Online first
Research paper
Published online: 2023-05-25

open access

Page views 289
Article views/downloads 290
Get Citation

Connect on Social Media

Connect on Social Media

Using progesterone to follicular index ratio is better correlated with intracytoplasmic sperm injection outcome than using serum progesterone level alone

Athba Abid Kadhim1, Thuraya Hussamuldeen Abdulla2, Ula Mohammad Alkawaz3
DOI: 10.5603/GP.a2023.0031
Pubmed: 37249266

Abstract

Objectives: to investigate the possibility of using the ratio of serum progesterone level to the number of follicles, according to ovarian response in the day of human chorionic gonadotrophin trigger, as a predictor of cycle outcome.

Material and methods: A prospective intervensional study was conducted at Kamal Al-Samarai Hospital for Infertility Treatment and IVF during the period from December 2020 to September 2021. Ninety infertile women underwent intracytoplasmic sperm injection (ICSI) cycles using antagonist protocol. Moreover, once the patient reached triggering criteria, meticulous recording of follicular index together with serum estrogen level and serum progesterone level are measured. Fresh embryo transfer of cleavage stage embryo is done once serum progesterone level was less than 1.5 ng/mL. A follow-up to confirm pregnancy rate and cycle outcome was done.

Results: The study showed a positive pregnancy rate of 28.9%. The relationship between progesterone follicular index (Prog/FI) ratio and (ICSI) outcome was highly significant with a p value of 0.001. Additionally, an inverse relationship, as the ratio was lower the pregnancy rate was improved, was documented. The receiver operating characteristic (ROC) curve for progesterone follicular index ratio was 0.711 with a cut off value of 0.0354 ng/mL in addition to a sensitivity of 65.6 and a specificity of 65.4.

Conclusions: The serum progesterone level is an independent factor for the prediction of intracytoplasmic sperm injection (ICSI) outcome, whereas the progesterone follicular index ratio can be used as a potential marker for predicting ICSI outcome in fresh embryo transfer

