26
views
0
recommends
+1 Recommend
2 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      The Role of Progesterone/Estradiol (P4/E2) Ratio in predicting Assisted Reproductive Technology (ART) Outcome in Agonist Cycles with Elevated Progesterone Levels on Trigger Day: A Prospective Study

      research-article

      Read this article at

      ScienceOpenPublisher
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          ABSTRACT

          Aim

          Progesterone (P4) rise on the day of the trigger is often regarded as a poor prognostic factor in assisted reproductive technology (ART) cycles. We aimed to identify the utility of the progesterone/estradiol (P4/E2) ratio as a predictor of pregnancy outcome in the subgroup of patients with P4 elevation.

          Materials and methods

          We conducted a prospective study on women with normal basal hormonal parameters who underwent ART utilizing the long downregulation protocol. Serum P4 and E2 were assayed on the day of the trigger. The role of P4 elevation and the role of the P4/E2 ratio in those with elevated P4 were analyzed with respect to ART outcome using the t-test and Mann–Whitney U test. Receiver operating characteristic (ROC) curve analysis was done to identify a cutoff value of the P4/E2 ratio below which a good prognosis could be predicted.

          Results

          We included 422 patients. The pregnancy rate was 42.4%. Elevated P4 > 1.5 ng/mL was seen in 20.4%. The P4/E2 ratio was higher in nonpregnant patients when compared to pregnant patients and was statistically significant (0.56 ± 0.81 vs 0.4 ± 0.61 and p = 0.001). The cutoff value for P4/E2 ratio by ROC curve analysis was 0.463, with a negative predictive value of 69.6%. Those with elevated P4 > 1.5 ng/mL and P4/E2 ratio >0.463 had a significantly lower pregnancy rate than those with normal (<1.5 ng/mL) P4 levels (45.4% vs 32%, and p = 0.03).

          Conclusion

          Progesterone/estradiol (P4/E2) assay on the day of human chorionic gonadotropin (HCG) assumes significance in predicting pregnancy outcomes in patients undergoing ART, especially those with elevated P4 levels. If the P4 level is high on the day of HCG, it is better to see P4/E2 ratio before the routine cancellation of the transfer.

          Clinical significance

          The clinical practice of freezing all the embryos in those with elevated P4 on the day of the trigger could be restricted to only those with elevated P4/E2 ratio also.

          How to cite this article

          Valiyathodi R, Parameswara Iyer R, Karunakaran GK. The Role of Progesterone/Estradiol (P4/E2) Ratio in predicting Assisted Reproductive Technology (ART) Outcome in Agonist Cycles with Elevated Progesterone Levels on Trigger Day: A Prospective Study. Int J Infertil Fetal Med 2023;14(2):75-79.

          Related collections

          Most cited references19

          • Record: found
          • Abstract: not found
          • Article: not found

          BIRTH AFTER THE REIMPLANTATION OF A HUMAN EMBRYO

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: analysis of over 4000 cycles.

            The influence of elevated serum progesterone levels during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles on pregnancy rates is a matter of continued debate among fertility clinicians. Efforts to resolve this question have been impeded by the various assays used to measure progesterone and the different, arbitrary threshold values for defining 'high' progesterone levels. A non-interventional, retrospective, observational, single-centre cohort study evaluated the relationship between serum progesterone levels on the day of human chorionic gonadotrophin (hCG) administration and the ongoing pregnancy rate in 4032 patients undergoing IVF/ICSI cycles using gonadotrophin-releasing hormone (GnRH) analogues for pituitary down-regulation. Ongoing pregnancy rates were inversely associated with serum progesterone levels on the day of hCG (P 1.5 ng/ml (31.0 versus 19.1%; P = 0.00006); odds ratio, 0.53 (95% confidence interval, 0.38-0.72). Multivariate regression analysis showed that daily follicle-stimulating hormone dose, number of oocytes and estradiol values on the day of hCG administration were positively associated with progesterone levels (P 1.5 ng/ml were associated with lower ongoing pregnancy rates following IVF/ICSI cycles irrespective of the GnRH analogue used for pituitary down-regulation.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Endometrial receptivity is affected in women with high circulating progesterone levels at the end of the follicular phase: a functional genomics analysis.

              Elevated serum progesterone levels at the end of the follicular phase in controlled ovarian stimulation (COS) leads to a poorer ongoing pregnancy rate in IVF cycles due to reduced endometrial receptivity. The objective of this study was to use microarray technology to compare endometrial gene expression profiles at the window of implantation according to the levels of circulating progesterone. For this prospective cohort study, microarray data were obtained from endometrial biopsies from 12 young healthy oocyte donors undergoing COS with pituitary suppression by either gonadotrophin-releasing hormone (GnRH) agonists or antagonists, and recombinant FSH. On the day of recombinant chorionic gonadotrophin (rCG) administration, six women had serum progesterone levels (P) >1.5 ng/ml (study group) and six had serum P levels <1.5 ng/ml (control group). Endometrial samples were collected using a Pipelle catheter 7 days after the rCG injection. Using the parametric test, we identified 140 genes significantly dysregulated (64 up- and 76 down-regulated) in the study group endometria compared with the control endometria, regardless of the GnRH analogue employed. These genes are related to cell adhesion, developmental processes, the immune system and others, which are all required for normal endometrial function development. Of the 25 gene targets previously proposed as markers for endometrial receptivity, 13 appeared over-regulated in the study group. Our results reveal that elevated progesterone levels on the day of rCG administration can induce significant alterations in the gene expression profile of the endometrium.
                Bookmark

                Author and article information

                Contributors
                URI : https://orcid.org/0000-0002-3361-8152
                Journal
                IJIFM
                International Journal of Infertility and Fetal Medicine
                IJIFM
                Jaypee Brothers Medical Publishers
                2229-3817
                2229-3833
                May-August 2023
                : 14
                : 2
                : 75-79
                Affiliations
                [1 ]Department of Reproductive Medicine, Iqraa International Hospital and Research Centre, Kozhikode, Kerala, India
                [2 ]Department of Reproductive Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
                [3 ]Department of Reproductive Medicine, Edappal Hospitals, Edappal, Kerala, India
                Author notes
                Ramesh Parameswara Iyer, Department of Reproductive Medicine, Government Medical College, Thiruvananthapuram, Kerala, India, Phone: +91 9249426575, e-mail: drrameshp07@ 123456gmail.com
                Article
                10.5005/jp-journals-10016-1313
                d4e46be1-52c8-4b3b-8ead-613f3d8e62c1
                Copyright © 2023; The Author(s).

                © The Author(s). 2023 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 12 May 2021
                : 15 February 2023
                : 12 May 2023
                Categories
                RESEARCH ARTICLE
                Custom metadata
                ijifm-14-075.pdf

                Obstetrics & Gynecology
                Assisted reproductive technology,Clinical pregnancy,Progesterone elevation,Progesterone/estradiol ratio

                Comments

                Comment on this article