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Bila J, Makhadiyeva D, Dotlic J, Andjic M, Aimagambetova G, Terzic S, Bapayeva G, Laganà AS, Sarria-Santamera A, Terzic M. Predictive Role of Progesterone Levels for IVF Outcome in Different Phases of Controlled Ovarian Stimulation for Patients With and Without Endometriosis: Expert View. Reprod Sci 2024; 31:1819-1827. [PMID: 38388924 DOI: 10.1007/s43032-024-01490-2] [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: 08/03/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
The study aimed to review the role of basal, trigger, and aspiration day progesterone levels (PLs) as predictors of in vitro fertilization (IVF) success for patients with and without endometriosis. A non-systematic review was conducted by searching papers published in English during the period of 1990-2023 in MEDLINE and PubMed, Embase, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), and Web of Science. The most widely used IVF predictor success was the trigger day progesterone serum level. Many studies utilize the threshold level of 1.5-2.0 ng/ml. However, the predictive power of only progesterone level failed to show high sensitivity and specificity. Contrary, progesterone level on the trigger day combined with the number of mature retrieved oocytes had the highest predictive power. High baseline progesterone level was associated with poor IVF outcomes. Research on progesterone and IVF success in patients with endometriosis is limited but indicates that endometriosis patients seem to benefit from higher progesterone concentrations (≥ 37.1 ng/ml) in IVF cycles. Currently, there is limited data for a definitive insight into the mportance of progesterone in the estimation of IVF success. Nonetheless, this summarized evidence could serve as up-to-date guidance for the role of progesterone in the prediction of IVF outcomes, both in patients with and without endometriosis.
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Affiliation(s)
- Jovan Bila
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000, Belgrade, Serbia
| | - Dinara Makhadiyeva
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana, 010000, Kazakhstan
| | - Jelena Dotlic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000, Belgrade, Serbia
| | - Mladen Andjic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000, Belgrade, Serbia
| | - Gulzhanat Aimagambetova
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana, 010000, Kazakhstan.
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana, 010000, Kazakhstan
| | - Gauri Bapayeva
- Clinical Academic Department of Women's Health, Corporate Fund "University Medical Center", Turan Ave. 32, Astana, 010000, Kazakhstan
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133, Palermo, Italy
| | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana, 010000, Kazakhstan
| | - Milan Terzic
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana, 010000, Kazakhstan
- Clinical Academic Department of Women's Health, Corporate Fund "University Medical Center", Turan Ave. 32, Astana, 010000, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, School of Medicine, 300 Halket Street, Pittsburgh, PA, 15213, USA
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Liu R, Zhou L, Chen X, He H, Cai Z. Letrozole Supplementation and the Increased Risk of Elevated Progesterone Levels on Trigger Day. Front Endocrinol (Lausanne) 2022; 13:904089. [PMID: 35957830 PMCID: PMC9359123 DOI: 10.3389/fendo.2022.904089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022] Open
Abstract
Although using letrozole (LE) during in vitro fertilisation and intracytoplasmic sperm injection (IVF/ICSI) has many advantages, it remains unclear whether LE induces an increase in progestogen during the late follicular phase. The objective of this study was to investigate whether progesterone levels increased under antagonist protocols supplemented with LE on the trigger day using a retrospective cohort study. The study included 1,133 women who underwent IVF/ICSI cycles from January 2018 to June 2020. After propensity score matching (PSM) for baseline characteristics, 266 patients with gonadotropin-releasing hormone-antagonist (GnRH-ant) were matched to 266 patients with letrozole + GnRH-ant (LE GnRH-ant) (PSM 1 cohort), and 283 patients with gonadotropin-releasing hormone-agonist (GnRH-a) were matched to 283 patients with LE GnRH-ant (PSM 2 cohort). In the PSM 1 cohort, patients in the LE GnRH-a group presented higher progesterone levels (1.22 ± 0.95 ng/mL vs 0.86 ± 0.60 ng/mL, P < 0.001), with a higher proportion of patients with progesterone level > 1.5 ng/mL (24.81% vs 7.52%, P < 0.001). In PSM 2 cohort, patients in the LE GnRH-a group presented higher progesterone levels on trigger day (1.23 ± 0.91 ng/mL vs 0.98 ± 0.61 ng/mL, P < 0.001), with a higher proportion of patients with progesterone level > 1.5 ng/mL (25.45% vs 12.70%, P < 0.001). In the PSM 1 cohort, progesterone levels on the trigger day increased by 0.05 ng/mL, with an increase in every retrieved oocyte in the LE GnRH-ant group (β 0.05 ng/mL [95% CI 0.04, 0.06], P < 0.001), whereas an increase of 0.02 ng/mL was observed in the GnRH-ant group (β 0.02 ng/mL [95% CI 0.01, 0.03], P < 0.001), with P for interaction being 0.0018. In the PSM 2 cohort, progesterone levels on the trigger day increased by 0.05 ng/mL with an increase in every retrieved oocyte in the LE GnRH-ant group (β 0.05 ng/mL [95% CI 0.04, 0.06], P < 0.001), whereas an increase of 0.02 ng/mL was observed in the GnRH-a group (β 0.02 ng/mL [95% CI 0.01, 0.03], P < 0.001), with P for interaction being 0.0002. LE supplementation on the antagonist protocols may increase progesterone levels in the late follicular stage.
