Elevated progesterone levels in the late follicular phase do not predict success of in vitro fertilization-embryo transfer

Objective: To examine the effects of subtle elevation in P levels in late follicular phase on the outcome of IVF-ET cycles, using GnRH agonist (GnRH-a) and hMG +/- FSH protocol. Design: A retrospective analysis of data. Setting: Tertiary care teaching medical center. Patients: Fifty-four patients who completed 63 IVF-ET cycles were treated with midluteal GnRH-a, followed by hMG +/- pure FSH. Depending on serum P levels on the day of hCG administration, patients were divided into two groups. In group 1, P levels were less than or equal to 0.9 ng/mL (conversion factor to SI unit, 3.180) and in group 2, the levels were >0.9 ng/mL. Results: Luteinizing hormone levels, on the day of hCG administration, as measured by RIA, were suppressed completely. In cycles with subtle P rise (71%), we observed a significantly higher serum E(2) concentration, greater number of mature follicles, and greater number of oocytes retrieved: There were no differences between the two groups in fertilization rate, number of embryos transferred, clinical pregnancy rate, implantation rate, and miscarriage or delivery rates. Conclusions: We conclude that in IVF-ET cycles, when pretreated with GnRH-a, P levels may increase on the day of hCG administration despite LH suppression and such elevation may not affect adversely the final outcome.