Tripling of serum progesterone (P4) and embryonic morphological features in conception and nonconception cycles, after human in vitro fertilization.

A series of 26 in vitro fertilization (IVF) cycles was studied for changes of serum progesterone levels before and after injection of human chorionic gonadotropin (hCG) by a comparison of the number of follicles punctured, number of oocytes recovered, morphological features of oocytes, fertilization rate, cleavage rate, and quality of embryos before their transfer. Subjects were further divided into three groups according to their pregnancy outcome. Five pregnancies were generated and reached the stage of clinical confirmation of live baby delivery or live fetus by ultrasound scanning of the uterine contents. Six patient cycles that had a prolonged luteal phase and beta-hCG levels greater than 40 MIU/ml were described as biochemical pregnancies. Fifteen patient cycles showed no sign of pregnancy. The significant finding of this study is related to the serum progesterone level increase from 20 to 34 hr after hCG injection. The nonpregnancy group yielded a 1.2-fold increase compared with the biochemical pregnancy and pregnancy groups, which had a 3-fold increase. The usage of this multiple effect of progesterone may aid in the prediction of the "high-quality embryo" that might result from a given treatment cycle, indicate the completion of luteinization, the proper timing of hCG to induce final oocyte maturation, and the necessary length of preincubation, and aid in the prediction as to whether or not a pregnancy is likely to result.