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Affiliation(s)
- Rongju Liu
- Reproductive Medical Center, Dongguan Songshan Lake (SSL) Central Hospital, Dongguan City, China
- *Correspondence: Rongju Liu,
| | - Liling Zhou
- Reproductive Medical Center, Dongguan Songshan Lake (SSL) Central Hospital, Dongguan City, China
| | - Xuemei Chen
- Reproductive Medical Center, Dongguan Songshan Lake (SSL) Central Hospital, Dongguan City, China
| | - Hongmei He
- Reproductive Medical Center, Dongguan Songshan Lake (SSL) Central Hospital, Dongguan City, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou City, China
| | - Zhaowei Cai
- Reproductive Medical Center, Dongguan Songshan Lake (SSL) Central Hospital, Dongguan City, China
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Smitz J, Platteau P. Influence of human chorionic gonadotrophin during ovarian stimulation: an overview. Reprod Biol Endocrinol 2020; 18:80. [PMID: 32762698 PMCID: PMC7409634 DOI: 10.1186/s12958-020-00639-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
It is widely known that luteinising hormone (LH) and human chorionic gonadotrophin (hCG) are integral in the female reproductive lifecycle. Due to the common binding site and similarity in molecular structure, they were previously thought to have overlapping roles. However, with the development of both purified urinary-derived and recombinant gonadotrophins, the individual characteristics of these molecules have begun to be defined. There is evidence to suggest that LH and hCG preferentially activate different signalling cascades and display different receptor-binding kinetics. The data generated on the two molecules have led to an improved understanding of their distinct physiological functions, resulting in a debate among clinicians regarding the most beneficial use of LH- and hCG-containing products for ovarian stimulation (OS) in assisted reproductive technologies (ARTs). Over the past few decades, a number of trials have generated data supporting the use of hCG for OS in ART. Indeed, the data indicated that hCG plays an important role in folliculogenesis, leads to improved endometrial receptivity and is associated with a higher quality of embryos, while presenting a favourable safety profile. These observations support the increased use of hCG as a method to provide LH bioactivity during OS. This review summarises the molecular and functional differences between hCG and LH, and provides an overview of the clinical trial data surrounding the use of products for OS that contain LH bioactivity, examining their individual effect on outcomes such as endometrial receptivity, oocyte yield and embryo quality, as well as key pregnancy outcomes.
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Affiliation(s)
- Johan Smitz
- Follicle Biology Laboratory, Vrije Universiteit Brussel, Laarbeeklaan, 103, 1090 Brussels, Belgium
| | - Peter Platteau
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Armijo O, Egea G, Martín-Cameán M, Lobo S, Sanz C, Iniesta S, Fernández S, Sánchez MJ, Silva P, Hernández A. Effects of progesterone variation on IVF Progesterone variation during controlled ovarian stimulation: effects on in vitro results. J OBSTET GYNAECOL 2019; 40:825-829. [PMID: 31769702 DOI: 10.1080/01443615.2019.1671817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this study was to investigate the impact of the progesterone variation (PV) between early progesterone and preovulatory progesterone on pregnancy rate (PR), number of oocytes, and embryo quality. Three hundred and thirty-eight cycles of in vitro fertilisation were included and progesterone was measured on 5th day of stimulation GnRH as well as on the day of induction of ovulation. Fresh embryo transfer (ET) on the second-third day after follicular puncture was made in 152/338 cycles, with positive pregnancies in 61/152 (40%). In the cycles in which ET was cancelled (186/338) higher levels of estradiol and P2 were detected, as well as greater PV and number of oocytes obtained than those made in with fresh transfer. A greater PV was not associated with a worse clinical PR but with a minor embryo quality in the group of 35-37 years old patients.Impact StatementWhat is already known on this subject? Preovulatory progesterone (P2) elevation has been linked to worse results in IVF cycles. It has also been described been reported that there is a lower pregnancy rate (PR) in patients with high progesterone in the early follicular phase (P1). In our study, we measured P1 and P2 to evaluate the possible repercussion of progesterone variation (PV) (ratio of P2 to P1) on PR, a variable that has not previously been analysed.What do the results of this study add? Negative correlation between preovulatory progesterone and embryo quality was found, according to the literature. In the present study, a negative significant correlation between PV and embryo quality was also found, however, only in the group of 35-37 years old women.What are the implications of these findings for clinical practice and/or further research? This could indicate that a rapid increase in progesterone levels after the early follicular phase is related to a lower quality of the obtained embryos, although further studies are required to achieve greater statistical significance.
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Affiliation(s)
- Onica Armijo
- Human Reproduction Service, Department of Obstetrics and Gynecology, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - Guillermo Egea
- Human Reproduction Service, Department of Obstetrics and Gynecology, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - María Martín-Cameán
- Human Reproduction Service, Department of Obstetrics and Gynecology, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - Sonia Lobo
- Human Reproduction Service, Department of Obstetrics and Gynecology, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - Clara Sanz
- Human Reproduction Service, Department of Obstetrics and Gynecology, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - Silvia Iniesta
- Human Reproduction Service, Department of Obstetrics and Gynecology, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - Sara Fernández
- Human Reproduction Service, Department of Obstetrics and Gynecology, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - Maria José Sánchez
- Human Reproduction Service, Department of Obstetrics and Gynecology, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - Patricia Silva
- Human Reproduction Service, Department of Obstetrics and Gynecology, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - Alicia Hernández
- Human Reproduction Service, Department of Obstetrics and Gynecology, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain
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Affiliation(s)
- Gautam N Allahbadia
- Rotunda-The Center For Human Reproduction, Mumbai, India ; New Hope IVF, Sharjah, UAE
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Comparison of progesterone measurement on day of, and day after, HCG administration in IVF–embryo transfer cycles. Reprod Biomed Online 2015; 30:157-65. [DOI: 10.1016/j.rbmo.2014.10.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 10/26/2014] [Accepted: 10/28/2014] [Indexed: 11/24/2022]
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