AUTHOR=De Cesare Raffaella , Morenghi Emanuela , Cirillo Federico , Ronchetti Camilla , Canevisio Valentina , Persico Paola , Baggiani Annamaria , Sandri Maria Teresa , Levi-Setti Paolo Emanuele 

TITLE=The Role of hCG Triggering Progesterone Levels: A Real-World Retrospective Cohort Study of More Than 8000 IVF/ICSI Cycles

JOURNAL=Frontiers in Endocrinology

VOLUME=11

YEAR=2020

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.547684

DOI=10.3389/fendo.2020.547684

ISSN=1664-2392

ABSTRACT=<p><bold>Objective:</bold> To assess the association between serum ovulation trigger progesterone (P) levels and the outcome of <italic>in vitro</italic> fertilization cycles.</p><p><bold>Design Setting:</bold> Real world single-center retrospective cohort study.</p><p><bold>Patient Intervention(s):</bold> All fresh cleavage and blastocyst-stage embryo transfers (ETs) performed from January 2012 to December 2016.</p><p><bold>Main outcome Measure(s):</bold> The impact of premature high serum P levels cycles in terms of clinical pregnancy rates (CPRs) and live birth rates (LBRs).</p><p><bold>Results:</bold> 8,034 ETs were performed: 7,597 cleavage-stage transfers and 437 blastocyst transfers. Serum P levels demonstrated to be inversely related to CPR (OR 0.72, <italic>p</italic> &lt; 0.001) and LBR (OR 0.73, <italic>p</italic> &lt; 0.001). The progressive decrease of LBR and CPR started when P levels were &gt;1 ng/ml in a good prognosis cleavage ET subgroup, whereas in patients with worse prognosis only for <italic>P</italic> ≥ 1.75 ng/ml. In the blastocyst ET subgroup, the negative effect of P elevation was reported only if P was &gt;1.75 ng/ml. CPR (OR 0.71 (0.62–0.80), <italic>p</italic> &lt; 0.001) and LBR (OR 0.73 (0.63–0.84), <italic>p</italic> &lt; 0.001) in thawed cycles resulted statistically significantly higher than in fresh cycles in the cleavage-stage subgroup. In the blastocyst group, no significant difference resulted between thawed and fresh cycles, independently of P levels [CPR OR 0. 37 (0.49–1.09), <italic>p</italic> = 0.123; LBR OR 0.71 (0.46–1.10), <italic>p</italic> = 0.126].</p><p><bold>Conclusion:</bold> High P levels decrease CPR as well as LBR in both cleavage and blastocyst ET. In the cleavage group, for P levels below 1.75 ng/ml, our data suggest the possibility to wait until day 5 for ET, and if P level is ≥1.75 ng/ml, it should be considered to freeze all embryos and postpone the ET.</p><p><bold>Clinical Trial Registration:</bold><ext-link ext-link-type="uri" xlink:href="https://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, ID: NCT04253470</p>