Title: Effect of the duration of elevated progesterone (P) levels during in vitro fertilization (IVF) on pregnancy rates
Abstract: There are conflicting reports in the literature on the effect of premature P elevation on pregnancy outcomes during IVF. However, most of these studies have evaluated the adverse effect of a single P measurement on the day of hCG trigger. This study assessed whether the duration of P elevation has an adverse effect on IVF outcomes. Retrospective cohort. Patients < 40 years of age who underwent IVF and embryo transfer cycles between 5/2010-3/2013 were included in the analysis. Pregnancy outcomes were compared in patients with P levels ≥1 ng/dl for 0, 1, 2, and ≥3 days of elevation. ANOVA was used for evaluation of continuous variables with Tukey's HSD test for post-hoc evaluation. Categorical variables were analyzed using Chi-Squared test with post hoc pair-wise comparisons. A total of 982 cycles consisting of P elevation ≥1 ng/dl for 0, 1, 2, and ≥3 days duration were analyzed. Baseline characteristics and outcomes of stimulation between the four groups are shown in Table 1. The pregnancy rates were significantly lower with prolonged P elevation.Tabled 1IVF outcomes by duration of P elevation.Number of Days of P Elevation0 (n=559)1 (n=159)2 (n=152)≥3 (n=112)Age (years)33.9 ± 3.7a34.9 ± 3.5a34.3 ± 3.334.0 ± 3.9AMH (ng/ml)2.7 ± 3.22.2 ± 2.12.2 ± 2.32.5 ± 2.8FSH (mIU/ml)7.0 ± 2.77.0 ±2.46.9 ± 2.36.4 ± 2.3Stimulation days (n)8.8 ± 2.09.0 ± 2.58.9 ± 2.09.3 ± 1.8Peak E2 (pg/ml)11739 ± 795a1906 ± 74512073 ± 816b12168 ± 931bP4 on day of hCG (ng/ml)0.6 ± 0.1a1.1 ± 0.2b1.3 ± 0.3c1.4 ± 0.4c# oocytes retrieved (n)11.9 ± 6.0a13.3 ± 5.913.4 ± 5.914.3 ± 6.5bNumber embryos transferred (n)1.8 ± 0.61.9 ± 0.71.8 ± 0.61.9 ± 0.6CPR (%)62.1% (347/559)a48.4% (77/159)b36.8% (56/152)c27.7% (31/112)cOPR (%)54.7% (306/559)a41.5% (66/159)b26.6% (42/152)c17.9% (20/112)ca, b, and c are significantly different (p<0.05). Open table in a new tab a, b, and c are significantly different (p<0.05). Prolonged P elevation ≥1ng/ml during the follicular phase progressively impairs pregnancy outcomes.