Fertility and sterility · 2026
Premature progesterone elevation during controlled ovarian stimulation has limited impact on embryologic outcomes.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Sachdev Devika, Kalafat Erkan, George Lea, Whitehead Christine, Werner Marie, García-Velasco Juan, Seli Emre
Аннотация
OBJECTIVE: To evaluate the impact of elevated progesterone (P4) level on embryology outcomes in patients undergoing in vitro fertilization (IVF).
DESIGN: Retrospective cohort study using propensity-score matched analysis (PSM).
SUBJECTS: Patients undergoing their first freeze-all cycle between January 2017 and December 2024 at an academic-affiliated center.
EXPOSURE: Trigger day serum P4 level.
MAIN OUTCOME MEASURES: Primary outcome was blastulation rate per fertilized zygote (2PN). Secondary outcomes included oocyte maturation, fertilization, and euploidy rates. Outcomes were compared between elevated (≥1.5 ng/mL) versus normal (<1.5 ng/mL) P4 levels, as well as across P4 quartiles. An additional analysis was performed to assess the probability of persistent P4 elevation in a subsequent cycle. Analysis cohort was formed after PSM on oocyte age, partner age, day 3 FSH, sperm type, BMI, AMH, antral follicle count, pituitary suppression protocol, follicle count at trigger, trigger type, and stimulation duration. Multivariable regression analyses doubly adjusting for AMH, FSH, oocyte age, >15mm follicle count, and trigger estradiol (E2) levels were conducted.
RESULTS: 16,321 cycles were initially analyzed - 3,749 with trigger day P4 ≥1.5 ng/mL and 12,572 with P4 <1.5 ng/mL. Following PSM, 6,620 cycles (3,310 per group) were analyzed. Despite matching, patients with P4 elevation had higher trigger day E2 (median 3,369 vs. 3,105.5 pg/mL, p<0.001) and follicles >15mm (median 16.0 vs. 15.0, p<0.001). P4 elevation was associated with a small but statistically significant decrease in oocyte maturation rate (67.2 vs 68.5%; adjusted Risk Ratio [aRR] 0.98, 95% CI 0.97-0.98, p<0.001), fertilization rate (82.1 vs. 82.6%; aRR 0.99, 95% CI 0.99-1.00, p=0.018) and blastulation rate per 2PN (67.0 vs 68.3%; aRR 0.98, 95% CI 0.97-0.99, p=0.001), but no difference in euploidy rate. A higher percentage of immature oocytes was noted in the higher P4 quartiles. The probability of P4 elevation in a subsequent cycle was significantly higher for those with a first cycle elevation compared to those with no first cycle elevation (57.5% vs. 14.3%, respectively, p<0.001).
CONCLUSION: Premature P4 elevation is associated with significant decreases in oocyte maturation, fertilization, and blastulation rates; however, the magnitude of these differences is small and may not be clinically meaningful.
DESIGN: Retrospective cohort study using propensity-score matched analysis (PSM).
SUBJECTS: Patients undergoing their first freeze-all cycle between January 2017 and December 2024 at an academic-affiliated center.
EXPOSURE: Trigger day serum P4 level.
MAIN OUTCOME MEASURES: Primary outcome was blastulation rate per fertilized zygote (2PN). Secondary outcomes included oocyte maturation, fertilization, and euploidy rates. Outcomes were compared between elevated (≥1.5 ng/mL) versus normal (<1.5 ng/mL) P4 levels, as well as across P4 quartiles. An additional analysis was performed to assess the probability of persistent P4 elevation in a subsequent cycle. Analysis cohort was formed after PSM on oocyte age, partner age, day 3 FSH, sperm type, BMI, AMH, antral follicle count, pituitary suppression protocol, follicle count at trigger, trigger type, and stimulation duration. Multivariable regression analyses doubly adjusting for AMH, FSH, oocyte age, >15mm follicle count, and trigger estradiol (E2) levels were conducted.
RESULTS: 16,321 cycles were initially analyzed - 3,749 with trigger day P4 ≥1.5 ng/mL and 12,572 with P4 <1.5 ng/mL. Following PSM, 6,620 cycles (3,310 per group) were analyzed. Despite matching, patients with P4 elevation had higher trigger day E2 (median 3,369 vs. 3,105.5 pg/mL, p<0.001) and follicles >15mm (median 16.0 vs. 15.0, p<0.001). P4 elevation was associated with a small but statistically significant decrease in oocyte maturation rate (67.2 vs 68.5%; adjusted Risk Ratio [aRR] 0.98, 95% CI 0.97-0.98, p<0.001), fertilization rate (82.1 vs. 82.6%; aRR 0.99, 95% CI 0.99-1.00, p=0.018) and blastulation rate per 2PN (67.0 vs 68.3%; aRR 0.98, 95% CI 0.97-0.99, p=0.001), but no difference in euploidy rate. A higher percentage of immature oocytes was noted in the higher P4 quartiles. The probability of P4 elevation in a subsequent cycle was significantly higher for those with a first cycle elevation compared to those with no first cycle elevation (57.5% vs. 14.3%, respectively, p<0.001).
CONCLUSION: Premature P4 elevation is associated with significant decreases in oocyte maturation, fertilization, and blastulation rates; however, the magnitude of these differences is small and may not be clinically meaningful.