Subtle progesterone rise on the day of human chorionic gonadotropin administration is associated with lower live birth rates in women undergoing assisted reproductive technology: a retrospective study with 2,555 fresh embryo transfers

Objective: To evaluate the association between serum P levels on the day of hCG administration and pregnancy outcome in women undergoing controlled ovarian hyperstimulation, prevention of premature ovulation by GnRH analogues, and fresh ET after 5 days of embryo culture. Design: Retrospective, observational, cohort study. Setting: Private IVF center. Patient(s): A total of 2,555 women undergoing fresh ET on day 5 in 2,062 GnRH agonist and 493 GnRH antagonist cycles. Intervention(s): None. Main Outcome Measure(s): Live birth rate. Result(s): Live birth rate in cycles with GnRH agonists was significantly lower in women with P levels >= 2.0 ng/mL (17.4%) on the day of hCG administration as compared with women with P levels < 1.5 ng/mL (24.6%) and 1.5-1.99 ng/mL (26.7%). No such significant differences in live birth rates in cycles with GnRH antagonist could be observed. Conclusion(s): A rise of serum P levels >= 2.0 ng/mL on the day of hCG administration is associated with impaired early embryo implantation and reduced live birth rate in cycles with GnRH agonists after day-5 fresh ET. Clinical Trial Registration Number: NCT01426152. (Fertil Steril (R) 2012;98:347-54. (C) 2012 by American Society for Reproductive Medicine.)