Elevated serum progesterone during in vitro fertilization treatment and the risk of ischemic placental disease

Progesterone levels during ovarian stimulation in segmented ART cycles inversely correlate with normalized birthweight of neonates conceived through subsequent frozen-thawed embryo transfer

PURPOSE

To evaluate the association between serum progesterone (P) at the day of ovulation trigger and neonatal birthweight in singletons born after frozen-thawed embryo transfer in segmented ART cycles.

METHODS

A retrospective multicenter cohort study involving data from patients who achieved uncomplicated pregnancy and term delivery of ART-conceived singleton babies following a segmented GnRH antagonist cycle. The main outcome was birthweight's z-score of the neonate. Univariate and multivariate linear logistic regression analyses were made to investigate the relation of z-score with variables inherent to the patient and to the ovarian stimulation. The variable P per oocyte was created by dividing the value of progesterone at ovulation trigger by the number of oocytes retrieved at oocyte retrieval.

RESULTS

A total of 368 patients were included in the analysis. At univariate linear regression, the birthweight z-score of the neonate appeared to be inversely related to both P levels at the ovulation trigger (- 0.101, p = 0.015) and P levels per oocyte at trigger (- 1.417, p = 0.001), while it was directly related to the height of the mother (0.026, p = 0.002) and to the number of previous live births (0.291, p = 0.016). In multivariate analysis, both serum P (- 0.1; p = 0.015) and P per oocyte (- 1.347, p = 0.002) maintained the significant inverse association with birthweight z-score after adjusting for height and parity.

CONCLUSIONS

Serum progesterone level on the day of ovulation trigger inversely correlates with normalized birthweight of neonates in segmented GnRH antagonist ART cycles.

Impact of Elevated Progesterone in Late Follicular Phase on Early Pregnancy Outcomes and Live Birth Rate After Fresh Embryo Transfers

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.