Skip to main content

Advertisement

SpringerLink
Log in

Elevated progesterone in GnRH agonist down regulated in vitro fertilisation (IVFICSI) cycles reduces live birth rates but not embryo quality

  • Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To assess the impact of pre-hCG elevated progesterone on live birth outcomes during GnRH agonist long down regulated protocol assisted reproduction cycles.

Design

Retrospective cohort study.

Setting

Single Centre Private IVF Clinic.

Patients

A total of 582 consecutive cycles of IVF/ICSI in 2003.

Interventions

All patients underwent a long down-regulation protocol, controlled ovarian stimulation and IVF/ICSI. Serum progesterone concentrations were measured just prior to HCG administration. 253 patients were followed to 2009 for outcomes of their frozen embryo cycles.

Main Outcome measure

Live birth rate in fresh and frozen cycles.

Results

Patients in the upper quartile pre-hCG progesterone concentration (≥5.4 pmol/L) had a higher final estradiol level, more oocytes collected and more usable embryos, when compared to those with lower quartiles. They also had lower live birth rates per cycle started (21.9% vs. 15%, P < 0.05). However, live birth rates from frozen embryo cycles were not significantly different between the groups.

Conclusions

Pre-hCG progesterone elevation leads to lower live birth rates in stimulated IVF cycles. Live birth rates achieved with frozen embryos in the high progesterone cycles suggest, that pre-hCG progesterone elevation negatively affects endometrial receptivity without adversely affecting embryo quality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hofmann GE, Bentzien F, Bergh PA et al (1993) Premature luteinisation in controlled ovarian hyperstimulation has no adverse effect on oocyte and embryo quality. Fertil Steril 60:675–679

    PubMed  CAS  Google Scholar 

  2. Fanchin R, de Zeigler D, Righini C, Selva J, Olivennes F, Frydman R (1996) Premature progesterone elevation does not alter oocyte quality in in vitro fertilization. Fertil Steril 65:1178–1183

    PubMed  CAS  Google Scholar 

  3. Legro RS, Ary BA, Paulson RJ et al (1993) Premature luteinisation as detected by elevated serum progesterone is associated with a higher pregnancy rate in donor oocyte in-vitro fertilization. Hum Reprod 8:1506–1511

    PubMed  CAS  Google Scholar 

  4. Bosch E, Labarta E, Crespo J, Simón C, Remohí J, Jenkins J, Pellicer A (2010) Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: analysis of over 4000 cycles. Hum Reprod 25(8):2092–2100

    Article  PubMed  CAS  Google Scholar 

  5. Silverberg KM, Burns WN, Olive DL, Riehl RM, Schenken RS (1991) Serum progesterone levels predict success of in vitro fertilization/embryo transfer in patients stimulated with leuprolide acetate and human menopausal gonadotropins. J Clin Endocrinol Metab 73:797–803

    Article  PubMed  CAS  Google Scholar 

  6. Schoolcraft W, Sinton E, Schlenker T, Huynh D, Hamilton F, Meldrum DR (1991) Lower pregnancy rate with premature luteinisation during pituitary suppression with leuprolide acetate. Fertil Steril 55:563–566

    PubMed  CAS  Google Scholar 

  7. Fanchin R, de Zeigler D, Taieb J, Hazout A, Frydman R (1993) Premature elevation of plasma progesterone alters pregnancy rates of in vitro fertilization and embryo transfer. Fertil Steril 59:1090–1094

    PubMed  CAS  Google Scholar 

  8. Younis J, Matilsky M, Radin O, Ben-Ami M (2001) Increased progesterone/estradiol ratio in the late follicular phase could be related to low ovarian reserve in in vitro fertilization-embryo transfer cycles with a long gonadotropin-releasing hormone agonist protocol. Fertil Steril 76:294–299

    Article  PubMed  CAS  Google Scholar 

  9. Hofman G, Khoury J, Michener C (2002) Elevated serum progesterone-to-estradiol ratio during gonadotropin stimulation for intrauterine insemination or in vitro fertilization is not associated with diminished ovarian reserve. Fertil Steril 78:47–50

    Article  Google Scholar 

  10. Fanchin R, Righini V, Olivennes F, Ferreira A, de Zeigler D, Frydman R (1997) Consequences of premature progesterone elevation on the outcome of in vitro fertilization: insights into a controversy. Fertil Steril 68:799–805

    Article  PubMed  CAS  Google Scholar 

  11. Lindheim S, Cohen M, Chang P, Sauer M (1999) Serum progesterone before and after human chorionic gonadotropin injection depends on the estradiol response to ovarian hyperstimulation during in vitro fertilisation-embryo transfer cycles. J Ass Reprod Genet 16(5):242–246

