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De Cesare R, Morenghi E, Cirillo F, Ronchetti C, Canevisio V, Persico P, Baggiani A, Sandri MT, Levi-Setti PE. The Role of hCG Triggering Progesterone Levels: A Real-World Retrospective Cohort Study of More Than 8000 IVF/ICSI Cycles. Front Endocrinol (Lausanne) 2020; 11:547684. [PMID: 33071968 PMCID: PMC7538643 DOI: 10.3389/fendo.2020.547684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/14/2020] [Indexed: 12/05/2022] Open
Abstract
Objective: To assess the association between serum ovulation trigger progesterone (P) levels and the outcome of in vitro fertilization cycles. Design Setting: Real world single-center retrospective cohort study. Patient Intervention(s): All fresh cleavage and blastocyst-stage embryo transfers (ETs) performed from January 2012 to December 2016. Main outcome Measure(s): The impact of premature high serum P levels cycles in terms of clinical pregnancy rates (CPRs) and live birth rates (LBRs). Results: 8,034 ETs were performed: 7,597 cleavage-stage transfers and 437 blastocyst transfers. Serum P levels demonstrated to be inversely related to CPR (OR 0.72, p < 0.001) and LBR (OR 0.73, p < 0.001). The progressive decrease of LBR and CPR started when P levels were >1 ng/ml in a good prognosis cleavage ET subgroup, whereas in patients with worse prognosis only for P ≥ 1.75 ng/ml. In the blastocyst ET subgroup, the negative effect of P elevation was reported only if P was >1.75 ng/ml. CPR (OR 0.71 (0.62-0.80), p < 0.001) and LBR (OR 0.73 (0.63-0.84), p < 0.001) in thawed cycles resulted statistically significantly higher than in fresh cycles in the cleavage-stage subgroup. In the blastocyst group, no significant difference resulted between thawed and fresh cycles, independently of P levels [CPR OR 0. 37 (0.49-1.09), p = 0.123; LBR OR 0.71 (0.46-1.10), p = 0.126]. Conclusion: High P levels decrease CPR as well as LBR in both cleavage and blastocyst ET. In the cleavage group, for P levels below 1.75 ng/ml, our data suggest the possibility to wait until day 5 for ET, and if P level is ≥1.75 ng/ml, it should be considered to freeze all embryos and postpone the ET. Clinical Trial Registration: ClinicalTrials.gov, ID: NCT04253470.
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Affiliation(s)
- Raffaella De Cesare
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Federico Cirillo
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Camilla Ronchetti
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Valentina Canevisio
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Paola Persico
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Annamaria Baggiani
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Maria Teresa Sandri
- Clinical Analysis Laboratory, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Paolo Emanuele Levi-Setti
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
- *Correspondence: Paolo Emanuele Levi-Setti
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