The relationship of premature progesterone rise with serum estradiol levels and number of follicles in GnRH antagonist/recombinant FSH-stimulated cycles

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 162; no. 2; pp. 165 - 168
• Main Authors: Kyrou, D, Al-Azemi, M, Papanikolaou, E.G, Donoso, P, Tziomalos, K, Devroey, P, Fatemi, H.M
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.06.2012
• Subjects: Adult; Estradiol; Estradiol - blood; Female; Follicle Stimulating Hormone, Human; Follicles; GnRH antagonist; Gonadotropin-Releasing Hormone - analogs & derivatives; Gonadotropin-Releasing Hormone - antagonists & inhibitors; Humans; Obstetrics and Gynecology; Ovarian Follicle - physiology; Progesterone - blood; Progesterone rise; Reproductive Techniques, Assisted; Progesterone rise; Follicles; Estradiol; GnRH antagonist
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2012.02.025

Abstract Objective(s) To investigate the relationship between premature progesterone (P) rise and serum estradiol (E2 ) levels and the number of follicles in GnRH antagonist/rec-FSH stimulated cycles. Study design Two hundred and seven patients treated by IVF/ICSI at the Centre for Reproductive Medicine of the Dutch-Speaking Brussels Free University were included in this observational study. They received 200 IU/day rec-FSH from day 2 of the cycle and daily GnRH antagonist starting on day 6 of stimulation. The criteria for hCG administration included the presence of ≥3 follicles of ≥17 mm diameter. Serum P, E2 and LH were determined on the day of hCG administration. The outcome measure was to identify a threshold of E2 and number of follicles on the day of hCG administration which would define a progesterone rise on the day of hCG administration (cut-off value of 1.5 ng/ml). Result(s) Patients with a P >1.5 ng/ml had significantly higher concentrations of E2 and increased number of follicles on the day of hCG administration compared to those with P ≤1.5 ng/ml. However, patients with a P >1.5 ng/ml the day of hCG showed lower pregnancy rates than those with P <1.5 ng/ml (17.8 vs. 32.7%, respectively; p < 0.05). A ROC curve was employed in order to estimate a cut-off for E2 on day of hCG >1790.5 pg/ml and more than 9.5 follicles of ≥11 mm in diameter for progesterone rise over 1.5 ng/ml. Conclusion(s) A significant impact is shown on progesterone rise by E2 and number of follicles on the day of hCG administration in GnRH antagonist/rec-FSH-stimulated cycles. With this knowledge, an upcoming progesterone rise during follicular phase can be anticipated and prevented.