Basal progesterone level as the main determinant of progesterone elevation on the day of hCG triggering in controlled ovarian stimulation cycles

Enrico Papaleo, Laura Corti, Valeria Stella Vanni, Luca Pagliardini, Jessica Ottolina, Francesca De Michele, Antonio La Marca, Paola Viganò, Massimo Candiani

Research output: Contribution to journalArticle

Abstract

Purpose: Modest increases of serum progesterone at human chorionic gonadotrophin (hCG) administration in controlled ovarian hyperstimulation (COH) cycles have been shown to have a negative impact on pregnancy outcomes. The aim of this study was to identify early predictors of progesterone elevation at hCG. Design: Pregnancy outcome of 303 consecutive patients undergoing COH and fresh day-3 embryo transfer was analysed. Considering the non-linear relationship between progesterone at hCG triggering and pregnancy outcomes, partial area under the curve (pAUC) analysis was used to implement marker identification potential of receiver operating characteristic (ROC) curve analysis. Multivariate logistic analysis was then performed to identify predictors of progesterone rise. Results: Pregnancy outcomes could be predicted by pAUC analysis (pAUC = 0.58, 95 % CI 0.51-0.66, p = 0.02) and a significant detrimental cut-off could be calculated (progesterone at hCG > 1.35 ng/ml). Total dose of rFSH administered, E2 level at hCG but mostly basal progesterone level (OR = 12.21, 95 % CI 1.82-81.70) were predictors of progesterone rise above the cut-off. Conclusion: Basal progesterone is shown to be the main prognostic factor for progesterone elevation. This observation should be taken into consideration in the clinical management of IVF/ICSI cycles to improve pregnancy outcomes.

Original languageEnglish
Pages (from-to)169-176
Number of pages8
JournalArchives of Gynecology and Obstetrics
Volume290
Issue number1
DOIs
Publication statusPublished - 2014

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Keywords

  • Controlled ovarian hyperstimulation
  • hCG
  • In vitro fertilization
  • Partial area under the curve
  • Progesterone
  • ROC curve

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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