The Relationship Between Late Follicular Phase Progesterone Level And Pregnancy Outcome

Objective1. To investigate the effect of both low and high progesterone levels on the day of human chorionic gonadotrophin administration on pregnancy outcome during in vitro fertilization-embryo transfer cycles.2. To investigate serum P level sustained high on the day of HCG administration and two days before affacts on IVF-ET outcomes. MethodsPart one is a retrospective study. Clinical data of 1914 fresh embryo transfer cycles were selected from Reproductive Center in Tianjin Central Hospital of Gynecology Obestetrics during January 2013-December 2014.According to the day of HCG administration serum P levels in turn divided into the following six group. A: <0.50ng/ml(n=136); B:0.50~0.75ng/ml(n=346);C:0.75~ 1.00ng/ml(n=468);D:1.00~1.25ng/ml(n=440); E:1.25~1.50ng/ml(n=262);F:?1.50ng/ ml(n=262). Compare the clinical pregnancy rate under different levels of serum P.According to statistically significant difference between the groups(P <0.05) to find a related cut-off value that can judgment whether both low and high progesterone levels on the day of HCG administration on pregnancy outcome.According to the the cut-off value divided into three group:low progesterone group, normal progesterone group and elevated progesterone group. Compare of clinical parameters between two groups.To further explore the factors that influence the elevated serum P of the day of HCG injection, logistic regression analysis was performed to analysis age, duration of infertility, BMI, basic FSH, total dose of gonadotropin, total time of gonadotropin, E2 level on the day of HCG injection, LH levels on the day of HCG injection, number of oocytes retrieved which factors were relevant to serum P levels on the day of HCG injection.Part two was a prospective cohort study. Subjects selected from the patients who had entered the IVF cycle in our Reproductive Center during July to October 2015,a total of 546. The study grouped as follows:Fresh transfer cycle: Exclude conformed Freeze-all policy cycles(n=164) and patients that only a single day of serum P level was more than 1.0ng / ml(n=102), A total of 279 cycles entered the study design and according to serum P concentrations of HCG day and two days before were divided into three groups. Group A: all three days P concentration ? 1.0ng/ml(n=215);group B: two days P concentration >1.0ng/ml(n=40);one day P concentration>1.0ng/ml(n=24). Compare the clinical parameters between each group.Group ET and FET: 164 frozen-thawed embryo cycles had transplanted as follow, among them 61 cycles, serum P level>1.0ng/ml sustained ? 2 days in the late follicular period attribute to frozen-thawed embryo transfer group(FET); in fresh transfer cycles, serum P concentration> 1.0ng / ml sustained ?2 cycles attribute to fresh transplantation group(ET). Compare the clinical parameters between two group. Results1.According to serum P level on the day of HCG administration,1914 fresh embryo transfer cycles were divided into six group and the clinical pregnancy rate in each group was 36.8%?43.9%?45.3%?39.1?33.6%?26.7%. In the F group, the clinical pregnancy rate was significantly lower, so the cut-off value of the elevated serum P was 1.5ng/ml. Although A group has no statistically significant difference in clinical pregnancy rate, but there is a downward trend,so the cut-off value of the low serum P on the day of the HCG injection was 0.5ng/ml.2. 1914 cycles were divided into three group: low progesterone group, normal progesterone group and elevated progesterone group. Pairwise comparison found: The rate of mature oocytes in low P group was significantly higher than the other two groups, the difference was statistically significant(P> 0.05); and in elevated P group embryo implantation rate, biochemical pregnancy and clinical pregnancy rate was significantly lower than the other two groups,the difference was statistically significant(P <0.05).3. Logistic regression results show that total dose of gonadotropin, total time of gonadotropin, E2 level on the day of HCG injection, and number of oocytes retrieved were relevanted to serum P levels on the day of HCG injection.4. In the fresh transfer cycles,laboratory parameters include number of number of oocytes retrieved, mature eggs(MII) number, 2PN number, the number of available embryos, the number of embryos available also had no significant difference(P> 0.05); but,embryo implantation rate, biochemical pregnancy, clinical pregnancy rate in group C was significantly lower than group A(P<0.05).5.Group ET had no difference with FET group in general information(P> 0.05), embryo implantation rate was significantly higher in FET group, the difference was statistically significant(P <0.05). Conclusions1. low serum P level on the day of HCG injection had no adverse effects on pregnancy outcome while elevated serum P level on the day of HCG injection had negative effects on pregnancy outcome.2. The cut-off value of elevated serum P level was 1.5ng / ml according our center data.3. Elevated serum P on the day of HCG injection have an adverse effect on endometrial receptivity, without affecting egg and embryo quality.4. Ovarian response and the elevated serum P on the day of HCG injection was relevant.5. The serum P levels continue to rise during late follicular phase may also have a negative impact on pregnancy outcomes, particularly affects embryo implantation. Only assess one day serum P level of the day of HCG injection is not sufficient.6. The serum P levels continue to rise during late follicular phase could change the endometrial receptivity, without affecting the quality of embryos.