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Wu D, Yu T, Shi H, Zhai J. Effect of elevated progesterone levels the day before ovulation on pregnancy outcomes in natural cycles of frozen thawed embryo transfer. Gynecol Endocrinol 2022; 38:726-730. [PMID: 35901839 DOI: 10.1080/09513590.2022.2103671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVE We aimed to analyze whether elevated progesterone levels on the day before ovulation affected pregnancy outcomes in natural cycles of frozen thawed embryo transfer (NC-FET). METHODS A retrospective analysis was conducted in a public university hospital. Data on clinical pregnancy, live birth, ectopic pregnancy, and miscarriage rates were collected, along with other patient data. Patients were divided into two groups according to their progesterone levels the day before ovulation: the progesterone elevation (PE) group (progesterone level >1.0 ng/mL) and the normal progesterone (NP) group (progesterone level ≤1.0 ng/mL). We assessed the effect of elevated progesterone levels in NC-FET by performing multivariate logistic regression analysis. RESULTS Overall 1159 women with tubal factor infertility who underwent NC-FET were enrolled, including 666 women who received cleavage-stage embryo transfers and 493 women who received blastocyst embryo transfers. When two cleavage-stage embryos were transferred, the clinical pregnancy rate was significantly higher in the PE than in the NP group following NC-FET (p < .05). After correcting for various confounders, we found that elevated progesterone levels (adjusted odds ratio [OR]: 1.672; 95% confidence interval [CI]: 1.089-2.566, p = .018) improved the clinical pregnancy rate following transfer of two cleavage-stage embryos but did not affect the pregnancy rate when blastocyst-stage embryos were transferred (adjusted OR: 0.856; 95% CI: 0.536-1.369; p = .517). CONCLUSIONS The results showed that in patients undergoing cleavage-stage NC-FET, progesterone levels >1.0 ng/mL improved the clinical pregnancy rates. However, the level of progesterone had no effect on the clinical pregnancy rate for patients undergoing blastocyst-stage NC-FET.
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Affiliation(s)
- Di Wu
- Centre for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynaecological Diseases (Reproductive Medicine) Clinical Research Centre, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Yu
- Centre for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynaecological Diseases (Reproductive Medicine) Clinical Research Centre, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Shi
- Centre for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynaecological Diseases (Reproductive Medicine) Clinical Research Centre, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Zhai
- Centre for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynaecological Diseases (Reproductive Medicine) Clinical Research Centre, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Pouya K, Şükür YE, İsrafilova G, Özmen B, Sönmezer M, Berker B, Atabekoğlu CS, Aytaç R. hCG day progesterone level has no impact on the frozen thawed embryo transfer cycle outcome. J Gynecol Obstet Hum Reprod 2021; 50:102120. [PMID: 33737250 DOI: 10.1016/j.jogoh.2021.102120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/11/2021] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the association between hCG day progesterone levels and subsequent frozen-thawed embryo transfer (FET) cycle outcome in infertile women with and without polycystic ovary syndrome (PCOS). METHOD Data of 178 women who underwent FET at a university-based infertility clinic between January 2016 and December 2019 were reviewed. The study group consisted of women who had progesterone elevation (PE) during fresh controlled ovarian stimulation (COS) cycle. A sub-group analysis was also performed in PCOS and non-PCOS patients. RESULTS There were no differences in clinical pregnancy (47.7 % vs. 50.7 %, p = 0.729), miscarriage (15.9 % vs. 22.4 %, p = 0.359), and live birth rates (27.3 % vs. 23.9 %, p = 0.652) following FET between women with and without PE in the fresh cycle. The results remained non-significant regarding the clinical pregnancy (46.7 % vs. 53.4 %, p = 0.549), miscarriage (13.3 % vs. 27.6 %, p = 0.133), and live birth rates (26.7 % vs. 19.0 %, p = 0.408) in participants with PCOS (n = 88). CONCLUSION hCG day progesterone level in the fresh COS cycle does not have a significant impact on the subsequent FET cycle neither in PCOS nor in non-PCOS women.