    Article  CAS  Google Scholar 

  12. Ubaldi F, Camus M, Smitz J, Bennink HC, Van Steirteghem A (1996) Devroey premature luteinisation in in vitro fertilization cycles using gonadotropin-releasing hormone agonist (GnRH-a) and recombinant follicle-stimulating hormone (FSH) and GnRH-a and urinary FSH. Fertil Steril 66:275–280

    PubMed  CAS  Google Scholar 

  13. Ozcakir HT, Levi R, Tavmergen E, Goker ENT (2004) Premature luteinisation defined as progesterone estradiol ratio > 1 on hCG administration day seems to adversely affect clinical outcome in long gonadotropin-releasing hormone agonist cycles. J Obstet Gynaecol Res 30(2):100–104

    Article  PubMed  CAS  Google Scholar 

  14. Edelstein MC, Seltman HJ, Cox BJ, Robinson SM, Shaw RA, Muasher SJ (1990) Progesterone levels on the day of human chorionic gonadotrophin administration in cycles with gonadotropin-releasing hormone agonist suppression are not predictive of pregnancy outcome. Fertil Steril 54:853–857

    PubMed  CAS  Google Scholar 

  15. Simon C, Oberye J, Bellver J, Vidal C, Bosch E, Horcajadas JA, Murphy C, Adams S, Riesewijk A, Mannaerts B, Pellicer A (2005) Similar endometrial development in oocyte donors treated with either high- or standard-dose GnRH antagonist compared to treatment with a GnRH agonist or in natural cycles. Hum Reprod 20(12):3318–3327

    Google Scholar 

  16. Papanikolaou EG, Zepyridis L, Kolibianakis E, Grimpizia G, Pantos G, Bili E, Venetis C, Kyriazi L, Humaidan P, Tarlatzis B (2009) Comparing GnRH-agonist with antagonist IVF cycles, is the clinical outcome affected by the incidence of progesterone elevation. A RCT. Hum Reprod 24(Suppl 1):i78

    Google Scholar 

  17. Venetis CA, Kolibianakis EM, Papanikolaou E, Bontis J, Devroey P, Tarlatzis BC (2007) Is progesterone elevation on the day of human chorionic gonadotrophin administration associated with the probability of pregnancy in in vitro fertilisation? A systematic review and meta-analysis. Hum Reprod Update 13(4):343–355

    Article  PubMed  CAS  Google Scholar 

  18. Lahoud R, Al-Jefout M, Tyler J, Ryan J, Kwik M (2005) Raised mid-follicular serum progesterone levels in down-regulated in vitro fertilization cycles lead to decreased live birth rates. Fertil Steril 84(Suppl 1):S306

    Article  Google Scholar 

  19. Melo MAB, Meseguer M, Garrido N, Bosch E, Pellicer A, Remohi J (2006) The significance of premature luteinization in an oocyte-donation programme. Hum Reprod 21(6):1503–1507

    Article  PubMed  CAS  Google Scholar 

  20. Fleming R, Jenkins J (2010) The source and implications of progesterone rise during the follicular phase of assisted reproduction cycles. RBM Online 21(4):446–449

    PubMed  CAS  Google Scholar 

  21. Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C, Thomas S (2010) Embryo cryopreservation rescues cycles with premature luteinization. Fertil Steril 93(2):636–641

    Article  PubMed  CAS  Google Scholar 

  22. Papanikolaou EG, Kolibianakis EM, Pozzobon C, Tank P, Tournaye H, Bourgain C, Van Steirteghem A, Devroey P (2009) Progesterone rise on the day of human chorionic gonadotropin administration impairs pregnancy outcome in day 3 single-embryo transfer, while has no effect on day 5 single blastocyst transfer. Fertil Steril 91(3):949–952

    Google Scholar 

Download references

Conflict of interest

The authors declare there is no conflict of interest.

Author information

Authors and Affiliations

  1. IVF Australia, 176 Pacific Highway, Greenwich, Sydney, NSW, 2065, Australia

    Robert Lahoud, Michele Kwik, John Ryan, Jane Foley & Peter Illingworth

  2. Department of Obstetrics and Gynaecology, Mutah Medical Faculty, Mutah University, Karak, Jordan

    Moamar Al-Jefout

Authors
  1. Robert Lahoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michele Kwik
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Moamar Al-Jefout
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jane Foley
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter Illingworth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert Lahoud.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lahoud, R., Kwik, M., Ryan, J. et al. Elevated progesterone in GnRH agonist down regulated in vitro fertilisation (IVFICSI) cycles reduces live birth rates but not embryo quality. Arch Gynecol Obstet 285, 535–540 (2012). https://doi.org/10.1007/s00404-011-2045-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-011-2045-0

Keywords

Search

Navigation