [PMID: 34081318 DOI: 10.1007/s43032-021-00637-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/25/2021] [Indexed: 11/29/2022]
Abstract
The sex ratio at birth is defined as the secondary sex ratio (SSR). Ovarian hyperstimulation syndrome (OHSS) is a serious and iatrogenic complication associated with controlled ovarian stimulation (COS) during assisted reproductive technology (ART) treatments. It has been hypothesized that the human SSR is partially controlled by parental hormone levels around the time of conception. Given the aberrant hormonal profiles observed in patients with OHSS, this retrospective study was designed to evaluate the impact of OHSS on the SSR. In this study, all included patients were divided into 3 groups: non-OHSS (n=2777), mild OHSS (n=644), and moderate OHSS (n=334). Our results showed that the overall SSR for the study population was 1.033. The SSR was significantly increased in patients with moderate OHSS (1.336) compared to non-OHSS patients (1.002) (p=0.048). Subgroup analyses showed that increases in the SSR in patients with moderate OHSS were observed in the IVF group (1.323 vs 1.052; p=0.043), but not in the ICSI groups (1.021 vs 0.866; p=0.732). In addition, the elevated serum estradiol (E2) and progesterone (P4) levels in OHSS patients were not associated with SSR. In this study, for the first time, we report that a high SSR is associated with OHSS in patients who received fresh IVF treatments. The increases in SSR in OHSS patients are not attributed to the high serum E2 and P4 levels. Our findings may make both ART clinicians and patients more aware of the influences of ART treatments on the SSR and allow clinicians to counsel patients more appropriately.
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Affiliation(s)
- Qiongqiong Jia
- Center for Reproductive Medicine, Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 40, Daxue Road, Zhengzhou, 450052, Henan, China
| | - Lanlan Fang
- Center for Reproductive Medicine, Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 40, Daxue Road, Zhengzhou, 450052, Henan, China.
| | - Zhen Wang
- Center for Reproductive Medicine, Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 40, Daxue Road, Zhengzhou, 450052, Henan, China
| | - Ze Wu
- Center for Reproductive Medicine, Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 40, Daxue Road, Zhengzhou, 450052, Henan, China
| | - Yang Yan
- Center for Reproductive Medicine, Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 40, Daxue Road, Zhengzhou, 450052, Henan, China
| | - Boqun Liu
- Center for Reproductive Medicine, Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 40, Daxue Road, Zhengzhou, 450052, Henan, China
| | - Jung-Chien Cheng
- Center for Reproductive Medicine, Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 40, Daxue Road, Zhengzhou, 450052, Henan, China
| | - Ying-Pu Sun
- Center for Reproductive Medicine, Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 40, Daxue Road, Zhengzhou, 450052, Henan, China
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Merviel P, Bouée S, Jacamon AS, Chabaud JJ, Le Martelot MT, Roche S, Rince C, Drapier H, Perrin A, Beauvillard D. Progesterone levels on the human chorionic gonadotropin trigger day affect the pregnancy rates for embryos transferred at different stages of development in both general and selected IVF/ICSI populations. BMC Pregnancy Childbirth 2021; 21:363. [PMID: 33957886 PMCID: PMC8101180 DOI: 10.1186/s12884-021-03832-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background Two meta-analyses have shown that pregnancy and birth rates are significantly higher after blastocyst transfer than after cleaved embryo transfer. Other studies have revealed that a serum progesterone level > 1.5 ng/ml on the trigger day is responsible for premature luteinization and is associated with a low pregnancy rate. The objectives of this retrospective study were to determine whether blastocyst transfer gave higher pregnancy rates than cleaved embryo transfer at day 3 in both the general and selected IVF/ICSI populations, and whether the serum progesterone level influenced the pregnancy rate. Method We studied IVF/ICSI cycles with GnRH antagonist - FSH/hMG protocols in a general population (n = 1210) and a selected “top cycle” population (n = 677), after blastocyst transfer on day 5 or cleaved embryo transfer on day 3. The selected couples had to meet the following criteria: female age < 35, first or second cycle, and one or two embryos transferred. We recorded predictive factors for pregnancy and calculated the progesterone to oocyte index (POI), the progesterone:estradiol ratio (P:E2 ratio), and the progesterone to follicle (> 14 mm) index (PFI). Results In the general population, the clinical pregnancy rate was significantly higher after blastocyst transfer (33.3%) than after cleaved embryo transfer (25.3%; p < 0.01); the same was true for the birth rate (32.1 and 22.8%, respectively, p < 0.01). The differences between blastocyst and embryo transfer groups were not significant in the selected population (respectively 35.7% vs. 35.8% for the clinical pregnancy rate, and 33.9 and 34.9% for the birth rate). The serum progesterone levels on the eve of the trigger day and on the day itself were significantly lower in the pregnant women (p < 0.01). We found a serum progesterone threshold of 0.9 ng/ml, as also reported by other researchers. The POI and the PFI appear to have predictive value for cleaved embryos transfers. Conclusions Blastocyst transfers were associated with higher clinical pregnancy and birth rates than cleaved embryo transfers in a general population but not in a selected population. The serum progesterone levels on the eve of the trigger day and on the day itself predicted the likelihood of pregnancy.
