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Lawrenz B, Kalafat E, Ata B, Del Gallego R, Melado L, Elkhatib I, Fatemi H. The combination of dydrogesterone and micronized vaginal progesterone can render serum progesterone level measurements on the day of embryo transfer and rescue attempts unnecessary in an HRT FET cycle. J Assist Reprod Genet 2024; 41:885-892. [PMID: 38372882 PMCID: PMC11052972 DOI: 10.1007/s10815-024-03049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
PURPOSE To evaluate the role of serum progesterone (P4) on the day of embryo transfer (ET) when dydrogesterone (DYD) and micronized vaginal progesterone (MVP) are combined as luteal phase support (LPS) in a hormone replacement therapy (HRT) frozen ET (FET) cycles. METHODS Retrospective study, including single euploid HRT FET cycles with DYD and MVP as LPS and P4 measurement on ET day. Initially, patients with P4 levels < 10 ng/ml increased MVP to 400 mg/day; this "rescue" was abandoned later. RESULTS 560 cycles of 507 couples were included. In 275 women, serum P4 level was < 10 ng/ml on the ET day. Among those with low P4 levels, MVP dose remained unchanged in 65 women (11.6%) and was increased in 210 women (37.5%). Women with P4 levels ≥ 10 ng/ml continued LPS without modification. Overall pregnancy rates in these groups were 61.5% (40/65), 54.8% (115/210), and 48.4% (138/285), respectively (p = n.s.). Association of serum P4 levels with ongoing pregnancy rates was analyzed in women without any additional MVP regardless of serum P4 levels (n = 350); multivariable analysis (adjusted for age, BMI, embryo quality (EQ)) did not show a significant association of serum P4 levels with OPR (OR 0.96, 95% CI 0.90-1.02; p = 0.185). Using inverse probability treatment weights, regression analysis in the weighted sample showed no significant association between P4 treatment groups and OP. Compared to fair EQ, the transfer of good EQ increased (OR 1.61, 95% CI 1.22-2.15; p = 0.001) and the transfer of a poor EQ decreased the odds of OP (OR 0.73, 95% CI 0.55-0.97; p = 0.029). CONCLUSION In HRT FET cycle, using LPS with 300 mg/day MVP and 30 mg/day DYD, it appears that serum P4 measurement and increase of MVP in patients with P4 < 10 ng/ml are not necessary.
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Affiliation(s)
- B Lawrenz
- ART Fertility Clinic, Royal Marina Village, B22-23, POB: 60202, Abu Dhabi, UAE.
- Department of Reproductive Medicine, UZ Gent, Gent, Belgium.
| | - E Kalafat
- ART Fertility Clinic, Royal Marina Village, B22-23, POB: 60202, Abu Dhabi, UAE
- Faculty of Medicine, Department of Obstetrics & Gynecology, Koc University, Istanbul, Turkey
| | - B Ata
- Faculty of Medicine, Department of Obstetrics & Gynecology, Koc University, Istanbul, Turkey
- ART Fertility Clinic, Jumeirah St-Umm Suqeim-Umm Suqeim 3, Dubai, UAE
| | - R Del Gallego
- ART Fertility Clinic, Royal Marina Village, B22-23, POB: 60202, Abu Dhabi, UAE
| | - L Melado
- ART Fertility Clinic, Royal Marina Village, B22-23, POB: 60202, Abu Dhabi, UAE
| | - I Elkhatib
- ART Fertility Clinic, Royal Marina Village, B22-23, POB: 60202, Abu Dhabi, UAE
- School of Biosciences, University of Kent, Canterbury, UK
| | - H Fatemi
- ART Fertility Clinic, Royal Marina Village, B22-23, POB: 60202, Abu Dhabi, UAE
- ART Fertility Clinic, Jumeirah St-Umm Suqeim-Umm Suqeim 3, Dubai, UAE
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Suwannachote T, Wutthiwitthayaphong S, Arayatham S, Prasitsuwan W, Ruenphet S. A Precision Assessment of a Point-of-Care Immunological Analyzer for Swift Progesterone Measurement and Guidance for Determining the Optimal Breeding Time in Bitches. Animals (Basel) 2024; 14:377. [PMID: 38338020 PMCID: PMC10854716 DOI: 10.3390/ani14030377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
The measurement of serum progesterone often varies due to different laboratory methodologies and individual canine characteristics. In this investigation, serum progesterone outcomes obtained from a commercial point-of-care immunological analyzer, designed for efficient serum progesterone assessment in bitches, were compared with results derived from chemiluminescent microparticle immunoassay from reference laboratories in Thailand. Our thorough documentation encompassed various parameters: mean, standard deviation, 95% confidence interval, and minimum and maximum serum progesterone concentration values. Additionally, we meticulously recorded the Pearson's correlation coefficient, Lin's concordance correlation coefficient, and the bias correction factor. Interestingly, there was no significant difference (p > 0.05) in the means obtained by the point-of-care immunological analyzer and chemiluminescent microparticle immunoassay. The Pearson's correlation coefficient between the point-of-care immunological analyzer and chemiluminescent microparticle immunoassay stood at 0.957, with Lin's concordance correlation coefficient for point-of-care immunological analyzer recorded as 0.949. Furthermore, the bias correction factor was established at 0.991. This investigation followed established chemiluminescent microparticle immunoassay guidelines, modified to incorporate the mean and 95% confidence interval as criteria for optimal breeding time using the point-of-care immunological analyzer. In conclusion, the commercial point-of-care immunological analyzer emerges as a valuable tool, aiding in precisely determining the optimal timing for natural mating or artificial insemination in bitches.
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Affiliation(s)
- Thanikran Suwannachote
- Clinic for Small Domestic Animals and Radiology, Mahanakorn University of Technology, Bangkok 10530, Thailand;
| | | | - Saengtawan Arayatham
- Clinic for Gynecology and Animal Reproduction, Mahanakorn University of Technology, Bangkok 10530, Thailand;
- Animal Biotechnology, Mahanakorn University of Technology, Bangkok 10530, Thailand;
| | - Wisut Prasitsuwan
- Animal Biotechnology, Mahanakorn University of Technology, Bangkok 10530, Thailand;
| | - Sakchai Ruenphet
- Immunology and Virology Department, Mahanakorn University of Technology, Bangkok 10530, Thailand;
- Animal Biotechnology, Mahanakorn University of Technology, Bangkok 10530, Thailand;
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Pitner I, Mikuš M, Šprem Goldštajn M, Laganà AS, Chiantera V, Ferrari F, Shah M, D'Alterio MN, Vitale SG, Angioni S. Effects of different progesterone levels on reproductive outcomes in assisted reproductive technologies: from molecular basis to treatment strategies. Gynecol Endocrinol 2023; 39:2190806. [PMID: 36963420 DOI: 10.1080/09513590.2023.2190806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
PURPOSE The aim of this narrative review is to offer an overview about the role of progesterone levels on pregnancy outcome in patients undergoing assisted reproductive technologies (ARTs). METHODS A detailed computerized search of the literature was performed in the main electronic databases (MEDLINE, EMBASE, Web of Science) to determine the importance of elevated progesterone levels at different stages of the cycle for pregnancy rates in the in vitro fertilization (IVF) cycle. Our review also provides information on the differences between elevated progesterone levels and their interpretation in normal and in poorly responding women. RESULTS After careful evaluation, our search strategy yielded a total of 15 included articles, showing the possible factors that may have had an impact on the increased progesterone level before human chorionic gonadotropin (HCG) injection and the different thresholds above which the pregnancy rate was lower. Furthermore, increased progesterone on cycle day 2 or 3 could serve as a marker for increased progesterone in the late follicular phase, which is associated with a lower pregnancy rate. CONCLUSION Despite the literature data that support the negative effect of elevated progesterone on fresh cycles, due to lack of randomized controlled trials, the value of measuring progesterone in daily practice is questionable. Available evidence supports the detrimental effect of elevated progesterone in different subgroups of women, although there is still the need for defining different thresholds and durations of high progesterone exposure. The need for various thresholds for different cohorts of women, the inter-assay variability is making this decision harder.
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Affiliation(s)
- Iva Pitner
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Marina Šprem Goldštajn
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Mohsin Shah
- Department of Physiology, Khyber Medical University, Peshawar, Pakistan
| | - Maurizio Nicola D'Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Handelsman DJ, Jones G, Kouzios D, Desai R. Evaluation of testosterone, estradiol and progesterone immunoassay calibrators by liquid chromatography mass spectrometry. Clin Chem Lab Med 2023; 61:1612-1618. [PMID: 37272075 DOI: 10.1515/cclm-2022-1179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/09/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES In clinical practice, steroid measurements are performed mainly by direct, non-extraction immunoassays adapted to high throughput, automated immunoassay platforms and employing secondary calibrators. The accuracy of such steroid immunoassays is limited by cross-reactivity with structurally related steroids and nonspecific matrix interference as well as the metrological traceability of manufacturer supplied calibrators. The accuracy of steroid immunoassay calibrators has been little investigated by independent chemical methods. METHODS Steroid concentrations of 41 calibrators (4-6 replicates per calibrator) supplied by four manufacturers for use in testosterone (T), estradiol (E2), and progesterone (P4) commercial immunoassays were measured by ultra-pressure liquid chromatography-mass spectrometry (UPLC-MS). RESULTS Among 14 non-zero T calibrators, six (43 %) deviated significantly from the label concentration with 29 % outside 20 % of it. Among 14 E2 calibrators, eight (57 %) deviated significantly, whereas seven (50 %) were outside 20 % of the label concentration. Among 11 P4 calibrators, eight (73 %) deviated significantly whereas four (36 %) were outside within 20 % of the label concentration. CONCLUSIONS We conclude that inaccurate calibration of manufacturer's supplied standards may contribute to inaccuracy of commercial direct steroid immunoassays.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney, Concord, NSW, Australia
- Department of Andrology, Concord Hospital, Concord, NSW 2139, Australia
| | - Graham Jones
- SydPath, St Vincent's Hospital, Sydney and University of NSW, Darlinghurst, Australia
| | - Dorothy Kouzios
- Diagnostic Pathology Unit, Concord Repatriation Hospital, Concord, NSW, Australia
| | - Reena Desai
- ANZAC Research Institute, University of Sydney, Concord, NSW, Australia
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Zhang Y, Fu X, Gao S, Gao S, Gao S, Ma J, Chen ZJ. Preparation of the endometrium for frozen embryo transfer: an update on clinical practices. Reprod Biol Endocrinol 2023; 21:52. [PMID: 37291605 DOI: 10.1186/s12958-023-01106-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
Over the past decade, the application of frozen-thawed embryo transfer treatment cycles has increased substantially. Hormone replacement therapy and the natural cycle are two popular methods for preparing the endometrium. Hormone replacement therapy is now used at the discretion of the doctors because it is easy to coordinate the timing of embryo thawing and transfer with the schedules of the in-vitro fertilization lab, the treating doctors, and the patient. However, current results suggest that establishing a pregnancy in the absence of a corpus luteum as a result of anovulation may pose significant maternal and fetal risks. Therefore, a 'back to nature' approach that advocates an expanded use of natural cycle FET in ovulatory women has been suggested. Currently, there is increasing interest in how the method of endometrial preparation may influence frozen embryo transfer outcomes specifically, especially when it comes to details such as different types of ovulation monitoring and different luteal support in natural cycles, and the ideal exogenous hormone administration route as well as the endocrine monitoring in hormone replacement cycles. In addition to improving implantation rates and ensuring the safety of the fetus, addressing these points will allow for individualized endometrial preparation, also as few cycles as possible would be canceled.
