Publications scientifiques

Elevated progesterone on hCG trigger day is always detrimental for art result
Date de parution: 21/12/2011

Aubriot FX1, Olivennes F2, Cohen-Bacrie M3, Dumont M1,3, de Ziegler D4, de Mouzon J4
1- ART Unit Eylau Cherest Neuilly/Seine, France
2- ART Unit Eylau Muette, Paris, France
3- Laboratoire Eylau-Unilabs, Paris, France
4- Service de Gynécologie Obstétrique II et Médecine de la Reproduction, CHU Cochin, Université Paris Descartes, Paris, France

OBJECTIVES
Premature elevation of plasmatic progesterone (P4) is usually considered as a poor prognosis factor for achieving a pregnancy. However, in the same time, progesterone level generally increases with high ovarian response. We took the opportunity of having a large cohort of ART
cycles with P4 assessment on the day of HCG to better determine the risk factors of
P4 increase and its impact on ART results.

METHODS RESULTS
We have led retrospective study of an observational cohort of 10248 ART cycles in a private ART Unit (2004-2009).
All cycles with P4 measures on the day of hCG triggering were included. P4 level were compared according to women's age, ovarian reserve (FSH, E2, AMH, CF), stimulation protocol and results (total dose of gonadotropins, E2 at hCG, number of collected oocytes).
Then cycles were divided in 3 groups according to P4 value (<1.5, 1.5-1.9 and >=2.0 ng/ml). Pregnancy rate (PR) per transfer was compared among the 3 groups, taking in account age, ovarian response (collected oocytes and small follicles)
Statistical methods included variance analysis, chi-square, and multivariate logistic models.
P< 0.05 was considered statistically significant. P4 was the highest in good prognosis cases : age < 35 years, AMH > 2 ng/ml.
P4 was correlated with E2 on HCG day, with the numbers of oocytes and of small follicles.
On the contrary, PR decreased from 26.2% to 18.3% with increasing P4.
The drop was more important for young women, and was observed for all levels of ovarian response.
In a multilogistic model including age, stimulation protocol and ovarian response, high P4 was associated with decreased chances of pregnancy (OR=0.77, 95%CI : 0.63-0.93 and OR=0.56, 0.43-0.73 for P4 at 1.5-1.9 and of >=2.0 ng/ml, respectively).
Finally, abortion rate increased with high P4, particularly for women aged <35 and 35-39.

CONCLUSION
Thus, P4 level is higher in case of good ovarian reserve and response and of younger age.
However, when taking in account these variables, high P4 is always deleterious for ART results.