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Affiliation(s)
- P Merviel
- Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France.
| | - S Bouée
- Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France
| | - A S Jacamon
- Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France
| | - J J Chabaud
- Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France
| | - M T Le Martelot
- Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France
| | - S Roche
- Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France
| | - C Rince
- Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France
| | - H Drapier
- Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France
| | - A Perrin
- Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France
| | - D Beauvillard
- Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France
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10
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Gilli F, DiSano KD, Pachner AR. SeXX Matters in Multiple Sclerosis. Front Neurol 2020; 11:616. [PMID: 32719651 PMCID: PMC7347971 DOI: 10.3389/fneur.2020.00616] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is the most common chronic inflammatory and neurodegenerative disease of the central nervous system (CNS). An interesting feature that this debilitating disease shares with many other inflammatory disorders is that susceptibility is higher in females than in males, with the risk of MS being three times higher in women compared to men. Nonetheless, while men have a decreased risk of developing MS, many studies suggest that males have a worse clinical outcome. MS exhibits an apparent sexual dimorphism in both the immune response and the pathophysiology of the CNS damage, ultimately affecting disease susceptibility and progression differently. Overall, women are predisposed to higher rates of inflammatory relapses than men, but men are more likely to manifest signs of disease progression and worse CNS damage. The observed sexual dimorphism in MS may be due to sex hormones and sex chromosomes, acting in parallel or combination. In this review, we outline current knowledge on the sexual dimorphism in MS and discuss the interplay of sex chromosomes, sex hormones, and the immune system in driving MS disease susceptibility and progression.
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Affiliation(s)
- Francesca Gilli
- Department of Neurology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Krista D DiSano
- Department of Neurology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Andrew R Pachner
- Department of Neurology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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11
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Dudley JS, Murphy CR, Thompson MB, Lindsay LA, McAllan BM. Sex steroids influence the plasma membrane transformation in the uterus of the fat-tailed dunnart (Sminthopsis crassicaudata, Marsupialia). Reprod Fertil Dev 2019; 31:633-644. [PMID: 30449299 DOI: 10.1071/rd18202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/03/2018] [Indexed: 12/11/2022] Open
Abstract
The uterine epithelium undergoes remodelling to become receptive to blastocyst implantation during pregnancy in a process known as the plasma membrane transformation. There are commonalities in ultrastructural changes to the epithelium, which, in eutherian, pregnancies are controlled by maternal hormones, progesterone and oestrogens. The aim of this study was to determine the effects that sex steroids have on the uterine epithelium in the fat-tailed dunnart Sminthopsis crassicaudata, the first such study in a marsupial. Females were exposed to exogenous hormones while they were reproductively quiescent, thus not producing physiological concentrations of ovarian hormones. We found that changes to the protein E-cadherin, which forms part of the adherens junction, are controlled by progesterone and that changes to the desmoglein-2 protein, which forms part of desmosomes, are controlled by 17β-oestradiol. Exposure to a combination of progesterone and 17β-oestradiol causes changes to the microvilli on the apical surface and to the ultrastructure of the uterine epithelium. There is a decrease in lateral adhesion when the uterus is exposed to progesterone and 17β-oestradiol that mimics the hormone environment of uterine receptivity. We conclude that uterine receptivity and the plasma membrane transformation in marsupial and eutherian pregnancies are under the same endocrine control and may be an ancestral feature of therian mammals.
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Affiliation(s)
- Jessica S Dudley
- School of Medical Sciences and Bosch Institute, Anderson Stuart Building (F13), University of Sydney, Sydney, NSW 2006, Australia
| | - Christopher R Murphy
- School of Medical Sciences and Bosch Institute, Anderson Stuart Building (F13), University of Sydney, Sydney, NSW 2006, Australia
| | - Michael B Thompson
- School of Life and Environmental Science, Heydon-Laurence Building (A08), University of Sydney, Sydney, NSW 2006, Australia
| | - Laura A Lindsay
- School of Medical Sciences and Bosch Institute, Anderson Stuart Building (F13), University of Sydney, Sydney, NSW 2006, Australia
| | - Bronwyn M McAllan
- School of Medical Sciences and Bosch Institute, Anderson Stuart Building (F13), University of Sydney, Sydney, NSW 2006, Australia
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12
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Hussein RS, Elnashar I, Amin AF, Abou-Taleb HA, Abbas AM, Abdelmageed AM, Farghaly T, Zhao Y. Revisiting debates of premature luteinization and its effect on assisted reproductive technology outcome. J Assist Reprod Genet 2019; 36:2195-2206. [PMID: 31650455 PMCID: PMC6885458 DOI: 10.1007/s10815-019-01598-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022] Open
Abstract
The impact of the prematurely elevated serum progesterone on the late follicular phase, commonly known as premature luteinization (PL), is a matter of continuing debate. Available evidence supports that serum progesterone ≥ 1.5 ng/ml on the day of ovulation triggering could reduce the pregnancy potential in fresh in vitro fertilization (IVF) cycles by jeopardizing endometrial receptivity. Causes of PL during ovarian stimulation are unclear. Recent studies point toward the daily follicle-stimulating hormone dosage, duration of controlled ovarian stimulation, number of oocytes retrieved, and peak estradiol level as factors affecting the incidence of PL. Emerging data show additional influence on embryo quality. The prevention of PL has been challenging. The key elements in preventing PL include individualization of ovarian stimulation according to patient's ovarian reserve, proper ovulation trigger timing, and use of medications such as corticosteroids and metformin. Embryo cryopreservation with deferred embryo transfer is the established strategy to overcome PL, yet it is an extra burden to the IVF laboratory and increased cost for patients. Herein, we review the up-to-date knowledge of this frequent IVF problem including causes, proposed diagnostic criteria, and its impact on endometrial receptivity, embryo quality, and pregnancy outcomes. The preventive measures and rescue strategies are also discussed.