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Affiliation(s)
- Khadijeh Pouya
- Infertility Unit, Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
| | - Yavuz Emre Şükür
- Infertility Unit, Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Gülar İsrafilova
- Infertility Unit, Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Batuhan Özmen
- Infertility Unit, Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Murat Sönmezer
- Infertility Unit, Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Bülent Berker
- Infertility Unit, Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Cem Somer Atabekoğlu
- Infertility Unit, Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Ruşen Aytaç
- Infertility Unit, Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
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Robati S, Saab W, Durán-Retamal M, Saab W, Theodorou E, Cawood S, Serhal P, Seshadri S. The Association Between Elevated Progesterone Level on Day of hCG Trigger and Live Birth Rates in ART Cycles: A Single Centre Observational Study. J Reprod Infertil 2020; 21:283-290. [PMID: 33209745 PMCID: PMC7648872 DOI: 10.18502/jri.v21i4.4333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The advent of ovarian stimulation within an in vitro fertilization (IVF) cycle has resulted in modifying the physiology of stimulated cycles and has helped optimize pregnancy outcomes. In this regard, the importance of progesterone (P4) elevation at time of human chorionic gonadotrophin (hCG) administration within an IVF cycle has been studied over several decades. Our study aimed to evaluate the association of P4 levels at time of hCG trigger with live birth rate (LBR), clinical pregnancy rate (CPR) and miscarriage rate (MR) in fresh IVF or IVF-ICSI cycles. METHODS This was a retrospective cohort study (n=170) involving patients attending the Centre for Reproductive and Genetic Health (CRGH) in London. The study cohort consisted of women undergoing controlled ovarian stimulation using GnRH antagonist or GnRH agonist protocols. Univariate and multiple logistic regression analyses were used to evaluate the association of clinical outcomes. Differences were considered statistically significant if p≤0.05. RESULTS As serum progesterone increased, a decrease in LBR was observed. Following multivariate logistical analyses, LBR significantly decreased with P4 thresholds of 4.0 ng/ml (OR 0.42, 95% CI:0.17-1.0) and 4.5 ng/ml (OR 0.35, 95% CI:0.12-0.96). CONCLUSION P4 levels are important in specific groups and the findings were statistically significant with a P4 threshold value between 4.0-4.5 ng/ml. Therefore, it seems logical to selectively measure serum P4 levels for patients who have ovarian dysfunction or an ovulatory cycles and accordingly prepare the individualized management packages for such patients.
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Affiliation(s)
- Shahin Robati
- Institute for Women's Health, Faculty of Population Health Sciences, University College London, Lebanon, United Kingdom
| | - Wiam Saab
- Department of Obstetrics and Gynaecology, The American University of Beirut Medical Centre, Beirut, Lebanon
| | - Montserrat Durán-Retamal
- Institute for Women's Health, Faculty of Population Health Sciences, University College London, Lebanon, United Kingdom
| | - Wael Saab
- Institute for Women's Health, Faculty of Population Health Sciences, University College London, Lebanon, United Kingdom
| | - Efstathios Theodorou
- Institute for Women's Health, Faculty of Population Health Sciences, University College London, Lebanon, United Kingdom
| | - Suzanne Cawood
- Institute for Women's Health, Faculty of Population Health Sciences, University College London, Lebanon, United Kingdom
| | - Paul Serhal
- Institute for Women's Health, Faculty of Population Health Sciences, University College London, Lebanon, United Kingdom
| | - Srividya Seshadri
- Institute for Women's Health, Faculty of Population Health Sciences, University College London, Lebanon, United Kingdom