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Affiliation(s)
- Yiting Zhang
- Center for Reproductive Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Xiao Fu
- Center for Reproductive Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Shuli Gao
- Center for Reproductive Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Shuzhe Gao
- Center for Reproductive Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Shanshan Gao
- Center for Reproductive Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China.
| | - Jinlong Ma
- Center for Reproductive Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China
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Neves AR, Vuong NL, Blockeel C, Garcia S, Alviggi C, Spits C, Ma PQM, Ho MT, Tournaye H, Polyzos NP. The effect of polymorphisms in FSHR gene on late follicular phase progesterone and estradiol serum levels in predicted normoresponders. Hum Reprod 2022; 37:2646-2654. [PMID: 36069495 DOI: 10.1093/humrep/deac193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does the presence of FSHR single-nucleotide polymorphisms (SNPs) affect late follicular phase progesterone and estradiol serum levels in predicted normoresponders treated with rFSH? SUMMARY ANSWER The presence of FSHR SNPs (rs6165, rs6166, rs1394205) had no clinically significant impact on late follicular phase serum progesterone and estradiol levels in predicted normoresponders undergoing a GnRH antagonist protocol with a fixed daily dose of 150 IU rFSH. WHAT IS KNOWN ALREADY Previous studies have shown that late follicular phase serum progesterone and estradiol levels are significantly correlated with the magnitude of ovarian response. Several authors have proposed that individual variability in the response to ovarian stimulation (OS) could be explained by variants in FSHR. However, so far, the literature is scarce on the influence of this genetic variability on late follicular phase steroidogenic response. Our aim is to determine whether genetic variants in the FSHR gene could modulate late follicular phase serum progesterone and estradiol levels. STUDY DESIGN, SIZE, DURATION In this multicenter multinational prospective study conducted from November 2016 to June 2019, 366 patients from Vietnam, Belgium and Spain (166 from Europe and 200 from Asia) underwent OS followed by oocyte retrieval in a GnRH antagonist protocol with a fixed daily dose of 150 IU rFSH. All patients were genotyped for 3 FSHR SNPs (rs6165, rs6166, rs1394205) and had a serum progesterone and estradiol measurement on the day of trigger. PARTICIPANTS/MATERIALS, SETTING, METHODS Included patients were predicted normal responder women <38 years old undergoing their first or second OS cycle. The prevalence of late follicular phase progesterone elevation (PE), as well as mean serum progesterone and estradiol levels on the day of trigger were compared between the different FSHR SNPs genotypes. PE was defined as >1.50 ng/ml. MAIN RESULTS AND THE ROLE OF CHANCE The overall prevalence of PE was 15.8% (n = 58). No significant difference was found in the prevalence of PE in Caucasian and Asian patients (17.5% versus 14.5%). Estradiol levels on the day of trigger and the number of retrieved oocytes were significantly higher in patients with PE (4779 ± 6236.2 versus 3261 ± 3974.5 pg/ml, P = 0.003, and 16.1 ± 8.02 versus 13.5 ± 6.66, P = 0.011, respectively). Genetic model analysis, adjusted for patient age, body mass index, number of retrieved oocytes and continent (Asia versus Europe), revealed a similar prevalence of PE in co-dominant, dominant and recessive models for variants FSHR rs6166, rs6165 and rs1394205. No statistically significant difference was observed in the mean late follicular phase progesterone serum levels according to the genotypes of FSHR rs6166 (P = 0.941), rs6165 (P = 0.637) and rs1394205 (P = 0.114) in the bivariate analysis. Also, no difference was found in the genetic model analysis regarding mean late follicular phase progesterone levels across the different genotypes. Genetic model analysis has also revealed no statistically significant difference regarding mean estradiol levels on the day of trigger in co-dominant, dominant and recessive models for variants FSHR rs6166, rs6165 and rs1394205. Haplotype analysis revealed a statistically significant lower estradiol level on the day of trigger for rs6166/rs6165 haplotypes GA, AA and GG when compared to AG (respectively, estimated mean difference (EMD) -441.46 pg/ml (95% CI -442.47; -440.45), EMD -673.46 pg/ml (95% CI -674.26; -672.67) and EMD -582.10 pg/ml (95% CI -584.92; -579.28)). No statistically significant differences were found regarding the prevalence of PE nor late follicular phase progesterone levels according to rs6166/rs6165 haplotypes. LIMITATIONS, REASONS FOR CAUTION Results refer to a population of predicted normal responders treated with a normal/low fixed dose of 150 IU rFSH throughout the whole OS. Consequently, caution is needed before generalizing our results to all patient categories. WIDER IMPLICATIONS OF THE FINDINGS Based on our results, FSHR SNPs rs6165, rs6166 and rs1394205 do not have any clinically significant impact neither on late follicular phase serum progesterone nor on estradiol levels in predicted normal responders. These findings add to the controversy in the literature regarding the impact of individual genetic susceptibility in response to OS in this population. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by an unrestricted grant by Merck Sharp & Dohme (MSD, IISP56222). N.P.P. reports grants and/or personal fees from MSD, Merck Serono, Roche Diagnostics, Ferring International, Besins Healthcare, Gedeon Richter, Organon, Theramex and Institut Biochimique SA (IBSA). C.A. reports conference fees from Merck Serono, Medea and Event Planet. A.R.N., C.B., C.S., P.Q.M.M., H.T., C.B., N.L.V., M.T.H. and S.G. report no conflict of interests related to the content of this article. TRIAL REGISTRATION NUMBER NCT03007043.
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Affiliation(s)
- A R Neves
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain.,IVI-RMA Lisboa, Lisbon, Portugal.,Autonomous University of Barcelona, Cerdanyola del Vallès, Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Faculty of Medicine, Barcelona, Spain
| | - N L Vuong
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,IVFMD and HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - C Blockeel
- Brussels IVF, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - S Garcia
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - C Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - C Spits
- Research Group Reproduction and Genetics, Vrije Universiteit Brussels, Brussels, Belgium
| | - P Q M Ma
- IVFMD and HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - M T Ho
- IVFMD and HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - H Tournaye
- Brussels IVF, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.,Department of Obstetrics, Gynecology, Perinatology and Reproduction, Institute of Professional Education, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - N P Polyzos
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Ghent University (UZ Gent), Gent, Belgium
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Khahani Namin A, Mohammadian F, Garrosi L, Tofighi S. The effect of the ratio of serum progesterone level to oocyte count on the day of IVF-ICSI injection on pregnancy outcomes in HCG cycles. Horm Mol Biol Clin Investig 2022; 44:53-60. [PMID: 36063359 DOI: 10.1515/hmbci-2022-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/07/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND There has been several discussion and debates regarding the possible setremental influence of elevated serum progesterone (SP) on the day of human chorionic gonadotropin (hCG) administration. Our study aims to assess progestron to oocyte rates for assessing CPR and live birth rate (LBR) in IVF cycles and review previous articles. METHODS In this prospective cohort study, women under ovulation induction through IVF-ICSI using the GnRH-antagonist protocol were studied. Five specific indicators were considered to assess pregnancy outcome. The statistical analysis was done using SPSS software. RESULTS In the present research, 78 patients underwent IVF. The cut-off points for each of the three parameters were 1.2 (with a sensitivity of 65.4% and a specificity of 54%), 6.5 (with a sensitivity of 73.1% and a specificity of 56%), and 0.16 (with a sensitivity of 65.4% and a specificity of 60%, respectively). Only the number of oocytes (area below the curve of 0.64) was able to predict clinical pregnancy. The cut-off point for this parameter was 6.5 (with a sensitivity of 74.1% and a specificity of 66%). On the other hand, none of the parameters were able to predict live birth. CONCLUSIONS The findings of this study should assist in the clinical management of patients with high SP on the day of HCG administration. We recommend, that the ratio of SP to oocyte is a useful parameter for refining the criteria of patients who have had embryo freezing of all embryos (by selective freezing) and subsequent transfer of frozen embryos.
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Affiliation(s)
- Azita Khahani Namin
- Department of Obstetrics and Gynecology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Farnaz Mohammadian
- Department of Obstetrics and Gynecology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Lida Garrosi
- Department of Obstetrics and Gynecology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Shabnam Tofighi
- Department of Obstetrics and Gynecology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
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8
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Xu Y, Zhang J, Li A, Yang N, Cui N, Hao G, Gao BL. Impact of Elevated Progesterone in Late Follicular Phase on Early Pregnancy Outcomes and Live Birth Rate After Fresh Embryo Transfers. Front Cell Dev Biol 2022; 10:855455. [PMID: 35372334 PMCID: PMC8965638 DOI: 10.3389/fcell.2022.855455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: To investigate the effect of progesterone elevation during late follicular phase on early pregnancy outcomes and live births after fresh embryo transfers. Methods: Patients who underwent IVF/ICSI treatment cycles were retrospectively enrolled. The effect of progesterone elevation was analyzed on early pregnancy outcome and live births after fresh embryo transfers. Results: A total of 2,404 patients were enrolled on the day of HCG triggering (HCG0), 1,584 patients on the day before HCG triggering (HCG-1), and 800 patients 2 days before HCG triggering (HCG-2). With a 1 ng/ml increase in the progesterone level on HCG0 day when the progesterone level was ≥1.5 ng/ml, the clinical pregnancy rate decreased by 60% (95% CI: 0.2–0.7, p = 0.004), the intrauterine pregnancy rate decreased by 70% (95% CI: 0.2–0.7, p = 0.003), and the live birth rate decreased by 70% (95% CI: 0.1–0.7, p = 0.004). With a 1 ng/ml increase in the progesterone level on HCG-1 day, the clinical pregnancy rate decreased by 90% (95% CI: 0.0–0.5, p = 0.003) when the progesterone level was ≥1.6 ng/ml, the intrauterine pregnancy rate decreased by 90% (95% CI: 0.0–0.5, p = 0.001) when the progesterone was ≥1.5 ng/ml, and the live birth rate decreased by 90% (95% CI: 0.0–0.6, p = 0.015) when the progesterone was ≥1.7 ng/ml. On HCG-2 day when the progesterone was ≥1.2 ng/ml, the clinical pregnancy rate decreased by 80% (95% CI: 0.1–0.6, p = 0.003), and the intrauterine pregnancy rate decreased by 70% (95% CI: 0.1–0.7, p = 0.007) with a 1 ng/ml increase in the progesterone level. Conclusion: Elevated progesterone level during the late follicular phase is an independent risk factor affecting the clinical pregnancy rate, intrauterine pregnancy rate, and live birth rate among infertile patients undergoing IVF/ICSI after fresh embryo transfers. When the progesterone level exceeds a certain level, the early pregnancy and live birth rates after fresh embryo transfers show a rapid downward trend.