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Affiliation(s)
- Reda S Hussein
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ihab Elnashar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed F Amin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hisham A Abou-Taleb
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
- Women Health Hospital, Assiut, 71511, Egypt.
| | - Ahmed M Abdelmageed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Tarek Farghaly
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Yulian Zhao
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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13
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Wang Y, Liu M, Zhang J, Liu Y, Kopp M, Zheng W, Xiao S. Multidrug Resistance Protein 1 Deficiency Promotes Doxorubicin-Induced Ovarian Toxicity in Female Mice. Toxicol Sci 2019; 163:279-292. [PMID: 29462422 DOI: 10.1093/toxsci/kfy038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Multidrug resistance protein 1 (MDR1), a phase III drug transporter that exports substrates out of cells, has been discovered in both cancerous and normal tissues. The over expression of MDR1 in cancer cells contributes to multiple drug resistance, whereas the MDR1 in normal tissues protects them from chemical-induced toxicity. Currently, the role of MDR1 in the ovary has not been entirely understood. Our objective is to determine the function of MDR1 in protecting against chemotherapy-induced ovarian toxicity. Using both the in vivo transgenic mouse model and in vitro follicle culture model, we investigated the expression of MDR1 in the ovary, the effect of MDR1 deficiency on doxorubicin (DOX)-induced ovarian toxicity, and the ovarian steroid hormonal regulation of MDR1. Results showed that the MDR1 was expressed in the ovarian epithelial cells, stroma cells, theca cell layers, endothelial cells, and luteal cells. The lack of MDR1 did not affect female ovarian function and fertility; however, its deficiency significantly exacerbated the DOX-induced ovarian toxicity in both in vivo and in vitro models. The MDR1 showed significantly higher expression levels in the ovaries at estrus and metestrus stages than those at proestrus and diestrus stages. However, this dynamic expression pattern was not regulated by the ovarian steroid hormones of estrogen (E2) and progesterone (P4) but correlated to the number and status of corpus luteum. In conclusion, our study demonstrates that the lack of MDR1 promotes DOX-induced ovarian toxicity, suggesting the critical role of MDR1 in protecting female ovarian functions during chemotherapy.
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Affiliation(s)
- Yingzheng Wang
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina 29208
| | - Mingjun Liu
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina 29208
| | - Jiyang Zhang
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611
| | - Yuwen Liu
- Department of Human Genetics, The University of Chicago, Chicago, Illinois 60637
| | - Megan Kopp
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina 29208
| | - Weiwei Zheng
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Environmental Health, School of Public Health, Institution for Water Pollution and Health Research, Fudan University, Shanghai 20032, China
| | - Shuo Xiao
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina 29208
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14
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The role of progesterone/estradiol ratio in exploring the mechanism of late follicular progesterone elevation in low ovarian reserve women. Med Hypotheses 2019; 125:126-128. [PMID: 30902140 DOI: 10.1016/j.mehy.2019.02.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/04/2019] [Accepted: 02/27/2019] [Indexed: 11/22/2022]
Abstract
Late follicular progesterone (P) elevation continues to complicate a significant part of assisted reproductive technologies (ART) cycles, despite the ardent employment of gonadotropin releasing hormone (GnRH) analogues. In women with good ovarian reserve, late follicular P elevation is believed to be the result of the controlled ovarian stimulation (COS) itself, multiple follicular development and excessive ovarian steroidogenic activity. These mechanisms do not seem to be plausible in women with low ovarian reserve. In these women, excessive COS achieve a small number of pre-ovulatory follicles, which is not coupled to considerable ovarian steroidogenic activity. Therefore, other mechanisms should be pursued and explored. Delicate paracrine and autocrine mechanisms within the oocyte-cumulus complex were suggested to preserve the integrity of the pre-ovulatory follicle, including inhibition of P increase and follicular luteinization. However, clinical studies to demonstrate the disruption of these mechanisms in cases with low ovarian reserve and ageing oocytes are still lacking. Late follicular progesterone/estradiol (P/E2) ratio was introduced into clinical practice as a more appropriate way to analyze P rise in women undergoing COS to control for the E2 increase. The current hypothesis claims that in a follicular environment were the mechanism that prevent premature luteinization is disrupted, independent to LH surge; P rise at the late follicular phase may relatively bypass normal E2 production, at the pre-ovulatory stage of steroidogenesis, causing a rise in the P/E2 ratio. Therefore, in women with low ovarian reserve and few pre-ovulatory follicles, undergoing conventional COS, a negative (reverse) correlation between number of maturing follicles and P/E2 ratio may support the existence of such a mechanism as its disruption, while a no or a positive correlation may disapprove it.
