Elevated progesterone at initiation of stimulation is associated with a lower ongoing pregnancy rate after IVF using GnRH antagonists

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Abstract

BACKGROUND

The objective of this prospective study was to assess the impact of elevated serum progesterone levels on day 2 of the cycle on pregnancy rates in patients treated by IVF using GnRH antagonists.

METHODS

Ovarian stimulation was started on day 2 of the cycle if progesterone levels were normal (normal-P group, n=390). In the presence of elevated progesterone, initiation of stimulation was postponed for 1 or 2 days (high-P group, n=20) and was started if repeat progesterone levels returned to normal range (n=16). Stimulation was performed with recombinant FSH (rFSH) and GnRH antagonist was always started on day 6 of stimulation.

RESULTS

A significantly higher exposure to progesterone and a significantly lower exposure to estradiol was present in the high-P as compared with the normal-P group from day 1 to day 8 of stimulation. In addition, a significantly lower ongoing pregnancy rate both per started cycle (5.0% versus 31.8%; P=0.01) and per embryo transfer (6.3% versus 36.9%; P=0.01) was present in the high-P compared with the normal-P group, respectively.

CONCLUSIONS

The presence of elevated serum progesterone on day 2 of the cycle is associated with a decreased chance of pregnancy in patients treated with rFSH and GnRH antagonists.

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