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Affiliation(s)
| | | | | | | | - Na Cui
- *Correspondence: Na Cui, ; Guimin Hao,
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9
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Ranisavljevic N, Huberlant S, Montagut M, Alonzo PM, Darné B, Languille S, Anahory T, Cédrin-Durnerin I. Low Luteal Serum Progesterone Levels Are Associated With Lower Ongoing Pregnancy and Live Birth Rates in ART: Systematic Review and Meta-Analyses. Front Endocrinol (Lausanne) 2022; 13:892753. [PMID: 35757393 PMCID: PMC9229589 DOI: 10.3389/fendo.2022.892753] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED Progesterone plays a key role in implantation. Several studies reported that lower luteal progesterone levels might be related to decreased chances of pregnancy. This systematic review was conducted using appropriate key words, on MEDLINE, EMBASE, and the Cochrane Library, from 1990 up to March 2021 to assess if luteal serum progesterone levels are associated with ongoing pregnancy (OP) and live birth (LB) rates (primary outcomes) and miscarriage rate (secondary outcome), according to the number of corpora lutea (CLs). Overall 2,632 non-duplicate records were identified, of which 32 relevant studies were available for quantitative analysis. In artificial cycles with no CL, OP and LB rates were significantly decreased when the luteal progesterone level falls below a certain threshold (risk ratio [RR] 0.72; 95% confidence interval [CI] 0.62-0.84 and 0.73; 95% CI 0.59-0.90, respectively), while the miscarriage rate was increased (RR 1.48; 95% CI 1.17-1.86). In stimulated cycles with several CLs, the mean luteal progesterone level in the no OP and no LB groups was significantly lower than in the OP and LB groups [difference in means 68.8 (95% CI 45.6-92.0) and 272.4 (95% CI 10.8-533.9), ng/ml, respectively]. Monitoring luteal serum progesterone levels could help in individualizing progesterone administration to enhance OP and LB rates, especially in cycles without corpus luteum. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=139019, identifier 139019.
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Affiliation(s)
- Noemie Ranisavljevic
- Department of Reproductive Medicine, Centre Hospitalier Universitaire (CHU) and University of Montpellier, Montpellier, France
- *Correspondence: Noemie Ranisavljevic,
| | - Stephanie Huberlant
- Department of Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Carémeau, Nîmes, France
| | - Marie Montagut
- Center for Human Reproduction-Institut Francophone de Recherche Et d’études Appliquées à la Reproduction Et Sexologie (IFREARES), Clinique Saint Jean du Languedoc, Toulouse, France
| | | | | | | | - Tal Anahory
- Department of Reproductive Medicine, Centre Hospitalier Universitaire (CHU) and University of Montpellier, Montpellier, France
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11
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Maignien C, Bourdon M, Marcellin L, Laguillier-Morizot C, Borderie D, Chargui A, Patrat C, Plu-Bureau G, Chapron C, Santulli P. Low serum progesterone affects live birth rate in cryopreserved blastocyst transfer cycles using hormone replacement therapy. Reprod Biomed Online 2021; 44:469-477. [PMID: 34980570 DOI: 10.1016/j.rbmo.2021.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 01/25/2023]
Abstract
RESEARCH QUESTION Does serum progesterone concentration on the day of vitrified-warmed embryo transfer affect live birth rate (LBR) with hormonal replacement therapy (HRT) cycles? DESIGN Observational cohort study of patients (n = 915) undergoing single autologous vitrified-warmed blastocyst transfer under HRT using vaginal micronized progesterone. Women were included once, between January 2019 and March 2020. Serum progesterone concentration was measured by a single laboratory on the morning of embryo transfer. The primary end point was LBR. Univariate and multivariate logistic regression models were used for statistical analyses. RESULTS Median (25th-75th percentile) serum progesterone concentration on the day of embryo transfer was 12.5 ng/ml (9.8-15.3). The LBR was 31.5% (288/915) in the overall population. No significant differences were found in implantation rates (40.7% versus 44.9%); LBR was significantly lower in women with a progesterone concentration ≤25th percentile (≤9.8 ng/ml) (26.1% versus 33.2%, P = 0.045) versus women with a progesterone concentration >25th percentile. This correlated with a significantly higher early miscarriage rate (35.9% versus 21.6%, P = 0.005). After adjusting for potential confounding factors in multivariate analysis, low serum progesterone levels (≤9.8 ng/ml) remained significantly associated with lower LBR (OR 0.68 95% CI 0.48 to 0.97). CONCLUSION A minimum serum progesterone concentration is needed to optimize reproductive outcomes in HRT cycles with single autologous vitrified-warmed blastocyst transfer. Whether modifications of progesterone administration routes, dosage, or both, can improve pregnancy rates needs further study so that treatment of patients undergoing HRT cycles can be further individualized.
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Affiliation(s)
- Chloé Maignien
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France
| | - Mathilde Bourdon
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France; Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), 27 Rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Louis Marcellin
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France; Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), 27 Rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Christelle Laguillier-Morizot
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Biological Endocrinology (Professor Guibourdenche), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27 Rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Didier Borderie
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Automated Biological Diagnosis (Professor Borderie), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27 Rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Ahmed Chargui
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Histology and Reproductive Biology (Professor Patrat), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France
| | - Catherine Patrat
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Histology and Reproductive Biology (Professor Patrat), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France
| | - Geneviève Plu-Bureau
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France; Equipe EPOPE, INSERM U1153
| | - Charles Chapron
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France; Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), 27 Rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Pietro Santulli
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France; Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), 27 Rue du Faubourg Saint-Jacques 75014 Paris, France.
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12
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The effect of late-follicular phase progesterone elevation on embryo ploidy and cumulative live birth rates. Reprod Biomed Online 2021; 43:1063-1069. [PMID: 34654613 DOI: 10.1016/j.rbmo.2021.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022]
Abstract
RESEARCH QUESTION Does late-follicular phase progesterone elevation have a deleterious effect on embryo euploidy, blastocyst formation rate and cumulative live birth rates (CLBR)? DESIGN A multicentre retrospective cross-sectional study including infertile patients aged 18-40 years who underwent ovarian stimulation in a gonadotrophin-releasing hormone antagonist protocol and preimplantation genetic testing for aneuploidies (PGT-A) followed by a freeze-all strategy and euploid embryo transfer between August 2017 and December 2019. The sample was stratified according to the progesterone concentrations on the day of trigger: normal (≤1.50 ng/ml) and high (>1.50 ng/ml). Moreover, sensitivity analyses were performed to determine whether different conclusions would have been drawn if different cut-offs had been adopted. The primary outcome was the embryo euploidy rate. Secondary outcomes were the blastocyst formation rate, the number of euploid blastocysts and CLBR. RESULTS Overall 1495 intracytoplasmic sperm injection PGT-A cycles were analysed. Late-follicular phase progesterone elevation was associated with significantly higher late-follicular oestradiol concentrations (2847.56 ± 1091.10 versus 2240.94 ± 996.37 pg/ml, P < 0.001) and significantly more oocytes retrieved (17.67 ± 8.86 versus 12.70 ± 7.00, P < 0.001). The number of euploid embryos was significantly higher in the progesterone elevation group (2.32 ± 1.74 versus 1.86 ± 1.42, P = 0.001), whereas the blastocyst formation rate (47.1% [43.7-50.5%] versus 51.0% [49.7-52.4%]), the embryo euploidy rate (48.3% [44.9-51.7%] versus 49.1% [47.7-50.6%], the live birth rate in the first frozen embryo transfer (34.1% versus 31.1%, P = 0.427) and CLBR (38.9% versus 37.0%, P = 0.637) were not significantly different between the two groups. CONCLUSIONS Euploidy rate and CLBR do not significantly differ among PGT-A cycles with and without late-follicular progesterone elevation in a freeze-all approach.