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15
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Kaponis A, Chronopoulou E, Decavalas G. The curious case of premature luteinization. J Assist Reprod Genet 2018; 35:1723-1740. [PMID: 30051348 DOI: 10.1007/s10815-018-1264-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/11/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Premature luteinization (PL) affects 12.3-46.7% of fresh in vitro fertilization cycles, and there is accumulating evidence confirming its negative effect on success rates. However, despite its clinical significance, PL is poorly understood and defined. This narrative review aims to provide a fresh look at the phenomenon of PL by summarizing the existing evidence and re-evaluating fundamental issues. METHODS A thorough electronic search was conducted covering the period from 1978 until January 2018 in PubMed, Embase, and Medline databases, and references of relevant studies were cross-checked. Meeting proceedings of the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine were also hand searched. RESULTS In the curious case of PL, one should go back to the beginning and re-consider every step of the way. The pathogenesis, definition, measurement methods, clinical implications, and management strategies are discussed in detail, highlighting controversies and offering "food for thought" for future directions. CONCLUSIONS Authors need to speak the same language when studying PL in order to facilitate comparisons. The terminology, progesterone cut-off, measurement methods and days of measurement should be standardized and globally accepted; otherwise, there can be no scientific dialog. Future research should focus on specific patient profiles that may require a tailored approach. Progesterone measurements throughout the follicular phase possibly depict the progesterone exposure better than an isolated measurement on the day of hCG. Adequately powered randomized controlled trials should confirm which the best prevention and management plan of PL is, before introducing any strategy into clinical practice.
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Affiliation(s)
- Apostolos Kaponis
- Department of Obstetrics and Gynaecology, Patras University School of Medicine, General University Hospital of Patras, Rio, 26504, Patras, Greece
| | - Elpiniki Chronopoulou
- Department of Obstetrics and Gynaecology, Patras University School of Medicine, General University Hospital of Patras, Rio, 26504, Patras, Greece.
| | - George Decavalas
- Department of Obstetrics and Gynaecology, Patras University School of Medicine, General University Hospital of Patras, Rio, 26504, Patras, Greece
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16
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Progesterone rise on hCG day is negatively correlated with IVF-ET outcomes in natural cycles. Clin Chim Acta 2018; 478:194-199. [PMID: 29305844 DOI: 10.1016/j.cca.2017.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 12/23/2017] [Accepted: 12/29/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the effect of progesterone rise on hCG day on the laboratory and clinical outcomes in natural cycles and to explore the possible factors related to the occurrence of progesterone elevation. PATIENTS AND STUDY METHODS Retrospective analysis was performed in 1157 infertile women with decreased ovarian reserve. Eligible infertile women undergoing IVF in natural cycles were assigned to four groups according to serum progesterone levels on the day of hCG administration: group 1, P<2nmol/L; group 2, 2<P<2.9nmol/L; group 3, 3<P<3.9nmol/L; group 4, P≥4.0nmol/L. Data on clinical outcomes and LH level were collected and analyzed. RESULTS Number of retrieved oocytes, pronucleus cells, fertilized cells, and good embryos significantly decreased (p<0.05). A significant elevation of cancelled cycle rate, early follicle elimination rate and LH level on hCG day occurred when the serum progesterone levels were higher than 4.0nmol/L on the day of hCG administration (p<0.05). CONCLUSION In natural cycles, progesterone rise on the day of hCG administration (in this study, P≥4.0nmol/L) may negatively correlated with the quality of oocytes and embryos.
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17
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Kutlu T, Özkaya E, Şanverdi İ, Devranoğlu B, İpekçi C, Konukçu B, Şahin Y, Karateke A. The relationship between estradiol-progesterone alterations after ovulation trigger and treatment success in intrauterine insemination cycles. Turk J Obstet Gynecol 2016; 13:56-61. [PMID: 28913092 PMCID: PMC5558338 DOI: 10.4274/tjod.45656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/20/2016] [Indexed: 12/01/2022] Open
Abstract
Objective: To assess the relationship between the estrogen-progesterone alterations before and after ovulation trigger and treatment success in intrauterine insemination (IUI) cycles. Materials and Methods: Two hundred fifty-one women with infertility underwent ovulation induction followed by IUI. For all subjects, estradiol and progesterone concentrations were evaluated on the trigger and IUI day. The results were analyzed to assess the relationship between hormone levels and positive pregnancy test. Results: There were 34 women with a positive pregnancy test following controlled ovarian stimulation and IUI cycle. Estradiol and progesterone levels on the trigger day and the day of IUI were compared within groups with and without positive pregnancy tests. The comparison revealed significantly increased levels of progesterone after trigger in both groups; however, although there were estradiol level drops in both groups, the drop in the group with negative pregnancy tests was statistically significant. Conclusion: Significant drops in estradiol concentrations after ovulation trigger are associated with IUI cycle treatment failure.
