Premature progesterone elevation: targets and rescue strategies

Progesterone elevation impairs endometrial receptivity and could compromise embryo quality. Its prevention requires individualization of ovarian stimulation with reduction of stimulation intensity towards the end of ovarian stimulation.

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Volume 109, Issue 4, Pages 577–582

Authors:

Barbara Lawrenz, Ph.D., Elena Labarta, M.D., Human Fatemi, M.D., Ernesto Bosch, M.D.

Abstract:

Progesterone elevation during the late follicular phase of ovarian stimulation for in vitro fertilization negatively impacts the assisted reproductive technology-outcome. The evidence available supports an advanced endometrial maturation and a direct negative effect on its receptivity. On the other hand, some retrospective analysis suggests an impairment of oocyte and embryo quality. Recent publications confirm that enhanced follicle-stimulating hormone–stimulation towards the end of the follicular phase of ovarian stimulation is the main course of progesterone elevation. A key element in preventing this event is the individualization of ovarian stimulation according to the patient's ovarian reserve and the adaption of the stimulation dosage during late follicular phase according to the patient's response. Additional measures as corticosteroid administration, avoidance of prolonged stimulation and cycle segmentation with freeze-all-policy can be discussed.


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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. 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.

1 Comments

Go to the profile of Micah J Hill
Micah J Hill about 1 month ago

Thank you for a wonderful article on the history of premature progesterone elevation.   I wanted to point out there is evidence that premature P elevation negatively effects good and poor responders similarly, whereas your article only focused on studies suggesting the opposite.   We have demonstrated this in two studies (Fertility and Sterility, Vol. 107, Issue 3, p671–676.e2 and Fertility and Sterility, Vol. 103, Issue 6, p1477–1484.e5).  While good responder patients are more likely to get pregnant, their pregnancy rates still drop as progesterone rises.  We have demonstrated this to be true for age groups, ovarian response groups, and embryo quality groups.  There is a misconception that these patients should proceed with fresh embryo transfer because they are immune to the effects of premature P, but the data does not support this in my opinion.