Impact Of Serum Progesterone Level On Treatment Outcome And Its Appropriate Threshold Value During Late Follicular Phase In IVF-ET Cycle

Objective:To explore the relationship between serum progesterone level and the laboratory parameters and the clinical parameters in IVF-ET cycle, and to confirm the reference threshold of serum progesterone during late follicular phase.Methods:The clinical data of 436 IVF-ET cycle were retrospectively analyzed between January 2006 to December 2009 from the reproductive medicine center in affiliated hospital of zunyi college.The patients with retrieved oocyte numbers greater than or equal to 4 and less than or equal to 15 were divided into the normal reaction group, the patient with retrieved oocyte numbers greater than 15 were divided into the high reaction group. The A, B, C and D subgroups then were divided in the normal reaction group and the high reaction group according to the serum progesterone level at the day of hCG administration. The laboratory parameters and the clinical parameters were analyzed in each group. The ROC curve was drawn with normal cleavage as state variable. The reference threshold of serum progesterone during late follicular phase was determined by ROC curves.Result:There was no significant relationship between the serum progesterone level and the follicular numbers during late follicular phase in the normal ovarian response group, there was positive relationship between the serum progesterone level and the follicular numbers during late follicular phase in the high ovarian response group. The difference in the ratio of MⅡphase oocyte, the normal fertilization rate was not obvious between four subgroup in the normal reaction group (P>0.05). The difference in the ratio of retrieved oocyte,the ratio of over-matured oocyte,the normal cleavage rate was obvious between A1, B1 and C1.D1 subgroup (P<0.05) The difference in the immature oocyte rate, the transplantable embryo rate was distinct between B1 subgroup and C1, D1 subgroup (P<0.05). The ratio of the normal cleavage was higher in C1 subgroup than in D1 subgroup (P<0.05).The ratio the good quality embryo was higher in B1 subgroup than in Dl subgroup (P<0.05). There were distinct difference for the ratio of embryo implantation, the clinical pregnancy rate and the incidence of miscarriage between A1, B1 subgroup and D1 subgroup (P<0.05). There were distinct difference for the embryo implantation rate and clinical pregnancy rate between B1 subgroup and C1 subgroup (P<0.05). The good quality embryo rate, the transplantable embryo rate, the normal cleavage rate, the embryo implantation rate, the clinical pregnancy rate were the highest in B1 subgroup among four subgroup, the incidence of miscarriage was the highest in Dl subgroup among four subgroup. There were no significant difference for the ratio of retrieved oocyte, the ratio of MⅡphase oocyte, the ratio of transplantable embryo among four subgroup in the high ovarian response group (P >0.05. The difference in the immature oocyte rate, the rate of over-matured oocyte, the normal cleavage rate was obvious between A2, B2 and C2, D2 subgroup (P<0.05). The good quality embryo rate, the normal fertilization rate, the normal cleavage rate were the highest, but the ratio of over-matured oocyte was the lowest in B2 subgroup among four subgroup. ROC curve showed that the threshold value of serum progesterone was 4.95 nmol/L during late follicular phase in the normal ovarian response group, the threshold value of serum progesterone was 5.95 nmol/L during late follicular phase in the high ovarian response group.Conclusions:The level of serum progesterone may be related to the follicular numbers during late follicular phase. The abnormal rising of the serum progesterone level may have effect adversely on the laboratory parameters and the clinical parameters during late follicular phase in different ovarian response group. The reference threshold of serum progesterone is determined as 4.95 nmol/L, the most appropriate range of serum progesterone is 3.3～4.1nmol/Lduring late follicular phase in the normal ovarian response group, and the reference threshold of serum progesterone is determined as 5.95 nmol/L, the most appropriate range of serum progesterone is 4.1～5.2 nmol/Lduring late follicular phase in the high ovarian response groupin our center.