SERUM PROGESTERONE ENDOMETRIAL THICKNESS AND PATTERN ON THE DAY OF OOCYTE RETRIEVAL AS INDICATORS TO THE OUTCOME IN PATIENTS UNDERGOING IN-VITRO FERTILIZATION

Abstract

SUMMARY C ontrolled ovarian hyper-stimulation (COH) causes excessive follicular development and supra-physiological serum concentrations of estradiol (E2) in the follicular phase and progesterone (P4) in the luteal phase. The experience with human ART had revealed many relationships between successful conception and the concentration of steroid hormones and thus provides evidence to predict treatment outcomes. Since successful implantation depends on the quality of the embryo and a receptive endometrium, it was found that high serum progesterone levels have no adverse effect on the embryo itself as determined by pregnancy outcome following embryo transfer using donated eggs, but the main adverse effect of a rise of progesterone during controlled ovarian hyperstimulation seems to be on the endometrium. In the literature, the relationship between progesterone elevation in the day of hCG and pregnancy rate has been analyzed with wide range thresholds and no conclusive cut off value was reached. Also since the rise in progesterone is explained by the increase in "granulosa cell mass" a group of investigators proposed to use a ratio between progesterone /estradiol (P/E2) on the day of hCG with cut-off value > 1, but they also reported that P/E2 ratio cannot be used as a reliable predictor for pregnancy rate. So the day of oocyte retrieval is a provocative time point. Willman & Hinckley were the first to investigate the impact of serum progesterone level on the day of oocyte retrieval in both agonist and antagonist protocol and reported that serum progesterone level on the day of oocyte retrieval does not influence pregnancy outcome. However in 2008, Niu and his colleagues reported the same observation but they found a correlation between serum progesterone level and quantity of viable embryos in patient undergoing intracytoplasmic sperm injection using GnRH- agonist both long and short protocol. The same observation was stated 2 years latter that high serum progesterone levels were significantly correlated with higher number of follicles >15mm, oocytes retrieved and embryos transferred. Ochalski and his colleagues concluded that elevated progesterone level on the day of oocyte retrieval with cutoff value (> 10 ng/ml) negatively impacts intracytoplasmic sperm injection outcome in short antagonist protocol. Later, a prospective cohort study reported that implantation rate (positive hCG 14 days after embryo transfer) and pregnancy rate were significantly higher when the progesterone level was < 12 ng/mL on the day of oocyte retrieval in short antagonist protocol.