Progesterone elevation does not compromise pregnancy rates in high responders a pooled analysis of in vitro fertilization patients treated with recombinant FSH GnRH antagonist in six trials

Incidence of elevated P increases with ovarian response, and elevated P (>1.5 ng/mL) is independently associated with a decreased chance of pregnancy in low to normal, but not high, responders.

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Authors

Georg Griesinger, M.D., Bernadette Mannaerts, Ph.D., Claus Yding Andersen, D.M.Sc., Han Witjes, Ph.D., Efstratios M. Kolibianakis, M.D., Keith Gordon, Ph.D.

Volume 100, Issue 6, Pages 1622-1628.e3, December 2013

Abstract

Objective:

To compare the impact of elevated P during the late follicular phase on the chance of pregnancy in low, normal, and high responders.

Design:

Retrospective combined analysis from six clinical trials.

Setting:

IVF centers.

Patient(s):

Women up to 39 years of age with a regular menstrual cycle and an indication for ovarian stimulation before IVF/intracytoplasmic sperm injection.

Intervention(s):

Ovarian stimulation with recombinant (r) FSH in a GnRH antagonist protocol.

Main Outcome Measure(s):

Ongoing pregnancy rates (OPRs) assessed with the use of univariate and multivariate analyses according to serum P levels ≤1.5 ng/mL versus >1.5 ng/mL on the day of hCG administration and compared among low (1–5 oocytes), normal (6–18 oocytes), and high (>18 oocytes) responders.

Result(s):

A total of 157/1,866 women (8.4%; 95% confidence interval [CI] 7.2%–9.8%) had elevated P. Incidence of elevated P increased from 4.5% in low responders to 19.0% in high responders. Overall, OPRs were significantly lower in women with elevated P. Per started cycle, the >1.5 to ≤1.5 ng/mL adjusted odds ratio was 0.55 (95% CI 0.37–0.81). OPRs were not impaired in high responders with P elevation and were significantly higher compared with normal responders with P elevation.

Conclusion(s):

The incidence of elevated P increases with ovarian response, and elevated P at a threshold of 1.5 ng/mL is independently associated with a decreased chance of pregnancy in low to normal responders, but not in high responders, when using an rFSH/GnRH antagonist protocol.

Read the full text at: http://www.fertstert.org/article/S0015-0282(13)03011-2/fulltext


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. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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