Serum Progesterone Levels on the Day of Human Chorionic Gonadotrophin Trigger, and its effects on the Outcome of In Vitro Fertilization, and Embryo Transfer: A Two-Center Study

Abstract

Abstract Introduction: Gonadotrophin-releasing hormone analogs were expected to make preovulatory progesterone (P4) elevation rare during in vitro fertilization (IVF) cycles, but despite its widespread use, subtle rise in P4 levels on the day of ovulation trigger has a documented prevalence of 5%–38%. The effect of preovulatory progesterone levels on IVF outcomes is still controversial and published data from West Africa is sparse. Materials and Methods: This was a prospective observational study of 107 women who underwent IVF in both Garki and Nisa hospitals in Abuja, Nigeria. A serum sample was obtained from participants on the day of human chorionic gonadotrophin administration for a single determination of progesterone level. Oocytes retrieved, biochemical pregnancy, and clinical pregnancy were the primary outcomes. Results: The mean P4 on human chorionic gonadotrophin (hCG) trigger day was 2.07 ± 0.24 ng/mL and 48 (44.9%) had P4 > 1.5 ng/mL. There was no relationship between P4, and the number of oocytes retrieved but implantation, biochemical pregnancy, and clinical pregnancy were significantly diminished when P4 >1.5 and <1 ng/mL: biochemical pregnancy (27.3% vs. 61.5% vs. 14.6%, χ2 = 17.896; P < 0.0001), clinical pregnancy (24.2% vs. 50.0% vs. 14.6%, χ2 = 11.041; P = 0.004). Conclusion: Pregnancy rates are diminished when P4 on hCG trigger day is elevated.