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J Hum Reprod Sci. 2019 Jul-Sep;12(3):229-233. doi: 10.4103/jhrs.JHRS_120_18.

The Enigma of Early Progesterone Rise: Is It Associated with the Type of Gonadotropin Used?

Author information

1
IVF Unit, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India.
2
Department of Research, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India.

Abstract

Background:

It is debated whether the use of recombinant follicle-stimulating hormone (r-FSH) or human menopausal gonadotropin (HMG) is associated with progesterone (P) elevation in the late follicular phase.

Aims:

The aim is to determine whether the type of gonadotropin used for controlled ovarian stimulation (COS) in in vitro fertilization (IVF) is associated with P elevation in the late follicular phase using antagonist protocol.

Setting and Design:

This was a retrospective data analysis in the IVF unit.

Methods:

Data of women who underwent COS between January 2005 and December 2017.

Statistical Analysis:

Chi-square and unpaired Student's t-test in SPSS 20.

Results:

Data of 439 women was analyzed. Mean age was 31.45 ± 4.6 years. HMG was used in 193 (44%), r-FSH in 232 (52.8%), and a combination of both in 14 (3.2%) women. Proportion of women with elevated P was significantly higher in r-FSH group as compared to HMG group (19/232 [8.2%] vs. 6/193 [3.1%]; P = 0.027). Mean P levels were significantly higher in r-FSH group (0.75 ng/ml vs. 0.59 ng/ml; P = 0.049). Mean estradiol (E2) levels at trigger were significantly higher in women with elevated P as compared to normal P (2893.4 ± 2091.8 pg/ml vs. 1668.3 ± 1508.6 pg/ml respectively; P < 0.000). Fresh embryo transfers performed in 18/27 women with elevated P resulted in pregnancy in three (16.7%) women. Two had biochemical pregnancies and one was lost to follow-up.

Conclusions:

Use of r-FSH and E2 levels at trigger are associated with elevated P levels in the late follicular phase. Fresh embryo transfers performed in spite of elevated P levels were associated with low pregnancy rates and unfavorable outcomes.

KEYWORDS:

Early progesterone rise; gonadotropin; human menopausal gonadotropin; recombinant follicle-stimulating hormone

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