Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Progesterone/Estradiol Ratio as a Predictor in the ART Cycles with Premature Progesterone Elevation on the Day of hCG Trigger

Authors
Mariano Mascarenhas
Mohan Kamath
Achamma Chandy
Aleyamma Kunjummen
Reproductive Medicine Unit, Christian Medical College, Vellore, India
Abstract
Background: The purpose of the study was to evaluate the role of Progesterone/ Estradiol (P < sub>4/E2) ratio as a predictive tool for clinical pregnancy in ART cycles with a premature progesterone rise of >1.5 ng/ml on the day of human chorionic gonadotropin (hCG) trigger. Methods: Retrospective analysis was done on 569 fresh embryo transfer cycles from January 2011 to December 2012 at the infertility unit of a tertiary care hospital. Age, BMI, number of cycles and number of clinical pregnancies have been considered. Results: The overall clinical pregnancy rate per embryo transfer was 42.8% (244/569). The clinical pregnancy rate in the 36 cycles with progesterone (P < sub>4) level >1.5 ng/ml was significantly lower than the 533 cycles with normal p < sub>4 ≤1.5 ng/ml (22.2% vs. 44.2%; p=0.0092). The 36 cycles with progesterone level >1.5 ng/ml were divided into subgroups of P < sub>4/E2 >1 (n=20) and P < sub>4/E2 ≤1 (n=16). The 20 cycles with P < sub>4/E2 >1 and P < sub>4 >1.5 ng/ml had a significantly lower pregnancy rate than the cycles with P < sub>4 ≤1.5 ng/ml (15% vs. 42.8%; p=0.0103). The 15 cycles with P < sub>4/E2 ≤1 and P < sub>4 >1.5 ng/ml had a similar pregnancy rate as the cycles with P < sub>4 ≤1.5 ng/ml. Conclusion: A premature progesterone elevation in ART cycles is possibly associated with lower clinical pregnancy rates; this adverse impact of elevated progesterone seems to be limited mainly to a subgroup with an elevated P < sub>4/E2 ratio >1.
Keywords
art
Pregnancy
Premature progesterone elevation
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Journal of Reproduction & Infertility
Volume 16, Issue 3
Summer 2015
Pages 155-161