The Association of Serum Progesterone Levels on Day of Oocyte Retrieval with Pregnancy Outcome

Abstract

Aims and Objectives: To establish the level of serum progesterone (P4) on the day of oocyte retrieval beyond which it can affect the outcome of in vitro fertilisation (IVF), and to further establish the incidence of serum P4 rise in an agonist and antagonist cycle. Methods: This prospective observational cohort study was conducted from November 2020 to November 2021 at the Sarvodaya Fertility and IVF Centre, Delhi, India. For this study, the author recruited 352 couples with infertility who were treated with IVF/intracytoplasmic sperm injection-embryo transfer, of which 279 patients completed an IVF/intracytoplasmic sperm injection-embryo transfer cycle during the study period and were included in the final analysis. The standard gonadotropin-releasing hormone antagonist (fixed or variable) and long gonadotropin-releasing hormone agonist controlled ovarian stimulation protocols were used in all patients. Participants were recruited if they were undergoing controlled ovarian stimulation with all gonadotropins, recombinant follicle-stimulating hormone/urinary human menopausal gonadotropin, or recombinant luteinising hormone. The study population was sub-grouped into two groups according to their P4 level on day of oocyte retrieval (calculated according to receiver operating characteristics curve): Group A (p≤11.6 ng/dL; n=247 out of 27; 88.5%) and Group B (p>11.6 ng/dL; n=32 out of 279; 11.5%). Statistical analysis was performed with the Statistical Package for Social Sciences (SPSS) 17.0 version (IBM, New York City, New York, USA). Results: The percentage of patients with a rise in P4 on the day of oocyte retrieval were found significantly more in the antagonist protocol (13.3% [24 out of 181]) than in the agonist protocol (8.2% [8 out of 98]; p=0.04). Pregnancy rate was significantly higher in Group A (39.3% [97 out of 247]) compared with Group B (12.5% [4 out of 32]). The clinical pregnancy rate was also significantly higher in Group A (34.4% [85 out of 247]) compared with Group B (6.3% [2 out of 32]). Conclusion: Patients with higher levels of P4 (>11.6 ng/mL) were associated with lower pregnancy and clinical pregnancy rates.