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Turgut EN, Ecemis S, Boynukalin KF, Gultomruk M, Yarkiner Z, Findikli N, Bahceci M. Being on the side of old findings: progesterone elevation on the day of oocyte maturation induction does not affect embryological parameters throughout the blastocyst culture period. Arch Gynecol Obstet 2021; 303:581-7. [PMID: 32918591 DOI: 10.1007/s00404-020-05792-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate whether there is any detrimental effect of progesterone elevation (PE) on the day of oocyte maturation induction on embryological development potentials. METHODS This retrospective single-center cohort study included a total of 1485 individual intracytoplasmic sperm injection (ICSI) cycles between January 2014 and December 2018. Serum progesterone (P) levels were measured on the day of oocyte maturation induction following the GnRH antagonist suppression protocol. Embryological parameters such as maturation, fertilization rate (FR), top-quality embryo (TQE) formation rate per 2PN on day 3, and excellent-quality blastocyst (EQB) formation rate per 2PN on day 5/6 were recorded. The inclusion criteria for women were an age ≤ 37 years, a BMI ≤ 30 kg/m2, and access to a total sperm concentration ≥ 2 million. Groups were stratified according to the serum P levels using the cut-off levels of < 0.8 ng/ml; 0.8-1.49 ng/ml; and ≥ 1.5 ng/ml. RESULTS Peak E2 level and total number of oocytes retrieved were significantly related to PE (p < 0.001). FR did not display a significance difference between groups (p = 0.108). The TQE and the blastulation rates were not affected by PE (p = 0.82 and p = 0.68, respectively). Chi square analysis revealed a significant relationship between PE and the EQB formation rate (p = 0.01). GEE analysis failed to present any statistical significance regarding the effect of PE on neither the TQE nor the EQB formation rates per 2PN [OR 1.07; 95% (0.98-1.16) p = 0.113 and OR 0.93; 95% (0.80-1.07) p = 0.32, respectively]. CONCLUSIONS In accordance with previously published papers, our study could not find any detrimental effect of PE on embryological outcomes throughout the blastocyst culture period.
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Orvieto R, Kirshenbaum M, Galiano V, Zilberberg E, Haas J, Nahum R. Stop GnRH-Agonist Combined with Multiple-Dose GnRH-Antagonist for Patients with Elevated Peak Serum Progesterone Levels Undergoing Ovarian Stimulation for IVF: A Proof of Concept. Gynecol Obstet Invest 2020; 85:357-361. [PMID: 32580194 DOI: 10.1159/000508875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/21/2020] [Indexed: 11/19/2022]
Abstract
AIM The aim of the study was to examine whether the Stop GnRH-agonist combined with multiple-dose GnRH-antagonist protocol may overcome progesterone elevation during the late follicular phase. PATIENTS AND METHODS A cohort historical, proof of concept study consisting of 11 patients with progesterone elevation (>3.1 nmol/L) during conventional IVF/intracytoplasmic sperm injection (ICSI), who underwent a subsequent Stop GnRH-agonist combined with multiple-dose GnRH-antagonist ovarian stimulation (OS) protocol, within 3 months of the previous failed conventional IVF/ICSI cycle. RESULTS The Stop GnRH-agonist combined with multiple-dose GnRH-antagonist COH protocol revealed significantly lower peak progesterone levels, with significantly higher numbers of follicles >13 mm in diameter on the day of hCG administration, oocytes retrieved, mature oocytes, and top-quality embryos, with an acceptable clinical pregnancy rate (18.2%). CONCLUSIONS The combined Stop GnRH-ag/GnRH-ant OS protocol is a valuable tool in the armamentarium for treating patients with progesterone elevation during the late follicular phase. Further large prospective studies are needed to validate our observation and to characterize the appropriate patients' subgroup, which might benefit from the combined Stop GnRH-ag/GnRH-ant COH protocol.