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13
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Racca A, Vanni VS, Somigliana E, Reschini M, Viganò P, Santos-Ribeiro S, Drakopoulos P, Tournaye H, Verheyen G, Papaleo E, Candiani M, Blockeel C. Is a freeze-all policy the optimal solution to circumvent the effect of late follicular elevated progesterone? A multicentric matched-control retrospective study analysing cumulative live birth rate in 942 non-elective freeze-all cycles. Hum Reprod 2021; 36:2463-2472. [PMID: 34223890 DOI: 10.1093/humrep/deab160] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Is late follicular elevated progesterone (LFEP) in the fresh cycle hindering cumulative live birth rates (CLBRs) when a freeze only strategy is applied? SUMMARY ANSWER LFEP in the fresh cycle does not affect the CLBR of the frozen transfers in a freeze only approach, nor the embryo freezing rate. WHAT IS KNOWN ALREADY Ovarian stimulation promotes the production of progesterone (P) which has been demonstrated to have a deleterious effect on IVF outcomes. While there is robust evidence that this elevation produces impaired endometrial receptivity, the impact on embryo quality remains a matter of debate. In particular, previous studies have shown that LFEP is associated with a hindered CLBR. However, most clinical insight on the effect of progesterone on embryo quality in terms of CLBRs have focused on embryo transfers performed after the fresh transfer, thus excluding the first embryo of the cohort. To be really informative on the possible detrimental effects of LFEP, evidence should be derived from freeze-all cycles where no fresh embryo transfer is performed in the presence of progesterone elevation, and the entire cohort of embryos is cryopreserved. STUDY DESIGN, SIZE, DURATION This was a matched case-control, multicentre (three centres), retrospective analysis including all GnRH antagonist ICSI cycles in which a freeze all (FA) policy of embryos on day 3/5/6 of embryonic development was applied between 2012 and 2018. A total of 942 patients (471 cases with elevated P and 471 matched controls with normal P values) were included in the analysis. Each patient was included only once. PARTICIPANTS/MATERIALS, SETTING, METHODS The sample was divided according to the following P levels on the day of ovulation triggering: <1.50 ng/ml and ≥1.50 ng/ml. The matching of the controls was performed according to age (±1 year) and number of oocytes retrieved (±10%). The main outcome was CLBR defined as a live-born delivery after 24 weeks of gestation. MAIN RESULTS AND THE ROLE OF CHANCE The baseline characteristics of the two groups were similar. Estradiol levels on the day of trigger were significantly higher in the elevated P group. There was no significant difference in terms of fertilisation rate between the two groups. The elevated P group had significantly more cleavage stage frozen embryos compared to the normal P group while the total number of cryopreserved blastocyst stage embryos was the same. The CLBR did not differ between the two study groups (29.3% and 28.2% in the normal versus LFEP respectively, P = 0.773), also following confounder adjustment using multivariable GEE regression analysis (accounting for age at oocyte retrieval, total dose of FSH, progesterone levels on the day of ovulation trigger, day of freezing, at least one top-quality embryo transferred and number of previous IVF cycles, as the independent variables). LIMITATIONS, REASONS FOR CAUTION This is a multicentre observational study based on a retrospective data analysis. Better extrapolation of the results could be validated by performing a prospective analysis. WIDER IMPLICATIONS OF THE FINDINGS This is the first study demonstrating that LFEP in the fresh cycle does not hinder CLBR of the subsequent frozen cycles in a FA approach. Thus, a FA strategy circumvents the issue of elevated P in the late follicular phase. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for this study. Throughout the study period and manuscript preparation, authors were supported by departmental funds from: Centre for Reproductive Medicine, Brussels, Belgium; Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centro Scienze Natalità, San Raffaele Scientific Institute, Milan, Italy; and IVI-RMA, Lisbon, Portugal. E.S. has competing interests with Ferring, Merck-Serono, Theramex and Gedeon-Richter outside the submitted work. E.P. reports grants from Ferring, grants and personal fees from Merck-Serono, grants and personal fees from MSD and grants from IBSA outside the submitted work. All the other authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A Racca
- Department of Obstetrics Gynecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain.,Centre for Reproductive Medicine, UniversitairZiekenhuis Brussel, Brussels, Belgium
| | - V S Vanni
- Università Vita-Salute San Raffaele, Milan, Italy
| | - E Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - M Reschini
- Università Vita-Salute San Raffaele, Milan, Italy
| | - P Viganò
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milano, Italy.,Centro Scienze Natalità, San Raffaele Scientific Institute, Milan, Italy
| | | | - P Drakopoulos
- Centre for Reproductive Medicine, UniversitairZiekenhuis Brussel, Brussels, Belgium
| | - H Tournaye
- Centre for Reproductive Medicine, UniversitairZiekenhuis Brussel, Brussels, Belgium
| | - G Verheyen
- Centre for Reproductive Medicine, UniversitairZiekenhuis Brussel, Brussels, Belgium
| | - E Papaleo
- Centro Scienze Natalità, San Raffaele Scientific Institute, Milan, Italy
| | - M Candiani
- Università Vita-Salute San Raffaele, Milan, Italy.,Centro Scienze Natalità, San Raffaele Scientific Institute, Milan, Italy
| | - C Blockeel
- Centre for Reproductive Medicine, UniversitairZiekenhuis Brussel, Brussels, Belgium.,Department of Obstetrics & Gynaecology, University of Zagreb-School of Medicine, Zagreb, Croatia
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Conforti A, Esteves SC, Pellicer A, Sodano R, Messuti F, Carbone L, Morero S, Alviggi C, Sodano M. Effect of Dexamethasone Co-Treatment During Ovarian Stimulation in Women of Different Reproductive Age With Elevated Early Follicular Phase Progesterone Level: a Prospective Longitudinal Study. Reprod Sci 2021; 28:3258-3264. [PMID: 33928591 DOI: 10.1007/s43032-021-00590-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
The aim of this paper was to estimate the effect of dexamethasone during ovarian stimulation in women of different reproductive age with elevated early follicular phase progesterone level undergoing fresh IVF cycle. This study is a prospective longitudinal analysis of consecutive women who underwent fresh IVF cycles at a single center, between January 2012 to December 2013. Women with early follicular phase progesterone above 0.50 ng/ml, assessed in day 0 or day 5 of stimulation, were included. Study group (n = 113) included women who underwent dexamethasone supplementation until the day of triggering. Women who did not undergo dexamethasone treatment formed the control group (n = 109). We further stratified our study population according to age ranges: (1) ≤ 34 years, (2) between 35 and 39 years, and (3) ≥ 40 years. Significantly lower progesterone levels were observed in study than in control group (0.59 ± 0.21 vs 0.94 ± 0.42, p < 0.001). Such difference is not observed in women above 39 years old. Higher, albeit not significant, live birth rate was detected in the study versus control group, considering the overall population. In women ≤ 34 years old, a significantly higher live birth rate was observed in women who underwent dexametasone treatment than in the control group (67.5% vs 47.2%, p = 0.04). Conversely, live birth rates were similar between groups in women above 34 years old. Our data suggest that dexamethasone helps to modulate progesterone levels during the follicular phase and might improve live birth rate of women below 34 years old.
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Affiliation(s)
- Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy.
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil.,Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | | | - Luigi Carbone
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
| | | | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
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Anckaert E, Jank A, Petzold J, Rohsmann F, Paris R, Renggli M, Schönfeld K, Schiettecatte J, Kriner M. Extensive monitoring of the natural menstrual cycle using the serum biomarkers estradiol, luteinizing hormone and progesterone. Pract Lab Med 2021; 25:e00211. [PMID: 33869706 PMCID: PMC8042396 DOI: 10.1016/j.plabm.2021.e00211] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/10/2021] [Indexed: 11/04/2022] Open
Abstract
Expected values for estradiol (E2), luteinizing hormone (LH), and progesterone determined in serum allow accurate assessment of menstrual cycle phase. Automated immunoassays demonstrate variable degrees of bias, emphasizing the need to establish method-specific reference values. We therefore established method-specific reference intervals for the Elecsys® LH assay and new generation Elecsys Estradiol III and Progesterone III assays (cobas e 801 analyzer) in 85 apparently healthy women aged 22–37 (US)/18–37 (EU) years over one natural menstrual cycle. Cycle length and day of ovulation were standardized; phases were defined by LH surge and/or progesterone/E2 levels. Median (5th–95th percentile) concentrations (follicular/ovulation/luteal) were E2: 198 pmol/L (114–332), 757 pmol/L (222–1959) and 412 pmol/L (222–854); LH: 7.14 IU/L (4.78–13.2), 22.6 IU/L (8.11–72.7) and 6.24 IU/L (2.73–13.1); progesterone: 0.212 nmol/L (0.159–0.616), 1.81 nmol/L (0.175–13.2) and 28.8 nmol/L (13.1–46.3). Sub-phase (early/intermediate/late) reference values were also determined for follicular and luteal phases. This multicenter study established reliable, method-specific E2, LH and progesterone reference values that could assist clinical decision-making in women with fertility disorders and monitoring of natural cycles in assisted reproductive treatment. E2, LH and progesterone are biomarkers for assessing natural menstrual cycle phase. These biomarkers support diagnosis, monitoring and treatment of fertility disorders. E2, LH and progesterone profiles were derived using new generation Elecsys® assays. Expected serum values are presented for each menstrual cycle phase and sub-phase. Data will inform clinical decision-making for women with fertility disorders.
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Affiliation(s)
- Ellen Anckaert
- Laboratory of Hormonology and Tumour Markers, University Hospital Brussels (UZ Brussel), Free University of Brussels, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - Alexander Jank
- University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Julia Petzold
- University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Felix Rohsmann
- Praxis Dr Felix Rohsmann, Sindelsdorfer Str. 12, 82392, Habach, Germany
| | - Rhonda Paris
- Roche Diagnostics, 9115 Hague Rd, 46256, Indianapolis, IN, USA
| | - Martin Renggli
- Trina Bioreactives AG, Grabenstrasse 8, 8606, Nänikon, Switzerland
| | | | - Johan Schiettecatte
- Laboratory of Hormonology and Tumour Markers, University Hospital Brussels (UZ Brussel), Free University of Brussels, Laarbeeklaan 101, B-1090, Brussels, Belgium
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Kunanusont N, Punyadarsaniya D, Ruenphet S. Accuracy and precision guidelines for optimal breeding time in bitches using in-house progesterone measurement compared with chemiluminescent microparticle immunoassay. Vet World 2021; 14:585-588. [PMID: 33935401 PMCID: PMC8076448 DOI: 10.14202/vetworld.2021.585-588] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background and Aim: The concentration of serum progesterone is commonly used to determine the optimal mating time in bitches, and to diagnose reproductive-related abnormalities. This study aims to compare the serum progesterone results obtained by rapid fluorescence immunochromatography assay (RFICA) with those obtained by chemiluminescent microparticle immunoassay (CMIA) from the same serum samples to develop a standard guideline for optimal breeding time. Materials and Methods: Serum progesterone levels were measured in 124 bitches using RFICA and CMIA. Simple linear regression and correlation analyses were performed to analyze the data. The percentage difference between the maximum and minimum progesterone values in the same serum sample in the same assay was compared using Wilcoxon’s rank-sum test. Results: The present study showed a strong linear dependence of the results obtained by RFICA on those obtained by CMIA as R2=0.8976, with regression coefficient of 0.9474 and p<0.05, including the regression model was CMIA = (0.9483 × RFICA) − 0.761. Moreover, five critical measurement times during estrous in bitches showed statistically significant differences (p<0.05), except at the fertilizable period, which showed a non-significant difference (p>0.05). Conclusion: This study demonstrated that it is presumably acceptable to use the RFICA and CMIA methods interchangeably for quality progesterone measurements in serum samples from bitches. However, when considering the use of the RFICA method, it is advisable to carefully interpret the results and follow the interpretation guidelines. Finally, RFICA in the present study provides a reliable and convenient option for veterinarian practitioners to measure canine progesterone levels in-house.
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Affiliation(s)
- Nutnaree Kunanusont
- Clinic for Horse, Faculty of Veterinary Medicine, Mahanakorn University of Technology, Bangkok, Thailand
| | - Darsaniya Punyadarsaniya
- Department of Immunology and Virology, Veterinary Medicine Faculty, Mahanakorn University of Technology, Bangkok, Thailand
| | - Sakchai Ruenphet
- Department of Immunology and Virology, Veterinary Medicine Faculty, Mahanakorn University of Technology, Bangkok, Thailand
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Gibt es optimale Serumprogesteronwerte in In-vitro-Fertilisations- und Kryozyklen? GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-020-00366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Polyzos NP, Anckaert E, Drakopoulos P, Tournaye H, Schiettecatte J, Donner H, Bobba G, Miles G, Verhagen-Kamerbeek WDJ, Bosch E. EStradiol and PRogesterone in In vitro ferTilization (ESPRIT): a multicenter study evaluating third- versus second-generation estradiol and progesterone immunoassays. J Endocrinol Invest 2020; 43:1239-1248. [PMID: 32170594 PMCID: PMC7431432 DOI: 10.1007/s40618-020-01211-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/02/2020] [Indexed: 11/02/2022]
Abstract
PURPOSE To assess estradiol (E2) and progesterone levels during ovarian stimulation determined by third-generation (Gen III) and second-generation (Gen II) Elecsys® immunoassays. METHODS E2 and progesterone concentrations were measured using Elecsys® Gen III and Gen II immunoassays, and progesterone concentrations on the day of ovulation triggering were determined by LC-MS/MS. This was a retrospective, non-interventional study conducted at European tertiary referral infertility clinics in women aged 18-45 years, with a body mass index 18-35 kg/m2, regular menses, and both ovaries. RESULTS Serum samples were obtained from 230 women classified by oocyte retrieval as poor (33.0%; 0-3 oocytes), normal (40.9%; 4-15 oocytes), or high (26.1%; > 15 oocytes) responders. E2 and progesterone levels increased during ovarian stimulation, with greatest increases observed in high responders. Elecsys® Gen III and Gen II assay results were highly correlated for E2 (Pearson's r = 0.99) and progesterone (r = 0.89); Gen III results were lower than Gen II for both E2 and progesterone. On the day of triggering, Gen III E2 and progesterone levels showed a difference of - 15.0% and - 27.9%, respectively. Progesterone levels (on day of triggering) measured by LC-MS/MS correlated better with Gen III (0.98) than Gen II (0.90). Mean relative differences for Gen III and Gen II assays versus LC-MS/MS were 14.6% and 62.8%, respectively. CONCLUSION E2 and progesterone levels determined with Elecsys® Gen II and III assays were highly correlated; results were lower for Gen III versus Gen II. Differences observed for progesterone on the day of triggering may be clinically relevant.