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Affiliation(s)
- Tayfun Kutlu
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Enis Özkaya
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - İlhan Şanverdi
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Belgin Devranoğlu
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Cansu İpekçi
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Birsen Konukçu
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Yavuz Şahin
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ateş Karateke
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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18
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Elevated Progesterone Levels on the Day of Oocyte Maturation May Affect Top Quality Embryo IVF Cycles. PLoS One 2016; 11:e0145895. [PMID: 26745711 PMCID: PMC4706317 DOI: 10.1371/journal.pone.0145895] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022] Open
Abstract
In contrast to the impact of elevated progesterone on endometrial receptivity, the data on whether increased progesterone levels affects the quality of embryos is still limited. This study retrospectively enrolled 4,236 fresh in vitro fertilization (IVF) cycles and sought to determine whether increased progesterone is associated with adverse outcomes with regard to top quality embryos (TQE). The results showed that the TQE rate significantly correlated with progesterone levels on the day of human chorionic gonadotropin (hCG) trigger (P = 0.009). Multivariate linear regression analysis of factors related to the TQE rate, in conventional IVF cycles, showed that the TQE rate was negatively associated with progesterone concentration on the day of hCG (OR was -1.658, 95% CI: -2.806 to -0.510, P = 0.005). When the serum progesterone level was within the interval 2.0–2.5 ng/ml, the TQE rate was significantly lower (P <0.05) than when the progesterone level was < 1.0 ng/ml; similar results were obtained for serum progesterone levels >2.5 ng/ml. Then, we choose a progesterone level at 1.5ng/ml, 2.0 ng/ml and 2.5 ng/ml as cut-off points to verify this result. We found that the TQE rate was significantly different (P <0.05) between serum progesterone levels < 2.0 ng/ml and >2.0 ng/ml. In conclusion, the results of this study clearly demonstrated a negative effect of elevated progesterone levels on the day of hCG trigger, on TQE rate, regardless of the basal FSH, the total gonadotropin, the age of the woman, or the time of ovarian stimulation. These data demonstrate that elevated progesterone levels (>2.0 ng/ml) before oocyte maturation were consistently detrimental to the oocyte.
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19
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Shalom-Paz E, Aslih N, Samara N, Michaeli M, Ellenbogen A. Late follicular progesterone to estradiol ratio is not influenced by protocols or gonadotropins used. Reprod Biol Endocrinol 2015; 13:119. [PMID: 26542686 PMCID: PMC4635981 DOI: 10.1186/s12958-015-0116-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/13/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Increased progesterone level during follicular phase seemed to be associated with decreased pregnancy rate. STUDY DESIGN AND METHODS A prospective cohort study, 1.1.2012 - 31.8.13. The Progesterone (P) and Progesterone/Estrogen (P/E2) level on ovulation induction day were compared between the protocols and the different gonadotropins used. Roc analysis was calculated to determine the cutoff of P/E2 to predict delivery rates. P/E2 ratio was calculated as PX1000/e2 level. MAIN RESULTS One hundred thirty-nine patients were enrolled to the study. No difference in the P level at hCG stimulation day between different protocols, however, E2 and P/E2 ratio were significantly lower in the long protocol compare with antagonist protocol 1757.7 ± 923.2 vs. 1342.9 ± 1223; P = 0.003 and 0.48 ± 0.31 vs. 0.83 ± 0.87; P = 0.038). The endometrium was significantly thicker in the long group compare with short and antagonist. Significantly more top-quality embryos (TOP) were achieved in the antagonist group. Comparable results between the types of gonadotropins used in regards with cycle characteristics and pregnancy and delivery rates. The P/E2 ratio which can predict live birth rate was found to be 0.45, AUC = 0.632, p = 0.02 and 95 % CI 0.525-0.738 and a significantly higher pregnancy and delivery rates at a P/E2 bellow 0.45. CONCLUSION Endometrial receptivity is determined by the complex interactions of E2 and P.
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Affiliation(s)
- E Shalom-Paz
- Department of Obstetrics and Gynecology, IVF unit, Hillel Yaffe Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology, Hadera, Israel.
| | - N Aslih
- Department of Obstetrics and Gynecology, IVF unit, Hillel Yaffe Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology, Hadera, Israel.
| | - N Samara
- Department of Obstetrics and Gynecology, IVF unit, Hillel Yaffe Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology, Hadera, Israel.
| | - M Michaeli
- Department of Obstetrics and Gynecology, IVF unit, Hillel Yaffe Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology, Hadera, Israel.
| | - A Ellenbogen
- Department of Obstetrics and Gynecology, IVF unit, Hillel Yaffe Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology, Hadera, Israel.