Article available in PDF format

View PDF Download PDF file

References

  1. Bosch E, Valencia I, Escudero E, et al. Premature luteinization during gonadotropin-releasing hormone antagonist cycles and its relationship with in vitro fertilization outcome. Fertil Steril. 2003; 80(6): 1444–1449.
  2. Venetis CA, Kolibianakis EM, Papanikolaou E, et al. Is progesterone elevation on the day of human chorionic gonadotrophin administration associated with the probability of pregnancy in in vitro fertilization? A systematic review and meta-analysis. Hum Reprod Update. 2007; 13(4): 343–355.
  3. Bosch E, Labarta E, Crespo J, et al. Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: analysis of over 4000 cycles. Hum Reprod. 2010; 25(8): 2092–2100.
  4. Al-Azemi M, Kyrou D, Kolibianakis EM, et al. Elevated progesterone during ovarian stimulation for IVF. Reprod Biomed Online. 2012; 24(4): 381–388.
  5. Tsai YR, Huang FJ, Lin PY, et al. Progesterone elevation on the day of human chorionic gonadotropin administration is not the only factor determining outcomes of in vitro fertilization. Fertil Steril. 2015; 103(1): 106–111.
  6. Martinez F, Rodriguez I, Devesa M, et al. Should progesterone on the human chorionic gonadotropin day still be measured? Fertil Steril. 2016; 105(1): 86–92.
  7. Givens CR, Schriock ED, Dandekar PV, et al. Elevated serum progesterone levels on the day of human chorionic gonadotropin administration do not predict outcome in assisted reproduction cycles. Fertil Steril. 1994; 62(5): 1011–1017.
  8. Ubaldi F, Bourgain C, Tournaye H, et al. Endometrial evaluation by aspiration biopsy on the day of oocyte retrieval in the embryo transfer cycles in patients with serum progesterone rise during the follicular phase. Fertil Steril. 1997; 67(3): 521–526.
  9. Kayacik Günday Ö, Aldemir O, Özelçi R, et al. The effect of hCG day progesterone in 1318 cycles on pregnancy outcomes: ongoing discussion. Ginekol Pol. 2023 [Epub ahead of print].
  10. Xu B, Li Z, Zhang H, et al. Serum progesterone level effects on the outcome of in vitro fertilization in patients with different ovarian response: an analysis of more than 10,000 cycles. Fertil Steril. 2012; 97(6): 1321–7.e1.
  11. Griesinger G, Mannaerts B, Andersen CY, et al. Progesterone elevation does not compromise pregnancy rates in high responders: a pooled analysis of in vitro fertilization patients treated with recombinant follicle-stimulating hormone/gonadotropin-releasing hormone antagonist in six trials. Fertil Steril. 2013; 100(6): 1622–8.e1.
  12. Chikazawa K, Araki S, Tamada T. Morphological and endocrinological studies on follicular development during the human menstrual cycle. J Clin Endocrinol Metab. 1986; 62(2): 305–313.
  13. Daniel WW, Cross LC. Biostatistics: A Foundation for Analysis in the Health Sciences. 10th ed. John Wiley & Sons Inc., New York 2013.
  14. Gordis L. Assessing the Validity and Reliability of Diagnostic and Screening Tests. In: Gordis L. ed. Epidemiology. Elsevier/Saunders, Philadelphia 2014: 88–115.
  15. van Loendersloot LL, van Wely M, Limpens J, et al. Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis. Hum Reprod Update. 2010; 16(6): 577–589.
  16. Andersen CY, Bungum L, Andersen AN, et al. Preovulatory progesterone concentration associates significantly to follicle number and LH concentration but not to pregnancy rate. Reprod Biomed Online. 2011; 23(2): 187–195.
  17. Chen CH, Zhang X, Barnes R, et al. Relationship between peak serum estradiol levels and treatment outcome in in vitro fertilization cycles after embryo transfer on day 3 or day 5. Fertil Steril. 2003; 80(1): 75–79.
  18. Joo BoS, Park SH, An BM, et al. Serum estradiol levels during controlled ovarian hyperstimulation influence the pregnancy outcome of in vitro fertilization in a concentration-dependent manner. Fertil Steril. 2010; 93(2): 442–446.
  19. Roque M, Valle M, Sampaio M, et al. Ratio of progesterone-to-number of follicles as a prognostic tool for in vitro fertilization cycles. J Assist Reprod Genet. 2015; 32(6): 951–957.
  20. Shufaro Y, Sapir O, Oron G, et al. Progesterone-to-follicle index is better correlated with in vitro fertilization cycle outcome than blood progesterone level. Fertil Steril. 2015; 103(3): 669–74.e3.
  21. Bourgain C, Ubaldi F, Tavaniotou A, et al. Endometrial hormone receptors and proliferation index in the periovulatory phase of stimulated embryo transfer cycles in comparison with natural cycles and relation to clinical pregnancy outcome. Fertil Steril. 2002; 78(2): 237–244.
  22. Healy MWu, Patounakis G, Connell MT, et al. Does a frozen embryo transfer ameliorate the effect of elevated progesterone seen in fresh transfer cycles? Fertil Steril. 2016; 105(1): 93–9.e1.
  23. Racca A, De Munck N, Santos-Ribeiro S, et al. Do we need to measure progesterone in oocyte donation cycles? A retrospective analysis evaluating cumulative live birth rates and embryo quality. Hum Reprod. 2020; 35(1): 167–174.
  24. Shapiro BS, Daneshmand ST, Desai J, et al. The risk of embryo-endometrium asynchrony increases with maternal age after ovarian stimulation and IVF. Reprod Biomed Online. 2016; 33(1): 50–55.
  25. Filicori M, Cognigni GE, Pocognoli P, et al. Modulation of folliculogenesis and steroidogenesis in women by graded menotrophin administration. Hum Reprod. 2002; 17(8): 2009–2015.
  26. Kara M, Aydin T, Aran T, et al. Comparison of GnRH agonist and antagonist protocols in normoresponder patients who had IVF-ICSI. Arch Gynecol Obstet. 2013; 288(6): 1413–1416.