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Affiliation(s)
- N P Polyzos
- Department of Reproductive Medicine, Dexeus University Hospital, Gran Via Carles, 11171-75, 08028, Barcelona, Spain.
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
- Department of Clinical Medicine, Faculty of Health, Aarhus University Incuba/Skejby, Building 2, Palle Juul-Jensens Boulevard 82, Aarhus N, 8200, Aarhus, Denmark.
| | - E Anckaert
- Laboratory of Hormonology and Tumour Markers, Universitair Ziekenhuis Brussel, Free University of Brussels, Brussels, Belgium
| | - P Drakopoulos
- Centre for Reproductive Medicine, University Hospital (UZB), Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - H Tournaye
- Centre for Reproductive Medicine, University Hospital (UZB), Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - J Schiettecatte
- Laboratory of Hormonology and Tumour Markers, Universitair Ziekenhuis Brussel, Free University of Brussels, Brussels, Belgium
| | - H Donner
- Medical and Scientific Affairs, Roche Diagnostics GmbH, Nonnenwald 2, 82377, Penzberg, Germany
| | - G Bobba
- Medical and Scientific Affairs, Roche Diagnostics International Ltd, Forrenstrasse 2, 6343, Rotkreuz, Switzerland
| | - G Miles
- Biostatistics and Data Management, Roche Diagnostics Operations Inc., 9115 Hague Road, Building R, Indianapolis, IN, 46256, USA
| | - W D J Verhagen-Kamerbeek
- Medical and Scientific Affairs, Roche Diagnostics International Ltd, Forrenstrasse 2, 6343, Rotkreuz, Switzerland
| | - E Bosch
- Human Reproduction Unit, IVI-RMA, Plaza de la Policia Local 3, 46015, Valencia, Spain
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Li HJ, Martinez PE, Li X, Schenkel LA, Nieman LK, Rubinow DR, Schmidt PJ. Transdermal estradiol for postpartum depression: results from a pilot randomized, double-blind, placebo-controlled study. Arch Womens Ment Health 2020; 23:401-412. [PMID: 31372757 PMCID: PMC10105981 DOI: 10.1007/s00737-019-00991-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Abstract
Postpartum depression (PPD) is a common complication following delivery, though evidence-based treatment options are limited. This study explores the feasibility and efficacy of outpatient PPD treatment with transdermal estradiol (TE). In a pilot, double-blind, placebo-controlled trial, women with PPD were randomized to receive transdermal 17β-estradiol (100 mcg/day) or placebo patch. Over 6 weeks, women completed weekly ratings on the Beck Depression Inventory (BDI), Edinburgh Postnatal Depression Scale (EPDS), and Hamilton Depression Scale (HAM-D). Primary outcome measures were treatment response (> 50% decrease from baseline BDI) and remission (BDI < 10) at 6 weeks, and secondary outcome measures included severity on all scales at weeks 3 and 6. Of 12 recruited women, 6 received TE and 6 received placebo. By week 6, 5 women receiving TE responded to treatment and 4 showed symptom remission, compared to 2 responders and 1 remitter in the placebo group. This difference was not significant (p = 0.24). In a mixed-model of BDI ratings, TE was associated with a 9.2 point decrease at 3 weeks (95%CI - 19.5 to + 1.0, p = 0.074) and a 10.5 point decrease at 6 weeks (95%CI - 21.0-0.0, p = 0.049) compared to placebo, though these differences did not survive multiple comparisons correction. Analogous effects were found for HAM-D but not EPDS scores. Interestingly, no significant difference in plasma estradiol levels existed between groups. We were unable to demonstrate a significant therapeutic benefit of TE compared with placebo in PPD. Although limited by under-recruitment and loss to follow-up, our results suggest TE is a feasible option for outpatient PPD management, with preliminary evidence (based on secondary outcomes) for efficacy. Therapeutic effects may be seen as early as 3 weeks and may not directly depend on peripheral measures of estradiol.
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Affiliation(s)
- Howard J Li
- Harvard Medical School, Boston, MA, USA
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Pedro E Martinez
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Xiaobai Li
- Biostatistics and Epidemiology, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Linda A Schenkel
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lynnette K Nieman
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Peter J Schmidt
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
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20
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Bozdag G, Turkyilmaz E, Yildiz S, Mumusoglu S, Yarali H. Progesterone Elevation and Preventive Strategies to Avoid Implantation Failure. Semin Reprod Med 2020; 37:265-272. [PMID: 31975355 DOI: 10.1055/s-0039-1700531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite the wide utilization of gonadotropin-releasing hormone analogs, progesterone elevation (P4E) in the late follicular phase occurs in 5 to 30% of all ovarian stimulation (OS) cycles. Although the detrimental effect of P4E on pregnancy rates in fresh in vitro fertilization cycles is valid in all subsets of cases, higher levels of P4 and a longer duration of P4E may be needed in patients with a hyper-ovarian response in order for a negative impact on pregnancy rates to occur. Available preclinical and clinical data suggest that aggressive OS with high doses of follicle-stimulating hormone might increase 3β-hydroxy steroid dehydrogenase and 17β-hydroxy steroid dehydrogenase enzyme activity in human granulosa cells, which leads to high P4 production and hence a higher amount of leakage to the systemic circulation due to a lack of 17α-hydroxylase enzyme expression in human species. High P4 concentrations appear to alter gene expression in the endometrium; however, caution is necessary regarding its potential effect on oocyte/embryo quality with respect to the role of inherent follicular disruption in some women. In terms of the mechanism of overproduction in P4 synthesis, the main preventive strategy should be avoiding aggressive stimulation. Unfortunately, there is lack of large-scale randomized controlled trials for other approaches, including deferred embryo transfer in the thaw cycle. Since there is a significant inter-assay variability for P4 measurement, it may be wise to recommend that every center should define their own P4E and the level needed for harm to occur based on their own assays and datasets before deciding the best approach.
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Affiliation(s)
- Gurkan Bozdag
- Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Esengul Turkyilmaz
- Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Sule Yildiz
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, Istanbul, Turkey
| | - Sezcan Mumusoglu
- Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Hakan Yarali
- Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey.,Anatolia IVF and Women Health Centre, Ankara, Turkey
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21
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Tal S, Mazaki-Tovi M, Druker S, Novak S, Raz T, Aroch I. Evaluation of two chemiluminescent assays compared with radioimmunoassay for serum progesterone measurement in bitches. Theriogenology 2019; 147:116-123. [PMID: 31806245 DOI: 10.1016/j.theriogenology.2019.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/22/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
Serum progesterone (sP4) measurement is commonly used to determine the optimal time for mating in bitches, and to diagnose reproduction-related abnormalities. Radioimmunoassay (RIA) is the gold standard assay, but is becoming less available, and has several practical disadvantages. Chemiluminescence immunoassays (CLIA) are commonly used in human medicine for sP4 measurement, and are becoming more available in veterinary medicine. Our objective was to compare the sP4 results obtained by RIA and two CLIA systems (Immulite-Siemens [IS-CLIA] and Elecsys-Roche [ER-CLIA]) in the same sera in 60 client-owned healthy bitches at different estrous cycle stages. The agreement between the two CLIAs and RIA was examined using the Passing-Bablok regression and Bland Altman plots. Comparing sP4 concentrations measured by the IS-CLIA to the RIA yielded an intercept of 0.16 ng/mL (95% confidence interval [95%CI], 0.03-0.25) with a slope of 0.45 (95%CI, 0.44-0.47) and a median difference of -2.10 ng/mL (P < 0.0001) that was strongly correlated to the average of measurements (r = -0.97; P < 0.0001). Comparing sP4 concentrations measured by the ER-CLIA to the RIA yielded an intercept of -0.23 ng/mL (95%CI, -0.56 to -0.09) with a slope of 1.06 (95%CI, 1.00-1.12) and a median difference of -0.09 ng/mL (P = 0.9), that was weakly correlated to the average of measurements (r = 0.34; P = 0.018). The performance of the ER-CLIA was similar to the RIA, while the IS-CLIA showed significantly different results compared to the RIA. Our study supports the conclusion that sP4 results generated by the ER-CLIA can be used interchangeably with RIA results for clinical purposes, while IS-CLIA results require adjustment to RIA results for clinical practice.
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Affiliation(s)
- Smadar Tal
- Department of Theriogenology, Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot, 761001, Israel
| | - Michal Mazaki-Tovi
- Department of Small Animal Internal Medicine, Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot, 761001, Israel
| | - Shaked Druker
- Koret School of Veterinary Medicine, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot, 761001, Israel
| | - Shiri Novak
- Koret School of Veterinary Medicine, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot, 761001, Israel
| | - Tal Raz
- Koret School of Veterinary Medicine, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot, 761001, Israel.
| | - Itamar Aroch
- Department of Small Animal Internal Medicine, Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot, 761001, Israel
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22
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González-Foruria I, Rodríguez I, Martínez F, Rodríguez-Purata J, Montoya P, Rodríguez D, Nicolau J, Coroleu B, Barri PN, Polyzos NP. Clinically significant intra-day variability of serum progesterone levels during the final day of oocyte maturation: a prospective study with repeated measurements. Hum Reprod 2019; 34:1551-1558. [DOI: 10.1093/humrep/dez091] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/05/2019] [Accepted: 04/22/2019] [Indexed: 01/24/2023] Open
Abstract
Abstract
STUDY QUESTION
Is there significant variability in progesterone levels during the final day of oocyte maturation in women undergoing ovarian stimulation?
SUMMARY ANSWER
Progesterone levels drop from the basal level up to 44% during the final day of oocyte maturation in women undergoing ovarian stimulation.
WHAT IS KNOWN ALREADY
It has been suggested that elevated progesterone levels on the final day of ovarian stimulation may be related to poorer outcomes in in vitro fertilization fresh cycles due to a negative impact on the endometrium. However, despite conflicting results regarding the actual effect of progesterone on pregnancy rates and the lack of a well-established cut off, currently many IVF patients have their embryo transfer deferred when progesterone values surpass a threshold of 1.5 ng/ml on the day of ovulation triggering.
