Serum progesterone level effects on the outcome of in vitro fertilization in patients with different ovarian response: an analysis of more than 10,000 cycles

Elevated serum P levels are associated with reduced ongoing pregnancy rates regardless of different ovarian responses. Increased P threshold concentration is associated with better ovarian responses.

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Bei Xu, Ph.D., Zhou Li, Ph.D., Hanwang Zhang, Ph.D., Lei Jin, Ph.D., Yufeng Li, Ph.D., Jihui Ai, Ph.D., Guijin Zhu, M.D.

Vol 97, Issue 6 , Pages 1321-1327.e4



To investigate the relationship between serum P levels on the day of hCG administration and pregnancy outcomes in different responders undergoing IVF.


Retrospective study.


Teaching hospital.


A total of 11,055 women who underwent their first IVF/intracytoplasmic sperm injection cycles and a subgroup of 4,021 women undergoing frozen-embryo transfer (FET) cycles.


Patients underwent IVF-ET with the long GnRH agonist protocol. The ovarian response was classified as high (≥20 oocytes; n = 2,023), poor (≤4 oocytes; n = 827), or intermediate (remaining cases; n = 8,205) according to the number of oocytes retrieved. Clinical outcomes of IVF-ET and FET cycles were analyzed according to plasma P levels.

Main Outcome Measure(s):

Ongoing pregnancy rates (PRs).


Ongoing PRs in fresh cycle were inversely associated with serum P levels on the day of hCG administration for all patients. Different P threshold concentrations were determined according to different ovarian response: We proposed a serum P level of 1.5 ng/mL as the threshold for poor responders, 1.75 ng/mL for intermediate responders, and 2.25 ng/mL for high responders. Our study does not show negative results for elevated P levels on oocyte performance in terms of fertilization, cleavage rate, or PR of FET cycles within different ovarian responses, offering no evidence for a detrimental effect of high P on oocyte quality.


Elevated P levels on the day of hCG administration negatively influence PR regardless of different ovarian responses, although increased P threshold concentration is associated with better ovarian responses. The detrimental effect of P elevation on PR seems to be unrelated to oocyte quality in all responders.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.