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20
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Dai W, Bu ZQ, Wang LL, Sun YP. The relationship between the changes in the level of progesterone and the outcome of in vitro fertilization-embryo transfer. Syst Biol Reprod Med 2015; 61:388-97. [PMID: 26247832 DOI: 10.3109/19396368.2015.1064489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We observed the effects of changes in progesterone (P) during late follicular phases on the treatment outcome of in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI) in patients with different ovarian responses. The data of 8,575 cycles of patients receiving gonadotropin-releasing hormone (GnRH) agonist using the long protocol were retrospectively analyzed. According to the number of oocytes retrieved, the cycles were divided into poor ovarian response group (oocyte retrieval <5), intermediate ovarian response group (5≤ oocyte retrieval ≤15), and high ovarian response group (oocyte retrieval ≥16). We found that in the poor ovarian response group, the clinical pregnancy rate was not significantly associated with both the level of P or the day of human chorionic gonadotrophin (hCG) and the duration of pre-hCG P elevation (p = 0.66 and p = 0.1874). In intermediate and high ovarian response groups, the clinical pregnancy rate was inversely related to both the level of P on the day of hCG administration and the duration of pre-hCG P elevation (all p < 0.0001). The cut-off values of serum P level on the day of hCG administration were 1 ng/ml and 1.75 ng/ml in intermediate and high ovarian response groups, respectively. The cut-off values of pre-hCG P elevation duration were obtained on day 1 in the intermediate ovarian response group, and days 1 or 3 in the high ovarian response group. After correcting for other confounding factors, multivariate logistic regression analysis indicated that P level on the day of hCG administration was not associated with clinical pregnancy rates, but pre-hCG P elevation duration was negatively associated with clinical pregnancy rate in the intermediate and high ovarian response groups. P level is associated with clinical pregnancy rate only in the patients with intermediate or high ovarian response. The longer the duration of pre-hCG P 1 ng/ml, the lower the clinical pregnancy rate.
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Affiliation(s)
- Wei Dai
- a Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Zhi-qin Bu
- a Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Lin-lin Wang
- a Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Ying-pu Sun
- a Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
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Liu Y, Copeland C, Chapple V, Roberts P, Feenan K, Matson P. The relationship between embryo quality assessed using routine embryology or time–lapse videography and serum progesterone concentration on the day of ovulatory trigger in in vitro fertilization cycles. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2015. [DOI: 10.1016/s2305-0500(15)30011-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Roque M, Valle M, Sampaio M, Geber S, Checa MA. Ratio of progesterone-to-number of follicles as a prognostic tool for in vitro fertilization cycles. J Assist Reprod Genet 2015; 32:951-7. [PMID: 25925350 DOI: 10.1007/s10815-015-0487-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/13/2015] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To establish a ratio of the P level to the number of follicles (P/F ratio) on the day of human chorionic gonadotropin (hCG) administration and to evaluate whether this ratio is associated with in vitro fertilization (IVF) outcome. METHODS This study was conducted between January 2012 and June 2013. A total of 337 patients with cleavage-stage day-3 fresh embryo transfer with P levels ≤1.5 ng/mL on the day of hCG administration were included in the study. The main outcome was ongoing pregnancy rate. RESULT(S) The P/F ratio was calculated according to the equation (P[ng/mL]/number of follicles) on the day of final oocyte maturation. Using ROC, we established a cut-off level of 0.075 for the P/F ratio. The area under the curve (AUC) (0.756; 95 % confidence interval [CI]: 0.704-0.807) indicated that it was a good prognostic test. In group 1 (patients under 36 years old), the ongoing pregnancy rates were 57 and 30 % for patients with P/F ratios ≤ .075 and > .075, respectively, (p = 0.003). In group 2 (patients between 36 and 39 years old), the ongoing pregnancy rates were 58 % and 17 % (p = 0.001) for patients with P/F ratios ≤ .075 and > .075, respectively. In group 3 (patients ≥ 40 years old), the ongoing pregnancy rates were 41.7 and 10.9 % (p = 0.001) for patients with P/F ratios ≤ .075 and > .075, respectively. CONCLUSIONS The P/F ratio is a good prognostic test for predicting IVF outcome that can correlate the P level with ovarian response.
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Affiliation(s)
- Matheus Roque
- ORIGEN-Center for Reproductive Medicine, Avenida Rodolfo de Amoedo, 140, Barra da Tijuca, Rio de Janeiro, Brazil,
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Pohlmeier WE, Xie F, Kurz SG, Lu N, Wood JR. Progressive obesity alters the steroidogenic response to ovulatory stimulation and increases the abundance of mRNAs stored in the ovulated oocyte. Mol Reprod Dev 2014; 81:735-47. [PMID: 24824196 DOI: 10.1002/mrd.22342] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/08/2014] [Indexed: 11/09/2022]
Abstract
Obese women who are able to attain pregnancy are at increased risk for early-pregnancy loss due, in part, to reduced oocyte quality. We and others have demonstrated that female Lethal Yellow (LY) mice and female C57BL/6 mice fed a high fat diet (B6-HFD) exhibit phenotypes consistent with human obesity. These studies also showed that zygotes collected from LY and B6-HFD females have reduced developmental competence. The current hypothesis is that LY and B6-HFD females exhibit an abnormal response to gonadotropin stimulation compared to C57BL/6 controls fed normal rodent chow (B6-ND), resulting in the ovulation of oocytes with an altered molecular phenotype which may contribute to its reduced developmental competence. To test this hypothesis, age-matched B6-ND, B6-HFD, and LY females were stimulated with exogenous gonadotropins, then circulating hormone levels and the phenotypes of ovulated oocytes were analyzed. There was no difference in ovulation rate or in the percentage of morphologically abnormal oocytes collected from the oviduct of any females. Progesterone and progesterone/estradiol ratios, however, were increased in B6-HFD and LY compared to B6-ND females 16 hr post-human chorionic gonadotropin treatment. The transcript abundance of several candidate oocyte genes was also increased in B6-HFD- and LY-derived oocytes compared to B6-ND-derived oocytes. These data suggest that increased insulin and leptin levels of obese females elevated circulating progesterone concentrations, altered transcriptional activity during oocyte growth, and/or impaired mechanisms of RNA translation and degradation during oocyte maturation. These changes in mRNA abundance likely contribute to reduced oocyte quality and the subsequent poor embryogenesis associated with obesity.