STUDY DESIGN, SIZE, DURATION
This was a prospective cohort study conducted in 22 oocyte donors of a university-affiliated fertility centre between November 2017 and January 2018. We calculated the sample size to detect a difference of 15% between the first and last progesterone measurements with a 5% false-positive rate in a two-sided test with 80% statistical power and a 95% confidence interval (CI).
PARTICIPANTS/MATERIALS, SETTING, METHODS
Progesterone circulating levels were evaluated at four different times during the final day of oocyte maturation (08:00, 12:00, 16:00 and 20:00) before ovulation triggering in healthy oocyte donors. A flexible antagonist protocol was used, and ovarian stimulation was achieved with recombinant follicle-stimulating hormone (FSH) in all cases. The pairwise percentage differences in progesterone levels for each patient were calculated. Univariate linear regression analysis was adopted in order to evaluate variables associated with progesterone levels on the first measurement. The intra-day variability of progesterone was analysed using mixed models.
MAIN RESULTS AND THE ROLE OF CHANCE
Mean serum progesterone values at 08:00, 12:00, 16:00 and 20:00 were 1.75 ng/ml, 1.40 ng/ml, 1.06 ng/ml and 0.97 ng/ml. The progesterone difference between 08:00 and 20:00 was 0.77 (95% CI, 0.56–0.99), which is equivalent to a 44% decline in the mean progesterone values between the first (08:00) and the last determination (20:00; P < 0.001). Among those patients with basal (08:00) progesterone levels >1.5 ng/ml (n = 10), 70% (n = 7) showed levels reduced to <1.5 ng/ml on the last determination of the day (20:00). A mixed model analysis revealed that the progesterone reduction during the day was significantly associated with time and total recombinant FSH dose administered.
LIMITATIONS, REASONS FOR CAUTION
Only young healthy oocyte donors stimulated with an antagonist protocol using recombinant FSH were included. Extrapolation to the general IVF population, with different stimulation protocols and gonadotropins, needs to be confirmed.
WIDER IMPLICATIONS OF THE FINDINGS
This study suggests that a single progesterone determination on the final day of oocyte maturation is not reliable enough to make clinical decisions due to the enormous variation in progesterone during the day. Further studies are needed to better define the impact of the follicular progesterone rise on the endometrium of IVF cycles.
STUDY FUNDING/COMPETING INTEREST(S)
Funding was granted from Fundació Santiago Dexeus Font. N.P.P. received unrestricted grants and/or lectures fees from Roche Diagnostics, MSD, Merck, Ferring Pharmaceuticals, IBSA, Theramex and BESINS International, not associated with the current study. The remaining authors have no competing interests.
TRIAL REGISTRATION NUMBER
Clinicaltrials.gov NCT03366025.
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Affiliation(s)
- I González-Foruria
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - I Rodríguez
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - F Martínez
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - J Rodríguez-Purata
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - P Montoya
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - D Rodríguez
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - J Nicolau
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - B Coroleu
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - P N Barri
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - N P Polyzos
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
- Department of Surgical and Clinical Sciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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23
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Arvis P, Lehert P, Guivarc'h-Levêque A. Both high and low HCG day progesterone concentrations negatively affect live birth rates in IVF/ICSI cycles. Reprod Biomed Online 2019; 39:852-859. [PMID: 31570237 DOI: 10.1016/j.rbmo.2019.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/22/2019] [Accepted: 07/04/2019] [Indexed: 02/02/2023]
Abstract
RESEARCH QUESTION Can previous reports of a decreased probability of success in stimulated IVF cycles with premature rise of progesterone, as determined by progesterone concentration on HCG day (PHCG), be confirmed? DESIGN Retrospective, observational, single-centre cohort study conducted on 5447 IVF and intracytoplasmic (ICSI) cycles carried out among 2192 patients between 2009 and 2015, with conventional ovarian stimulation. This large database was used to develop a non-linear mixed prognosis model of live birth rate (LBR) incorporating PHCG as a predictor. RESULTS In addition to known predictors (age, body mass index, anti-Müllerian hormone, type of infertility), PHCG was associated with a linear effect (OR 0.78 per Log[PHCG]ng/ml, 95% CI 0.611 to 0.997, P = 0.047) combined with a strong quadratic effect (OR 0.585 per Log2(PHCG)ng/ml, 95% CI 0.444 to 0.775, P < 0.001) resulting into a parabolic reverse-U curve. A significant interaction (P = 0.038) was found between PHCG and number of oocytes if three or less, but the effect of PHCG remains modest. For higher oocyte numbers, LBR rapidly increases with number of retrieved oocytes; however, LBR becomes more sensitive to PHCG as the number of oocytes increases. Higher live birth prognoses occur for optimal PHCG but are sharply reduced for lower or higher PHCG. CONCLUSIONS Evidence is provided of an important negative effect of PHCG at lower and higher values, independent of oocyte number, thus defining appropriate ranges for fresh embryo transfer or freeze-all strategy. In poor responders, premature progesterone rise may be ignored, thus avoiding unnecessary cancellations or embryo freezing. Conversely, in higher responders, the negative effect of progesterone elevation is more pronounced, suggesting that freeze-all policy should be applied more widely.
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Affiliation(s)
| | - Philippe Lehert
- Faculty of Medicine, University of Melbourne, Australia; Faculty of Economics, Louvain, Belgium
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24
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The role of progesterone elevation in IVF. Reprod Biol 2019; 19:1-5. [DOI: 10.1016/j.repbio.2019.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/24/2022]
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25
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de Ziegler D, Andersen CY, Stanczyk FZ, Ayoubi JM. Endocrine mechanisms and assay issues in premature progesterone elevation in assisted reproductive technology. Fertil Steril 2018; 109:571-576. [PMID: 29653702 DOI: 10.1016/j.fertnstert.2018.02.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/27/2022]
Abstract
Progesterone elevation occurring in the late phases of controlled ovarian stimulation (COS) has been reported for over 25 years. Yet doubts remain regarding the mechanisms at play in this phenomenon and its net consequences on assisted reproductive technology outcome, which is known to occur in poor and good assisted reproductive technology responders. The pathophysiology of end-COS progesterone elevation encountered in gonadotropin-suppressed cycles is different from that prevailing at the time of, and just after, ovulation. The different divergence in practical consequences of end-COS progesterone elevation led to review the progesterone assays developed for measuring progesterone in the luteal phase of the menstrual cycle, but commonly used for measuring all forms of progesterone elevation.
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Affiliation(s)
- Dominique de Ziegler
- Department of Obstetrics Gynecology and Reproductive Medicine, Hopital Foch-Faculté de Médecine Paris Ouest (UVSQ), Suresnes, France.
| | - Clauslaus Yding Andersen
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Faculty of Health and Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frank Z Stanczyk
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Jean Marc Ayoubi
- Department of Obstetrics Gynecology and Reproductive Medicine, Hopital Foch-Faculté de Médecine Paris Ouest (UVSQ), Suresnes, France
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26
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Lawrenz B, Sibal J, Garrido N, Abu E, Jean A, Melado L, Fatemi HM. Inter-assay variation and reproducibility of progesterone measurements during ovarian stimulation for IVF. PLoS One 2018; 13:e0206098. [PMID: 30383804 PMCID: PMC6211677 DOI: 10.1371/journal.pone.0206098] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/05/2018] [Indexed: 11/18/2022] Open
Abstract
In recent years there is increasing evidence that elevated progesterone levels during ovarian stimulation for IVF / ICSI have a negative impact on the ART-outcome. However, different progesterone assays were used in the previous studies and different assays might produce varying results. This retrospective study evaluated the reproducibility and reliability of different progesterone assays with a special focus on progesterone levels below 1.5 ng/ml, as this range is crucial for early detection of progesterone rise during ovarian stimulation for IVF. A total of 413 blood samples were categorized in different progesterone ranges and whether they were retrieved on the day of final oocyte maturation and the results were compared regarding their reproducibility and reliability. To compare the reproducibility between the different progesterone assays, the Intraclass Correlation Coefficient (ICC) was calculated and interpretation of the ICC results was done according to Cicchetti, ranging from poor to excellent. The correlation of the assays was excellent when all samples were compared including samples retrieved on day of final oocyte maturation, however in the ranges of progesterone levels 1.0 ng/ml to < 1.5 ng/ml, 0.8 ng/ml to < 1.0 ng/ml and < 0.8 ng/ml, the ICC varied between poor and excellent. The assays “gen III” and “Architect” showed an excellent reproducibility of progesterone results throughout all ranges of progesterone levels. This analysis demonstrates, that different progesterone assays have a limited reproducibility and that the results depend on the assay used and the range of progesterone level. This fact leads to two important conclusions. Firstly the limited reproducibility might lead to substantially different treatment decisions in ovarian stimulation treatment for IVF and secondly critical interpretation of thresholds, provided by meta-analysis, is crucial despite the risk that the so far gained clinical experience might become irrelevant and has to be adjusted to the results, obtained by each assay.
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Affiliation(s)
- Barbara Lawrenz
- IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
- Obstetrical Department, Women´s University Hospital Tuebingen, Tuebingen, Germany
- * E-mail:
| | - Junard Sibal
- IVIRMA Middle-East Fertility Clinic, Laboratory, Abu Dhabi, United Arab Emirates
| | | | - Emmanuel Abu
- IVIRMA Middle-East Fertility Clinic, Laboratory, Abu Dhabi, United Arab Emirates
| | - Alliza Jean
- IVIRMA Middle-East Fertility Clinic, Laboratory, Abu Dhabi, United Arab Emirates
| | - Laura Melado
- IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - Human M. Fatemi
- IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
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Hill MJ, Healy MW, Richter KS, Parikh T, Devine K, DeCherney AH, Levy M, Widra E, Patounakis G. Defining thresholds for abnormal premature progesterone levels during ovarian stimulation for assisted reproduction technologies. Fertil Steril 2018; 110:671-679.e2. [DOI: 10.1016/j.fertnstert.2018.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/19/2018] [Accepted: 05/07/2018] [Indexed: 10/28/2022]
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28
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Grin L, Mizrachi Y, Cohen O, Lazer T, Liberty G, Meltcer S, Friedler S. Does progesterone to oocyte index have a predictive value for IVF outcome? A retrospective cohort and review of the literature. Gynecol Endocrinol 2018; 34:638-643. [PMID: 29373930 DOI: 10.1080/09513590.2018.1431772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The potential adverse effect of Serum progesterone (SP) elevation on the day of hCG administration is a matter of continued debate. Our study aimed to evaluate the relative value of progesterone to a number of aspirated oocytes ratio (POI) to predict clinical pregnancy (CP) and live birth (LB) in fresh IVF cycles and to review the relevant literature. A retrospective analysis of GnRH Antagonist IVF-ET cycles. POI was calculated by dividing the SP on the day of hCG by the number of aspirated mature oocytes. A multivariate logistic regression analysis was performed to evaluate the predictive value of POI for CP and LB. Cycle outcome parameters included clinical pregnancy, live-birth and miscarriage. A total of 2,693 IVF/ICSI cycles were analyzed. POI was inversely associated with CP adjusted OR 0.063 (95% CI 0.016-0.249, p < .001) and with LB adjusted OR 0.036 (95% CI 0.007-0.199, p < .001). For prediction of LB, the area under the curve (AUC) was 0.68 (95% CI 0.64-0.71, p < .001) for the POI model. POI above the 90th percentile with a value of 0.36 ng/mL/oocyte results in CP and LB rates of 8.0 and 5.9%, respectively. POI is a simple index for the prediction of IVF-ET cycle outcomes, it can advocate a limit above which embryo transfer should be reconsidered.