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Affiliation(s)
- Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel, .,The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, at the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel,
| | - Michal Kirshenbaum
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel
| | - Valentina Galiano
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel
| | - Eran Zilberberg
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel
| | - Jigal Haas
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel
| | - Ravit Nahum
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel
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Tsai YR, Lin YJ, Lin YC, Hsu TY, Lan KC. Factors associated with extremely high progesterone concentrations on the day of HCG administration. J Gynecol Obstet Hum Reprod 2020; 49:101720. [PMID: 32113001 DOI: 10.1016/j.jogoh.2020.101720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Progesterone elevation on the day of human chorionic gonadotropin (hCG) administration remains one of the most controversial topics in reproductive endocrinology. Factors associated with these increases have not been fully determined. The purpose of our study is to investigate factors associated with extreme progesterone elevation on the day of human chorionic gonadotropin (hCG) administration. MATERIALS AND METHODS This retrospective observational, single-center cohort study recruited 2000 fresh in vitro fertilization (IVF) and/or intracytoplasmic sperm injection(ICSI)-embryo transfer cycles from January 2000 to December 2014 in our institution. RESULTS When cycles were divided into those with progesterone <1.94 ng/mL (n = 1791) and ≧1.94 ng/mL (n = 209) on the day of hCG administration, five factors were positively associated with highly elevated progesterone concentration: protocol (GnRH agonist versus antagonist; odds ratio [OR = 2.786]), number of dominant follicles (OR = 1.098), total dose of follicle stimulating hormone (FSH) used (OR = 1.023), elevated luteinizing hormone (LH) (OR = 1.085) and estradiol (E2; OR = 1.001) concentrations on the day of hCG administration (p < 0.001 each). After omitting the protocol effect, the remaining factors showed limited contributions to highly elevated progesterone (ORs = 0.95-1.2). CONCLUSIONS The factor showing the greatest association with extreme progesterone elevation was use of the GnRH agonist protocol.
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Affiliation(s)
- Yi-Ru Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Yu-Ju Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Yi-Chi Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Te-Yao Hsu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Hussein RS, Elnashar I, Amin AF, Abou-Taleb HA, Abbas AM, Abdelmageed AM, Farghaly T, Zhao Y. Revisiting debates of premature luteinization and its effect on assisted reproductive technology outcome. J Assist Reprod Genet 2019; 36:2195-2206. [PMID: 31650455 PMCID: PMC6885458 DOI: 10.1007/s10815-019-01598-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022] Open
Abstract
The impact of the prematurely elevated serum progesterone on the late follicular phase, commonly known as premature luteinization (PL), is a matter of continuing debate. Available evidence supports that serum progesterone ≥ 1.5 ng/ml on the day of ovulation triggering could reduce the pregnancy potential in fresh in vitro fertilization (IVF) cycles by jeopardizing endometrial receptivity. Causes of PL during ovarian stimulation are unclear. Recent studies point toward the daily follicle-stimulating hormone dosage, duration of controlled ovarian stimulation, number of oocytes retrieved, and peak estradiol level as factors affecting the incidence of PL. Emerging data show additional influence on embryo quality. The prevention of PL has been challenging. The key elements in preventing PL include individualization of ovarian stimulation according to patient's ovarian reserve, proper ovulation trigger timing, and use of medications such as corticosteroids and metformin. Embryo cryopreservation with deferred embryo transfer is the established strategy to overcome PL, yet it is an extra burden to the IVF laboratory and increased cost for patients. Herein, we review the up-to-date knowledge of this frequent IVF problem including causes, proposed diagnostic criteria, and its impact on endometrial receptivity, embryo quality, and pregnancy outcomes. The preventive measures and rescue strategies are also discussed.
