Comparative Study of Serum Progesterone Levels at the Time of Human Chorionic Gonadotropin Trigger and Ovum PickUp in Predicting Outcome in Fresh in vitro Fertilization Cycles

BACKGROUND: Studies have shown that premature rise of progesterone in controlled ovarian stimulation (COS) at the time of human chorionic gonadotropin (hCG) trigger is negatively associated with in vitro fertilization (IVF) outcome in fresh IVF cycles. Some authors have failed to demonstrate this. One large single centre retrospective cohort study has compared the pre and post hCG progesterone and observed that the ratio of the rise in progesterone could be a positive predictor. There is paucity of literature on this aspect. AIMS AND OBJECTIVES: To compare the serum progesterone at hCG trigger and ovum pick-up (OPU) with IVF outcome by estimating the respective paired hormone levels. MATERIAL AND METHODS: Serum progesterone levels at hCG trigger and OPU are compared retrospectively in 301 fresh IVF cycles with IVF outcome by long protocols with GnRH agonists for two years. Parametric and nonparametric testing of null hypothesis is performed. P value <0.05 is taken as significant. RESULTS: There is no predictive association of IVF outcome with either progesterone levels. The ratio of rise in progesterone is strongly positively associated with IVF outcome (P < 0.001). However, after adjusting for confounders and modifiers the retrieved number of oocytes are positively associated with IVF outcome (P = 0.044). CONCLUSIONS: The ratio of rise in progesterone is significantly associated with number of oocytes retrieved which in turn is associated with successful IVF outcome in fresh cycles. Ratio of rise in progesterone seems to be therefore an indirect parameter for predicting successful IVF outcome in fresh cycles.