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Affiliation(s)
- Leonti Grin
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Yossi Mizrachi
- b Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Sackler Faculty of Medicine , Tel Aviv University , Holon , Israel
| | - Ornit Cohen
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Tal Lazer
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Gad Liberty
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Simion Meltcer
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Shevach Friedler
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
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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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Adda-Herzog E, Poulain M, de Ziegler D, Ayoubi JM, Fanchin R. Premature progesterone elevation in controlled ovarian stimulation: to make a long story short. Fertil Steril 2018; 109:563-570. [DOI: 10.1016/j.fertnstert.2018.02.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
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Lawrenz B, Melado L, Fatemi H. Premature progesterone rise in ART-cycles. Reprod Biol 2018; 18:1-4. [DOI: 10.1016/j.repbio.2018.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/17/2017] [Accepted: 01/01/2018] [Indexed: 01/22/2023]
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Thomsen LH, Humaidan P, Erb K, Overgaard M, Andersen CY, Kesmodel US. Mid-Luteal 17-OH Progesterone Levels in 614 Women Undergoing IVF-Treatment and Fresh Embryo Transfer-Daytime Variation and Impact on Live Birth Rates. Front Endocrinol (Lausanne) 2018; 9:690. [PMID: 30555411 PMCID: PMC6282693 DOI: 10.3389/fendo.2018.00690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/02/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Corpus luteum (CL) produces progesterone (P4) and 17-OH progesterone (17-OH P4) during the luteal phase. Contrary to P4, 17-OH P4 is not supplied as part of the luteal phase support following IVF-treatment. Therefore, measuring endogenous serum 17-OH P4 levels may more accurately reflect the CL function compared to monitoring serum P4 concentrations. Objective: To explore the correlation between mid-luteal serum 17-OH P4 levels and live birth rates and to explore the possible daytime variations in mid-luteal serum 17-OH P4. Design: Prospective cohort study. Patients: 614 women undergoing IVF-treatment and fresh embryo transfer. Intervention: All patients had serum 17-OH P4 measured 7 days after oocyte pick-up (OPU+7). Furthermore, on OPU+7, seven patients underwent repeated blood sampling during daytime to clarify the endogenous daytime secretory pattern of 17-OH P4. Outcome measure: Live birth rate. Secondary outcome measure: Daytime variation in serum 17-OH P4 levels. Results: The highest chance of a live birth was seen with mid-luteal 17-OH P4 between 6.0 and 14.0 nmol/l. The chance of a live birth was reduced below (RD -10%, p = 0.07), but also above the optimal range for 17-OH P4 (RD -12%, p = 0.04). Patients with diminished CL-function (17-OH P4 < 6 nmol/l) displayed clinically stable 17-OH P4 values, whereas patients with 17-OH P4 levels >6 nmol/l showed random 17-OH P4 fluctuations during daytime. Conclusion: The association between 17-OH P4 and reproductive outcomes is non-linear, and the negative effect of excessive CL-secretion seems to be just as strong as the negative effect of a reduced CL-function during the peri-implantation period.
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Affiliation(s)
- Lise Haaber Thomsen
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- *Correspondence: Lise Haaber Thomsen
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Karin Erb
- The Fertility Clinic, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Martin Overgaard
- Department of Biochemistry, Odense University Hospital, Odense, Denmark
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Schiøler Kesmodel
- The Fertility Clinic, Herlev University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Esteves SC, Khastgir G, Shah J, Murdia K, Gupta SM, Rao DG, Dash S, Ingale K, Patil M, Moideen K, Thakor P, Dewda P. Association Between Progesterone Elevation on the Day of Human Chronic Gonadotropin Trigger and Pregnancy Outcomes After Fresh Embryo Transfer in In Vitro Fertilization/Intracytoplasmic Sperm Injection Cycles. Front Endocrinol (Lausanne) 2018; 9:201. [PMID: 29755412 PMCID: PMC5932157 DOI: 10.3389/fendo.2018.00201] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/10/2018] [Indexed: 11/14/2022] Open
Abstract
Progesterone elevation (PE) during the late follicular phase of controlled ovarian stimulation in fresh embryo transfer in vitro fertilization (IVF)/intracytoplasmic sperm injection cycles has been claimed to be associated with decreased pregnancy rates. However, the evidence is not unequivocal, and clinicians still have questions about the clinical validity of measuring P levels during the follicular phase of stimulated cycles. We reviewed the existing literature aimed at answering four relevant clinical questions, namely (i) Is gonadotropin type associated with PE during the follicular phase of stimulated cycles? (ii) Is PE on the day of human chorionic gonadotropin (hCG) associated with negative fresh embryo transfer IVF/intracytoplasmic sperm injection (ICSI) cycles outcomes in all patient subgroups? (iii) Which P thresholds are best to identify patients at risk of implantation failure due to PE in a fresh embryo transfer? and (iv) Should a freeze all policy be adopted in all the cycles with PE on the day of hCG? The existing evidence indicates that late follicular phase progesterone rise in gonadotropin releasing analog cycles is mainly caused by the supraphysiological stimulation of granulosa cells with exogenous follicle-stimulating hormone. Yet, the type of gonadotropin used for stimulation seems to play no significant role on progesterone levels at the end of stimulation. Furthermore, PE is not a universal phenomenon with evidence indicating that its detrimental consequences on pregnancy outcomes do not affect all patient populations equally. Patients with high ovarian response to control ovarian stimulation are more prone to exhibit PE at the late follicular phase. However, in studies showing an overall detrimental effect of PE on pregnancy rates, the adverse effect of PE on endometrial receptivity seems to be offset, at least in part, by the availability of good quality embryo for transfer in women with a high ovarian response. Given the limitations of the currently available assays to measure progesterone at low ranges, caution should be applied to adopt specific cutoff values above which the effect of progesterone rise could be considered detrimental and to recommend "freeze-all" based solely on pre-defined cutoff points.
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Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Jatin Shah
- Mumbai Fertility Center – Kamala Polyclinic & Nursing Home, Mumbai, India
| | | | | | - Durga G. Rao
- Oasis Centre for Reproductive Medicine, Hyderabad, India
| | - Soumyaroop Dash
- Srishti Assisted Fertility & Advanced Laparoscopy Center, Srishti Hospital, Moolakulam, India
| | - Kundan Ingale
- Nirmiti Clinic, Centre for Assisted Reproduction, Chinchwad, India
| | | | | | | | - Pavitra Dewda
- Merck Limited, Mumbai, India
- *Correspondence: Pavitra Dewda,
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Skouridou V, Schubert T, Bashammakh AS, El-Shahawi MS, Alyoubi AO, O'Sullivan CK. Aptatope mapping of the binding site of a progesterone aptamer on the steroid ring structure. Anal Biochem 2017; 531:8-11. [PMID: 28499498 DOI: 10.1016/j.ab.2017.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 01/19/2023]
Abstract
In this work we report the mapping of the binding site of the only progesterone aptamer published to date, in an approach referred to as aptatope mapping. By linking the binding data obtained from microscale thermophoresis analysis to the structural differences on the ring structure of a range of steroids, we elucidated the moieties involved in aptamer-progesterone binding. This approach can be further exploited for the characterization of aptamer specificity and ultimately facilitate the development of aptamer-based assays depending on the desired specificity.
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Affiliation(s)
- Vasso Skouridou
- Nanobiotechnology & Bioanalysis Group, Departament d'Enginyeria Química, Universitat Rovira i Virgili, Avinguda Països Catalans 26, Tarragona 43007, Spain.
| | | | - Abdulaziz S Bashammakh
- Department of Chemistry, Faculty of Science, King Abdulaziz University, P.O. Box 80203, Jeddah 21589, Saudi Arabia
| | - Mohammad S El-Shahawi
- Department of Chemistry, Faculty of Science, King Abdulaziz University, P.O. Box 80203, Jeddah 21589, Saudi Arabia
| | - Abdulrahman O Alyoubi
- Department of Chemistry, Faculty of Science, King Abdulaziz University, P.O. Box 80203, Jeddah 21589, Saudi Arabia
| | - Ciara K O'Sullivan
- Nanobiotechnology & Bioanalysis Group, Departament d'Enginyeria Química, Universitat Rovira i Virgili, Avinguda Països Catalans 26, Tarragona 43007, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Passeig Lluís Companys 23, Barcelona 08010, Spain.
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Panaino TR, Silva JBD, Lima MATD, Lira P, Arêas PC, Mancebo ACA, Souza MMD, Antunes RA, Souza MDCBD. High Progesterone levels in the beginning of ICSI antagonist cycles and clinical pregnancy: still a concern? JBRA Assist Reprod 2017; 21:11-14. [PMID: 28333025 PMCID: PMC5365193 DOI: 10.5935/1518-0557.20170004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE In controlled ovarian hyperstimulation (COH) using antagonist cycles, an incomplete luteolysis could happen after an inefficient previous luteolysis. Since antagonist cycles are frequent today, this study aims to access the impact of serum progesterone in the beginning and at the end of stimulation, and pregnancy outcomes. METHODS single-center cohort study, 461 fresh embryo transfers in ICSI antagonist cycles. Serum progesterone levels was measured in the beginning of COH (P4i) and on hCG day (P4f) using threshold values of 1.5ng/mL. Four groups were created: Group 1, P4i and P4f ≤ 1.5; Group 2, P4i ≤ 1.5 and P4f > 1.5; Group 3, P4i > 1.5 and P4f ≤ 1.5 and Group 4, P4i and P4f > 1.5. The clinical pregnancy rate (CPR) and live birth rates (LBR) were the primary outcomes. RESULTS The number of cycles per group was: 393, 51, 6 and 11, respectively. Group 1 was considered the expected normal, while group 4 represented the persistence of higher levels. There was no difference in age, basal FSH and Estradiol, days of stimulation endometrium thickness and total amount of gonadotropins between group 1 versus group 4. However, significant differences occurred in embryological and clinical outcomes between these 2 groups. CONCLUSION The impact of serum progesterone in the beginning of stimulation and pregnancy outcomes is a matter of concern. Basal elevated levels could help identify patients that will repeat it on hCG day, being probably a marker to define a freeze-all strategy to these cycles.