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Affiliation(s)
- Reda S Hussein
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ihab Elnashar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed F Amin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hisham A Abou-Taleb
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
- Women Health Hospital, Assiut, 71511, Egypt.
| | - Ahmed M Abdelmageed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Tarek Farghaly
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Yulian Zhao
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Cuervo-Arango J, Claes AN, Stout TA. The recipient's Day after ovulation and the number of corpora lutea influence the likelihood of pregnancy in mares following transfer of ICSI frozen embryos. Theriogenology 2019; 135:181-188. [PMID: 31226608 DOI: 10.1016/j.theriogenology.2019.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/19/2019] [Accepted: 06/11/2019] [Indexed: 11/25/2022]
Abstract
Asynchronous embryo transfer is an excellent tool to investigate how subtle differences in the uterine environment affect embryo development and survival. Progesterone secreted from the corpus luteum following ovulation is one of the main factors responsible for establishing endometrial receptivity for the pre-implantation embryo via complex alterations in the expression of genes involved in the secretion of the histotroph. The objective of this retrospective study was to determine whether the recipient's Day after ovulation and the number of CL at ET influence the pregnancy rates of IVP horse embryos. The study included 650 heterologous frozen ICSI horse embryo transfer cycles and evaluated the pregnancy and ongoing pregnancy rate. The ongoing pregnancy was significantly lower in recipient mares with ET performed 5 and 6 days after ovulation (47.4% and 37.5%, respectively) than in recipients with ET 4 days after ovulation (67.3%). Furthermore, Day 5 recipient mares (Day 0 = Day of ovulation) with 2 corpora lutea (CL) at the time of ET had lower ongoing pregnancy rate (36.1%) than Day 5 recipient mares with 1 CL (51.9%). In contrast, the presence of 2 CL was associated with a higher ongoing pregnancy rate (75.8%) in recipient mares with a less advanced uterine stage at the time of ET (Day 3 and 4 after ovulation), compared to recipients with only 1 CL at ET (62.7%). In conclusion, both the number of days after ovulation and the number of CL recorded in the recipient mare at ET influenced the ongoing clinical pregnancy rate. This study highlights the importance of establishing exactly when progesterone rises above a threshold (relative to the Day of ovulation) when trying to determine the optimal window for transferring an IVF/IVP embryo.
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Affiliation(s)
- Juan Cuervo-Arango
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, the Netherlands.
| | - Anthony N Claes
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
| | - Tom A Stout
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chen Y, Ma L, Wang S. The impact of an increased progesterone-to-follicle number ratio on live delivery rates in women with normal ovarian reserve. Int J Gynaecol Obstet 2017; 139:84-89. [PMID: 28685817 DOI: 10.1002/ijgo.12256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/18/2017] [Accepted: 07/03/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore the relationship between progesterone-follicle number (P/F) ratio and live delivery rate in patients with normal ovarian reserve undergoing cleavage-stage embryo transfer with a long gonadotropin-releasing hormone agonist cycle. METHODS The present retrospective study included data from patients younger than 38 years with normal ovarian reserve who were undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer at Zhongnan Hospital, Wuhan University, China, between January 1, 2009 and December 31, 2015. Patients underwent cleavage-stage fresh embryo transfer with a long gonadotropin-releasing hormone agonist cycle, and associations between P/F ratios and fertility/pregnancy outcomes were analyzed. RESULTS Patients with a P/F ratio of 0.11 or above had higher serum progesterone levels (P<0.001) and lower serum estradiol levels (P<0.001) on the day of human chorionic gonadotropin administration in comparison with patients with lower P/F ratios; elevated P/F ratios were also associated with fewer follicles at least 14 mm in size (P<0.001) and lower live delivery rates (P<0.001). Multiple logistic regression confirmed that P/F ratio was an independent predictor of live delivery rate (P=0.001). CONCLUSION A P/F ratio of at least 0.11 was associated with lower live delivery rates in women with normal ovarian reserve undergoing cleavage-stage embryo transfer with a long gonadotropin-releasing hormone agonist cycle.
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Affiliation(s)
- Ya Chen
- School of Public Health, Wuhan University, Wuhan, China.,China Three Gorges University, Yichang, China
| | - Ling Ma
- Reproductive Medicine Centre, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Suqing Wang
- School of Public Health, Wuhan University, Wuhan, China
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