Premature progesterone elevation in controlled ovarian stimulation (COS): to make a long story short

We present an overview, from a historical perspective, of the scientific accomplishments that have been made with regard to premature progesterone eleva- tion during controlled ovarian stimulation.

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Volume 109, Issue 4, Pages 563–570

Authors:

Elodie Adda-Herzog, M.D.'Correspondence information about the author M.D. Elodie Adda-HerzogEmail the author M.D. Elodie Adda-Herzog, Marine Poulain, M.D., Dominique de Ziegler, M.D. Ph.D., Jean-Marc Ayoubi, M.D. Ph.D., Renato Fanchin, M.D. Ph.D.

Abstract:

Over the past decades many of us have contributed to the controversy surrounding the origins and consequences of premature progesterone elevation during controlled ovarian stimulation. In this article, we attempt to retrace the progression of information on this complex subject which required reviewing a number of publications that often contradicted one another. The definition of premature progesterone elevation, the pathophysiological mechanisms underlying the high peripheral progesterone levels, and the debated consequences of this event on in vitro fertilixation-embryo transfer outcome will be addressed from a historical perspective.


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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.

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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 literature. I agree that patients with good response represent a confounder that was not accounted for in early studies, as these patients have an increased risk of P elevation and yet are more likely to have good quality embryos.  I do no agree however that these patients do not suffer harm from elevated P.   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.