Julien Lepage1, Gwenola Keromnes2, Sylvie Epelboin3, Dominique Luton4, Chadi Yazbeck5. 1. Bichat Claude Bernard Hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France. Electronic address: julien.lepage@aphp.fr. 2. Groupe hospitalier Diaconesses Croix Saint-Simon, 12-18, rue du Sergent-Bauchat, 75012 Paris, France. 3. Bichat Claude Bernard Hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France. 4. Bichat Claude Bernard Hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Paris 7 Denis Diderot University Paris, France. 5. Cherest Fertility Center, 5, rue Pierre-Cherest, 92200 Neuilly-Sur-Seine, France.
Abstract
OBJECTIVE: To investigate the relationship between serum P levels on the day of hCG administration and pregnancy outcomes in patients undergoing IVF. DESIGN: Retrospective study. SETTING: Teaching hospital. PATIENTS: A total of 1022 IVF-ICSI cycles, frozen embryo transfer excluded. INTERVENTION(S): Patients-all types of responder - underwent IVF with agonist or antagonist protocols. Clinical outcomes of IVF were analyzed according to plasma P levels. MAIN OUTCOME MEASURE(S): Ongoing pregnancy rates. RESULTS: We proposed a serum P level of 1.57ng/ml on day of hCG as a threshold for all types of responders and all protocols combined. Ongoing implantation rates were not affected by elevated progesterone. Live birth rate was inversely associated with serum P levels on day of hCG and more miscarriages were associated with P>1.57ng/ml. We have not found the progesterone>1.57ng/ml on the day of hCG as a prognostic factor for pregnancy. CONCLUSION(S): Elevated P level on the day of hCG administration negatively influence live birth rate and is correlated to an increase of miscarriage. The detrimental effect of P elevation on pregnancy seems not to be related substantially to endometrium receptivity. Thus, despite a comparable clinical pregnancy rate and an initial implantation rate, we demonstrate more spontaneous abortion and it would seem that the effect of progesterone is later.
OBJECTIVE: To investigate the relationship between serum P levels on the day of hCG administration and pregnancy outcomes in patients undergoing IVF. DESIGN: Retrospective study. SETTING: Teaching hospital. PATIENTS: A total of 1022 IVF-ICSI cycles, frozen embryo transfer excluded. INTERVENTION(S): Patients-all types of responder - underwent IVF with agonist or antagonist protocols. Clinical outcomes of IVF were analyzed according to plasma P levels. MAIN OUTCOME MEASURE(S): Ongoing pregnancy rates. RESULTS: We proposed a serum P level of 1.57ng/ml on day of hCG as a threshold for all types of responders and all protocols combined. Ongoing implantation rates were not affected by elevated progesterone. Live birth rate was inversely associated with serum P levels on day of hCG and more miscarriages were associated with P>1.57ng/ml. We have not found the progesterone>1.57ng/ml on the day of hCG as a prognostic factor for pregnancy. CONCLUSION(S): Elevated P level on the day of hCG administration negatively influence live birth rate and is correlated to an increase of miscarriage. The detrimental effect of P elevation on pregnancy seems not to be related substantially to endometrium receptivity. Thus, despite a comparable clinical pregnancy rate and an initial implantation rate, we demonstrate more spontaneous abortion and it would seem that the effect of progesterone is later.