EFFECT OF HIGHER PROGESTERONE CONCENTRATION ON THE DAY OF ADMINISTRATION OF AN OVULATION TRIGGER ON THE OUTCOMES OF IVF CYCLES IN GNRH AGONIST PROTOCOLS


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Abstract

Objective. To estimate the frequency and effect of higher progesterone concentrations on the day of human chorionic gonadotropin (hCG) administration on the efficiency of infertility treatment in the GnRH agonists (GnRH-a) program. Subject and methods. A clinical controlled trial was conducted in 253 patients with tuboperitoneal and/or male factor fertility treated in accordance with assisted reproductive technology programs and in 19 oocyte donors. Ovarian function was stimulated by the standard long protocol using recombinant follicle-stimulating hormone (rFSH) in 141 (51.8%) patients and hCG in 131 (48.2%). The threshold value of serum progesterone levels was used to determine premature luteinization (PL) - 4.77 nmol/l (1.5 ng/mg; conversion rate, 3.18). According to the level of progesterone on day of hCG administration, the patients were divided into groups: 1) (n = 233); progesterone levels, < 4.77nmol/l; 2) (n = 39); progesterone levels, ≥ 4.77nmol/l. Results. The frequency of the raised serum progesterone level ≥ 4.77pmol/l (1.5 ng/ml) on the day of hCG administration was 14.3%. The elevated progesterone group showed higher E2 levels (9913.41±717.7 and 7330.9±269.4 pmol/l; p = 0.0001) on the day of hCH administration and a larger number of obtained oocytes (13.1±0.8 and 9.87±0.3; p = 0.0001) and it used a higher dose of the inducer (2719.2±155.1 and 2340.1±57.1 IU; p = 0.006) than the normal serum progesterone group. At the same time there were no differences in the count of mature oocytes (8.85±0.2 and 9.84±0.6; p = 0.135) and zygotes (7.07±0.2 and 7.8±0.6; p = 0.211). Analysis of the rate of PL in relation to the used inducer indicated that the progesterone concentrations of ≥ 4.77 nmol/l on the day of hCH administration were observed in 10 (7.6%) patients in the hCH group and in 29 (20.6%) patients in the rFSH group. Embryo transfer clinical pregnancy was achieved in 92 of 217 patients in the normal serum progesterone group (42.3%) and in 5 of 31 patients in the high progesterone group (16.1%) (p = 0.005). Conclusion. The serum progesterone level on the day of hCH administration is associated with the number of obtained oocytes and the concentration of E 2 at the end of stimulation, as well as with the total dose of gonadotropins. PL is most commonly observed in the use of rFSH. The rate of clinical pregnancy substantially decreases at the progesterone concentration of 4.77 nmol/l on the day of hCH administration.

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About the authors

Elena Viktorovna MITYURINA

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: mity-elena@yandex.ru
graduate student 117997, Russia, Moscow, Ac. Oparina str. 4

Svetlana Grigorievna PERMINOVA

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: perisvet@list.ru
MD, Leading Researcher 1st gynecological department 117997, Russia, Moscow, Ac. Oparina str. 4

Evelyna Rubenovna DURINYAN

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: evelina_durinyan@mail.ru
PhD, doctor of 1st gynecological department 117997, Russia, Moscow, Ac. Oparina str. 4

Tatiana Yurievna IVANETS

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: t_ivanets@oparina4.ru
PhD, head of research - diagnostic laboratory 117997, Russia, Moscow, Ac. Oparina str. 4

Idar Nazimovich ABUBAKIROV

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a_abubakirov@oparina4.ru
PhD, head of the 1st gynecology department 117997, Russia, Moscow, Ac. Oparina str. 4

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