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Affiliation(s)
| | | | | | - Paloma Lira
- Clinica Fertipraxis, Rio de Janeiro, RJ, Brazil
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Shankara-Narayana N, Zawada S, Walters KA, Desai R, Marren A, Handelsman DJ. Accuracy of a Direct Progesterone Immunoassay. ACTA ACUST UNITED AC 2016; 1:294-299. [DOI: 10.1373/jalm.2016.020123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 11/06/2022]
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Connell MT, Patounakis G, Healy MW, DeCherney AH, Devine K, Widra E, Levy MJ, Hill MJ. Is the effect of premature elevated progesterone augmented by human chorionic gonadotropin versus gonadotropin-releasing hormone agonist trigger? Fertil Steril 2016; 106:584-589.e1. [PMID: 27178228 DOI: 10.1016/j.fertnstert.2016.04.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/25/2016] [Accepted: 04/13/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare the effect of P on live birth rate between hCG and GnRH agonist (GnRH-a) trigger cycles. DESIGN Retrospective cohort study. SETTING Large private assisted reproductive technology (ART) practice. PATIENT(S) A total of 3,326 fresh autologous ART cycles. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live birth. RESULT(S) A total of 647 GnRH-a trigger cycles were compared with 2,679 hCG trigger cycles. Live birth was negatively associated with P in both the hCG trigger (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.52-0.76) and the agonist trigger cohorts (OR 0.56, 95% CI 0.45-0.69). Interaction testing evaluating P and trigger medication was not significant, indicating that P had a similar negative effect on live birth rates in both cohorts. Progesterone ≥2 ng/mL occurred more commonly in GnRH-a trigger cycles compared with hCG trigger cycles (5.5% vs. 3.1%) and was negatively associated with live birth in both the hCG trigger (OR 0.28, 95% CI 0.11-0.73) and agonist trigger cohorts (OR 0.35, 95% CI 0.14-0.90). When P ≥2 ng/mL, the live birth rates were poor and similar in the hCG and GnRH-a cohorts (5.9% vs. 14.2%), indicating that P ≥2 ng/mL had a similar negative effect on live birth in both cohorts. CONCLUSION(S) Elevated serum P on the day of hCG was negatively associated with live birth rates in both hCG and GnRH-a trigger cycles.
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Affiliation(s)
- Matthew T Connell
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - George Patounakis
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Mae Wu Healy
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Alan H DeCherney
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Kate Devine
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland
| | - Eric Widra
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland
| | - Michael J Levy
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland
| | - Micah J Hill
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
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Rota A, Vannozzi I, Marianelli S, Gavazza A, Lubas G. Laboratory and Clinical Evaluation of a Feia Method for Canine Serum Progesterone Assay. Reprod Domest Anim 2015; 51:69-74. [PMID: 26644390 DOI: 10.1111/rda.12647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
Abstract
The evaluation of progesterone (P4) concentration is a valuable tool in assessing physiological reproductive events and reproductive disorders in bitches. A reliable and rapid (preferable, point of care) determination of P4 is advisable in most cases. Aims of this study were to evaluate a fluorescence enzyme immunoassay (FEIA) for canine serum P4 concentration by (i) the agreement with liquid chromatography-tandem mass spectrometry (LC/MS/MS), (ii) the association with vaginal cytology and (iii) the accuracy in the prediction of the parturition date calculated from the estimated day of ovulation. Serum samples were collected from client-owned bitches presented between 2011 and 2014 for the evaluation of their oestrous cycle, pregnancy or reproductive disorders. The agreement between FEIA and LC/MS/MS, evaluated on 19 samples, was statistically significant (R(2) = 95.7%, p < 0.001), although FEIA showed significantly higher values than LC/MS/MS (p < 0.05). In the different phases of oestrous cycle, as determined by vaginal cytology, P4 concentrations (by FEIA) were statistically different (p < 0.05): anoestrus (n = 7) 0.38 ± 0.14 ng/ml, proestrus (n = 14) 1.04 ± 0.67 ng/ml and oestrus (n = 72) 6.8 ± 7.26 ng/ml. Mean pregnancy length from the estimated day of ovulation was 62.9 ± 1.8 days. In 13 of 22 (59.1%), 19 of 22 (86.3%) and 21 of 22 (95.5%) bitches pregnancy lasted 63 ± 1, 63 ± 2 and 63 ± 3 days, respectively. Three pregnancies were outside the 61-65 days range (60, 60 and 67 days). In conclusion, the FEIA method employed can be considered reliable and, in association with vaginal cytology, effective in evaluating the canine oestrous cycle.
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Affiliation(s)
- A Rota
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - I Vannozzi
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | | | - A Gavazza
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - G Lubas
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
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Huang Y, Wang EY, Du QY, Xiong YJ, Guo XY, Yu YP, Sun YP. 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. [PMID: 26238449 PMCID: PMC4524365 DOI: 10.1186/s12958-015-0075-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effect of progesterone elevation (PE) on the day of human chorionic gonadotropin (hCG) administration on the pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles is a matter of ongoing debate. The replacement of cleavage-stage embryos with blastocyst-stage embryos for transfer was proposed to avoid the possible impairment of PE in fresh cycles. This study aimed to assess the association between PE on the day of human chorionic gonadotropin (hCG) administration and clinical pregnancy rates (CPRs) in IVF/ICSI cycles with embryos transferred at different developmental stages (cleavage and blastocyst). Moreover, a secondary aim was to determine the thresholds at which PE has a detrimental effect on CPRs. METHODS This single-center retrospective cohort study included more than 10,000 patients undergoing day 3 cleavage-stage embryo transfer (ET) and 1146 patients undergoing day 5 blastocyst-stage embryo transfer (ET) using gonadotropin and GnRH agonist for controlled ovarian stimulation. RESULTS Serum PE was inversely associated with CPRs in both cleavage- and blastocyst-stage ET cycles. In the day 3 ET cycles, CPRs (progesterone levels < 0.5 ng/ml, 49.2 %) significantly declined when the progesterone concentration reached 1.0 ng/ml (45.5 %) and decreased further when the progesterone concentration increased to 1.5 ng/ml (36.2 %). In the day 5 blastocyst-stage ET cycles, patients with serum progesterone levels ≥1.75 ng/ml had significantly lower CPRs (31.3 % VS. 41.4 %, p < 0.001) compared to patients with serum progesterone levels <1.75 ng/ml. The negative association of PE with CPRs was noted in both ET groups, even after adjusting for confounders. Furthermore, the developmental stage of the transferred embryos was not linked to the effect of PE on CPRs because the interaction between the developmental stage of the transferred embryos and PE was not significant. CONCLUSIONS PE on the day of hCG administration is associated with decreased CPRs in GnRH agonist IVF/intracytoplasmic sperm injection (ICSI) cycles regardless of the developmental stage of the transferred embryos (cleavage versus blastocyst stage).
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Affiliation(s)
- Yan Huang
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China.
| | - En-Yin Wang
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China.
| | - Qing-Yun Du
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China.
| | - Yu-Jing Xiong
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China.
| | - Xiao-Yi Guo
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China.
| | - Yi-Ping Yu
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China.
| | - Ying-Pu Sun
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Jianshe Dong Road, Erqi District, Zhengzhou City, Henan Province, People's Republic of China.
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Differential expression of vascular endothelial growth factor angiogenic factors in different endometrial compartments in women who have an elevated progesterone level before oocyte retrieval, during in vitro fertilization-embryo transfer treatment. Fertil Steril 2015; 104:1030-1036. [PMID: 26143364 DOI: 10.1016/j.fertnstert.2015.06.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/03/2015] [Accepted: 06/09/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate the relationship between endometrial expressions of angiogenic factors around the time of embryo implantation and P level before oocyte retrieval during IVF-ET treatment. DESIGN Retrospective study. SETTING University Assisted Reproductive Unit. PATIENT(S) Forty patients were recruited, 20 women with an elevated P level, and 20 women with a normal P level, into cancelled embryo transfer (ET) cycles. INTERVENTION(S) Endometrial biopsy samples were obtained from women who had an elevated or normal P level 7 days after human chorionic gonadotropin administration. The protein expression levels of VEGF-A, VEGF-C, and PLGF were examined using immunohistochemistry. MAIN OUTCOME MEASURE(S) A semiquantitative analysis was performed using histochemical-score analysis of staining intensity in the luminal epithelium, glandular epithelium, and stroma, separately. RESULT(S) Luminal epithelial expression of vascular endothelial growth factor (VEGF)-A, VEGF-C, and PLGF did not significantly differ in women with elevated or normal P levels before oocyte retrieval. Glandular epithelial expression of VEGF-A, VEGF-C, and PLGF was higher in women with elevated P levels, compared with those with normal P levels. A significantly higher stromal expression of VEGF-A and PLGF was found in women with elevated P levels. CONCLUSION(S) A high P level before oocyte retrieval was associated with expression of VEGF angiogenic factors in glandular epithelium and stromal compartment around the time of embryo implantation. Our findings suggest that the lower implantation rates observed in this group of women may relate to decreased endometrial receptivity arising from altered expression of angiogenic factors.
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Hill MJ, Royster GD, Healy MW, Richter KS, Levy G, DeCherney AH, Levens ED, Suthar G, Widra E, Levy MJ. Are good patient and embryo characteristics protective against the negative effect of elevated progesterone level on the day of oocyte maturation? Fertil Steril 2015; 103:1477-84.e1-5. [PMID: 25881880 DOI: 10.1016/j.fertnstert.2015.02.038] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/11/2015] [Accepted: 02/27/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate if an elevated progesterone (P) level on the day of human chorionic gonadotropin (hCG) administration is associated with a decrease in live-birth rate in patients with a good prognosis. DESIGN Retrospective cohort study. SETTING Large, private, assisted reproductive technology (ART) practice. PATIENT(S) One thousand six hundred twenty fresh autologous ART cycles. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live-birth rate. RESULT(S) A total of 934 blastocyst and 686 cleavage-stage embryo transfer (ET) cycles were evaluated. Serum P levels were not associated with markers of oocyte or embryo quality, including fertilization, embryo stage at transfer, and embryos available for cryopreservation. Patient age, stage of ET, embryo quality, the number of embryos transferred, and P level on the day of hCG administration were all significantly associated with live birth. Higher P levels were associated with decreased odds of live birth for cleavage- and blastocyst-stage embryos, poor-fair and good-quality embryos, and poor- and high-responder patients. The nonsignificance of interaction tests of P levels with embryo stage, embryo quality, patient age, and ovarian response indicated that the relationship between P level and live birth was similar regardless of these factors. CONCLUSION(S) An elevated serum P level on the day of hCG administration was negatively associated with live birth, even in ETs with a good prognosis.
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Affiliation(s)
- Micah J Hill
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
| | - Greene Donald Royster
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Mae Wu Healy
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Kevin S Richter
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland
| | - Gary Levy
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Alan H DeCherney
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Eric D Levens
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland
| | - Geeta Suthar
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland
| | - Eric Widra
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland
| | - Michael J Levy
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland
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