Predictors Of HCG Trigger Day Progesterone Elevation In Normal Ovarian Response Population

Objective:To investigate the effect of Progesterone elevation on pregnancy outcome of fresh cycle In vitro fertilization-embryo transfer（IVF-ET）in moderate ovarian response population of Gonadotropin releasing hormone-antagonist（Gn RH-ant）protocol,and to further explore the causes of progesterone elevation,and to provide corresponding coping strategies to guide clinical practice.Methods:A retrospective analysis was performed on the medical records of the moderate ovarian response population（3<the number of retrieved oocytes≤15）who underwent ovulation induction with Gn RH-ant protocol and IVF-ET in the Reproductive Center of the First Hospital of Shanxi Medical University from January 2018 to December 2021.507 fresh cycles meeting the inclusion and exclusion criteria were obtained.With HCG trigger day progesterone level of 1.5ng/ml as the threshold,the patients were divided into the progesterone increased group（n=84）and the progesterone non-increased group（n=423）,and the clinical characteristics and pregnancy outcome were compared between the two groups.Correlation analysis was used to find out the relevant factors affecting the increase of progesterone on HCG trigger day.For significantly correlated factors,the Receiver operating characteristic curve（ROC curve）was used to calculate the best prediction point that could predict the increase of progesterone level on HCG trigger day.Results:1.A total of 507 fresh IVF-ET cycles are included in this study.The median progesterone level on HCG trigger day is 0.68 ng/ml,and the clinical pregnancy rate was39.05%（198/507）.2.The clinical pregnancy rate of the progesterone increased group is significantly lower than that of the progesterone not increased group（P<0.05）,and the positive rate of HCG is not significantly different between the two groups（P>0.05）.3.Multiple Logistic regression analysis suggested that basic progesterone value,basic Luteinizing hormone（LH）value,dosage of Human menopausal gonadotropin（HMG）,Estradiol（E₂）and the number of retrieved oocytes are correlated with the increase of progesterone on HCG trigger day（P<0.05）.Basal serum progesterone is significantly correlated with the increase of progesterone on HCG trigger day（OR=3.044,95%CI 1.883-4.920,P=0.000）.4.ROC curve can be obtained by the correlation between Basal serum progesterone level and serum progesterone level on HCG trigger day.The area under the curve（AUC）was 0.724（95%CI（0.664～0.785））.Combined with the statistical results,the maximum tangent point of Youden index is the critical point,that is,when the basic progesterone value is 0.735ng/ml,it can be used as the best prediction point for progesterone increase on HCG trigger day.The sensitivity and specificity of this point were 65.5%and 75.2%respectively.Conclusion:1.The increase of progesterone level on HCG trigger day can reduce the clinical pregnancy rate of fresh cycle IVF-ET.2.Basal progesterone value,basal LH value,total dosage of HMG,E₂ value on HCG trigger day and the number of retrieved oocytes are correlated with the increase of progesterone on HCG trigger day.3.When basal serum progesterone is 0.735 ng/ml,it can be used as the best prediction point of progesterone increase on HCG trigger day.