Correlation Between Serum Progesterone Level On The Day Of HCG And IVF/ICSI-ET Outcome

ObjectiveTo investigate the correlation between serum progesterone level on the day of HCG administration and pregnancy outcome of fresh blastocyst transfer in women undergoing in-vitro fertilization or intracytoplasmic sperm injection.MethodsThis was a retrospective analysis of the clinical data of 329 fresh blastocyst transfer cycles treated with short-acting long-protocol IVF/ICSI-ET from January 2016 to December 2018 in the Department of Reproductive Medicine,Lianyungang Maternal and Child Health Hospital.According to the progesterone(P)level on the HCG day,patients were divided into seven groups:?0.49 ng/ml(group Al),0.5?0.74ng/ml(group A2),0.75?0.99ng/ml(group A3),1.0?1.24ng/ml(group A4),1.25?1.49ng/ml(group A5),1.5?1.74ng/ml(group A6),and?1.75ng/ml(group A7).The clinical indicators of different groups were compared,and the effects of different levels of progesterone on pregnancy outcome of blastocyst transfer were analyzed and the cut-off point were obtained.Serum progesterone levels on HCG day were divided into low level progesterone group,medium level progesterone group and high level progesterone group according to the cut-off point,and then pregnancy outcomes and related clinical parameters were compared between the three groups.Logistic regression analysis was used to analyze the correlation between clinical parameters such as age,infertility years,basal FSH levels,BMI,total Gn dose,Gn duration,estradiol(E2)levels on HCG day,number of? 14mm follicles in diameter and number of oocytes retrieved and progesterone levels,so as to explore the relevant clinical factors affecting the rise of progesterone.Results1.329 fresh blastocyst transfer cycles were selected in this paper,including 282 IVF cycles and 47 ICSI cycles.The clinical pregnancy rates of the seven groups were 32.35%,57.89%,60.26%,56.52%,58.82%,56.41%,36.36%seperately.After adjusting for the effects of age,number of eggs harvested and E2 level on the clinical pregnancy rate,Logistic regression analysis showed that the clinical pregnancy rate of A2-A6 group was significantly higher than that of A1 group,with statistical difference(P<0.05),while there was no significant difference between A1 group and A7 group,There was also no statistical difference between groups from A2 to A6(P>0.05).Overall,these results indicated that either the progesterone level was too low(?0.49ng/ml)or too high(?1.75ng/ml),which had an adverse effect on the clinical pregnancy rate.Thus,the cut-off point for low progesterone levels on the HCG day was set at 0.5ng/ml,and the cut-off point for high progesterone levels was set at 1.75ng/ml.2.According to the cut-off points of progesterone levels,329 fresh blastocyst transfer cycles were divided into low level progesterone group,medium level progesterone group and high level progesterone group.Compared with the medium level progesterone group,the duration of infertility,BMI and pregnancy loss rate in the low level progesterone group were significantly higher;however,the ovulation rate,clinical pregnancy rate was significantly lower with statistically significant differences(P<0.05).The clinical pregnancy rate in the high level progesterone group was significantly lower than that in the medium level progesterone group,and pregnancy loss rate in the high level progesterone group was significantly higher(P<0.05).There was no significant difference in fertilization rate,available cleavage embryo rate and blastocyst formation rate among the three groups(P>0.05).3.Logistic regression analysis showed that the E2 levels,the number of follicles with diameter ?14mm on the day of HCG administration and the average number of oocytes retrieved were correlated with the increase of serum progesterone levels on HCG day,the E2 levels was significantly correlated with the increase of HCG day progesterone level.Conclusion1.There was correlation between progesterone level on the HCG day and pregnancy outcome of fresh blastocyst embryo transfer.2.Serum progesterone<0.5ng/ml or ?1.75ng/ml on HCG day had a negative effect on the pregnancy outcome of fresh blastocyst transplantation.3.There was no significant correlation between progesterone level on the HCG day and embryo quality.4.The increase of serum progesterone level on HCG day was correlated with E2 level on that day.