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Affiliation(s)
- William E Pohlmeier
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, Nebraska
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Progesterone elevation on the day of HCG administration may affect rescue ICSI. Reprod Biomed Online 2014; 29:88-93. [DOI: 10.1016/j.rbmo.2014.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 03/13/2014] [Accepted: 03/18/2014] [Indexed: 11/18/2022]
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Lee VCY, Li RHW, Chai J, Yeung TWY, Yeung WSB, Ho PC, Ng EHY. 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; 101:1288-93. [DOI: 10.1016/j.fertnstert.2014.01.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 11/26/2022]
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Lazaros L, Xita N, Hatzi E, Takenaka A, Kaponis A, Makrydimas G, Sofikitis N, Stefos T, Zikopoulos K, Georgiou I. CYP19 gene variants affect the assisted reproduction outcome of women with polycystic ovary syndrome. Gynecol Endocrinol 2013; 29:478-82. [PMID: 23461365 DOI: 10.3109/09513590.2013.774359] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Cytochrome P450 aromatase catalyzes the irreversible transformation of androgens into estrogens. The association of CYP19(TTTA)n polymorphism with the hormonal profile and the assisted reproduction outcome of women with polycystic ovary syndrome (PCOS) was explored. METHODS One hundred and thirty-two women with PCOS and 200 with male-factor infertility, as controls, participated in the current study. The CYP19(TTTA)n polymorphism was genotyped, while the hormonal profile was determined at the third day of the menstrual cycle. During oocyte retrieval, the follicular size, the follicle and oocyte numbers were recorded. RESULTS Genotype analysis revealed 6 CYP19(TTTA)n alleles with 7-12 repeats. In PCOS women, the CYP19(TTTA)7 allele presence was associated with lower serum E2 levels at the third day of the menstrual cycle (p < 0.009), lower large follicle (p < 0.02) and total oocyte numbers (p = 0.006), but with significantly higher pregnancy rates after assisted reproduction (p < 0.004). CONCLUSIONS Potential associations of the CYP19(TTTA)7 allele with ovarian response to standard gonadotrophin stimulation and with assisted reproduction outcome were found in PCOS women, probably due to androgen/estrogen ratio alterations.
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Affiliation(s)
- Leandros Lazaros
- Department of Obstetrics and Gynecology, Medical School, Ioannina University, Ioannina, Greece
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Measurement of serum estradiol/progesterone ratio on the day of embryo transfer to predict clinical pregnancies in intracytoplasmic sperm injection (ICSI) cycles. Is this of real clinical value? MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2012.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Premature progesterone rise negatively correlated with live birth rate in IVF cycles with GnRH agonist: an analysis of 2,566 cycles. Fertil Steril 2012; 98:664-670.e2. [PMID: 22704632 DOI: 10.1016/j.fertnstert.2012.05.024] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 05/20/2012] [Accepted: 05/22/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the occurrence of premature progesterone rise (PPR) in GnRH agonist long or short protocol, address the relationship between circulating P levels and live birth rates, and explore the possible mechanism through which PPR affects clinical outcomes and the possible factors related to the occurrence of PPR. DESIGN Retrospective analysis. SETTING Reproductive medicine center of a public hospital. PATIENT(S) A total of 2,566 patients receiving in vitro fertilization/intracytoplasmic sperm injection treatment with GnRH agonist long or short protocol. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live birth rates. RESULT(S) The corresponding incidence of PPR in long or short protocol was 22.86% (393/1,719) or 27.63% (234/847) with the cutoff value of 1.2 ng/mL or 2.0 ng/mL, respectively, being used to define PPR. Live birth rates decreased under the condition of PPR (40.65% vs. 29.77% in long protocol; 30.18% vs. 23.50% in short protocol). Logistic regression analysis showed that serum P level on the day of hCG administration was a strong predictor of live birth rate in both long and short protocols. Live birth rates in frozen embryo transfer cycles had no significant difference between groups with or without PPR (29.31% vs. 25.35% in long protocol; 24.84% vs. 24.22% in short protocol). Multivariate regression analysis showed that exogenous gonadotropin dose, the duration of stimulation, E(2) and LH levels on the day of hCG administration, the number of oocytes retrieved, and basal FSH level were all involved in PPR. CONCLUSION(S) In GnRH agonist cycles, PPR negatively correlated with live birth rate in fresh embryo transfer cycles, although no adverse impact on frozen embryo transfer was observed, implying that PPR may have deleterious effects on endometrial receptivity.
