In a nutshell
This study examined the impact of raised progesterone levels during in vitro fertilization treatment on live birth rates.
Some background
Many couples experiencing infertility undergo assisted reproductive techniques such as in-vitro fertilization (IVF). In IVF, a male sperm fertilizes the females’ egg in a laboratory dish outside the body, this is implanted into the woman's uterus. Human chorionic gonadotropin (hCG) is administered in IVF to stimulate the maturation and release of an egg from the ovaries of a female.
Progesterone (P) is a hormone that affects the thickness of the lining of the uterus. A high level of P on the day of hCG administration has been associated with poor pregnancy outcomes in IVF.
Methods & findings
This study examined the associated between P levels on the day of hCG administration and live birth rates. This study focused on 1,620 embryo (fertilized egg) transfers to the uterus, where embryos were fresh (not frozen) and the mothers own (not using a donated egg). Women were administered either a GnRH-antagonist (Ganirelix), or a GnRH-agonist cycles, leuprolide acetate (Lupron) to stimulate the ovaries to produce oocytes (eggs).
In 2.4% of cycles, P levels were greater than 2.0 ng/ml (very high). In 7% of cycles P levels were greater than 1.5 ng/ml (high).
Patients with a high P level on the day of hCG administration were 55% less likely to have a live birth compared to those with a lower P level.
The GnRH antagonist cycles were twice as likely to have a P level greater than 2 ng/ml and 1.5 ng/ml, compared to those taking a GnRH agonist.
355 cycles were classed as having a high response with at least 18 oocytes retrieved. The live birth rate was 49.7% among this group when the P level was less than 1.5 ng/ml. This is compared to a live birth rate of 24.5% when the P level was greater than 1.5 ng/ml.
Live birth rates were lower in those with a high P level, regardless of the age of the patient, the number of oocytes (eggs) that were fertilized and their quality. This was also the case for the response to ovarian stimulation and the number of embryos available for freezing (for future use).
The bottom line
This study concluded that an elevated progesterone level on the day of hCG administration can have a negative impact on live birth rates.
The fine print
This was a retrospective study, which means it looked back at the results of procedures already carried out and could not ensure the data was collected accurately.
What’s next?
Talk to your physician if you would like more information about the role of progesterone in IVF.
Published By :
Fertility and Sterility
Date :
Apr 14, 2015