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Effect of HCG-day serum progesterone and oestradiol concentrations on pregnancy outcomes in GnRH agonist cycles. Reprod Biomed Online 2012; 24:511-20. [DOI: 10.1016/j.rbmo.2012.02.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/27/2012] [Accepted: 02/02/2012] [Indexed: 11/20/2022]
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Elgindy EA, Abou-Setta AM, Mostafa MI. Blastocyst-stage versus cleavage-stage embryo transfer in women with high oestradiol concentrations: randomized controlled trial. Reprod Biomed Online 2011; 23:789-98. [DOI: 10.1016/j.rbmo.2011.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 08/04/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
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Different ART outcomes at increasing peak estradiol levels with long and antagonist protocols: retrospective insights from ten years experience. J Assist Reprod Genet 2011; 28:693-8. [PMID: 21519843 DOI: 10.1007/s10815-011-9570-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the impact of high estradiol (E2) levels on assisted reproductive technologies outcomes in high responders (≥12 oocytes retrieved) according to the controlled ovarian stimulation protocol (COS) used. METHODS Clinical retrospective evaluation of total, clinical pregnancy and implantation rates in ART cycles performed in high responders according to the COS protocol used (long or antagonist) at Pathophysiology Unit of Human Reproduction and Sperm Bank of Pordenone from June 2000 to December 2010. RESULTS In high responders total, clinical and implantation rates were significantly higher in long if compared with antagonist protocol with peak estradiol level ≤3,000 pg/ml; on the contrary there was a significantly higher implantation rate with antagonist than long protocol with peak estradiol >3,000 pg/ml. However in this subgroup of patients total and clinical pregnancy rates showed only a trend favouring antagonist possibly due to a statistical β error. CONCLUSIONS In high responders long protocol seems to work better than antagonist when peak E2 is lower than 3,000 pg/ml but the opposite may be true for cycles with higher E2 levels.
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Moini A, Zadeh Modarress S, Amirchaghmaghi E, Mirghavam N, Khafri S, Reza Akhoond M, Salman Yazdi R. The effect of adding oral oestradiol to progesterone as luteal phase support in ART cycles - a randomized controlled study. Arch Med Sci 2011; 7:112-6. [PMID: 22291742 PMCID: PMC3258705 DOI: 10.5114/aoms.2011.20613] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 02/15/2010] [Accepted: 06/30/2010] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Luteal phase support in assisted reproductive technology (ART) cycles is still controversial. The present study was conducted to evaluate the effect of adding oral oestradiol to progesterone during ART cycles. MATERIAL AND METHODS In this prospective case control study, infertile women under 35 years old who were candidates for IVF/ICSI cycles in Royan Institute were enrolled. A long gonadotropin-releasing hormone (GnRH) agonist protocol was used for ovarian stimulation. Patients were randomly divided into two groups for luteal phase support: the control group received vaginal administration of progesterone supplementation alone starting on the day after oocyte retrieval and continued until the tenth week if the chemical pregnancy test was positive. In the oestradiol group, 2 mg of oestradiol valerate was initiated orally with progesterone. The control group received a placebo instead of oestradiol. RESULTS Ninety-eight women were studied as oestradiol (N = 47) and control groups (N= 51). There were no significant differences in the mean number of retrieved oocytes, number of transferred embryos, or chemical and clinical pregnancy rates between the two groups. Although the serum progesterone concentration was higher in the oestradiol group in comparison to the control group on day 7, 10 and 12 after embryo transfer, these differences were not statistically significant. CONCLUSIONS The results suggested that adding oral oestradiol to vaginal progesterone supplementation does not improve the chemical and clinical pregnancy rates of IVF/ICSI cycles.
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Affiliation(s)
- Ashraf Moini
- Endocrinology and Female Infertility Department, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Tehran University of Medical Sciences & Health Services, Tehran, Iran
| | - Shahrzad Zadeh Modarress
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Sahid Beheshti University of Medical Sciences and Health Service, Tehran, Iran
| | - Elham Amirchaghmaghi
- Endocrinology and Female Infertility Department, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Naeimeh Mirghavam
- Endocrinology and Female Infertility Department, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Soraya Khafri
- Epidemiology and Reproductive Health Department, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Social Medicine and Health Department, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Reza Akhoond
- Epidemiology and Reproductive Health Department, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Statistics Department, Mathematial Science and Computer Faculty, Shahid Chamran University, Ahwaz, Iran
| | - Reza Salman Yazdi
- Andrology Department, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Bosch E, Labarta E, Crespo J, Simón C, Remohí J, Jenkins J, Pellicer A. Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: analysis of over 4000 cycles. Hum Reprod 2010; 25:2092-100. [DOI: 10.1093/humrep/deq125] [Citation(s) in RCA: 367] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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