Research On The Ralationship Between Serum Progesterone Level On The Day Of HCG Administration And The Progesterone And Number Of Retrieved Oocytes Ratio And IVF/ICSI-ET Outcome

Objective: This article aims to explore the predictive value of serumprogesterone level on the day of HCG administration （P） and the progesteroneand number of retrieved oocytes ratio （P/O） for IVF/ICSI-ET outcome inpatients of different ovarian response，so that better dicision and prediction canbe made.Methods: A retrospective analysis was conducted in825cycles inwhich GnRHa protocol was applied in our center from January2012toDecember2012. Among the825cycles,538had in vitro fertilization andembryo transfer while287had intra-cytoplasmic sperm injection and embryotransfer. According to the number of retrieved oocytes（N）, cycles were dividedinto2groups,71in the poor ovarian response group （N≤5，Group A） and754in the normal ovarian response group （N>5，Group B）. Receiver operatingcharacteristic curves （ROC） was applied to explore the predictive value ofserum progesterone level on the day of HCG administration and theprogesterone/number of retrieved oocytes ratio for IVF/ICSI-ET outcome. Thepatients in Group A and Group B were divided into two groups separatelyaccording to the demarcation value found by the ROC curve. We compared theage, duration of infertility, distribution of infertility types and infertility causes,the rate of IVF and ICSI,the number of basal antral follicles, the basalhormone level, the dosage and duration of gonadotrophin（Gn）, serum estradiollevel on the day of HCG administration, the number of retrieved oocytes,number of2PN embryos, cleavage rate, number of transferable embryos,number of good quality embryos, implantation rate, clinical pregnancy rateand frozen embryo rate between Group A1and A2,Group B1and B2seperately. Correlation analysis was applied between progesterone and related factors that have been reported in order to explore the possible causes ofelevated progesterone.Result: We found that the serum progesterone level on the day of HCGadministration can predict the outcome of patients with good ovarian responsewhile it is of no predictive value for the outcome of poor responsers. Theprogesterone and number of retrieved oocytes ratio can be applied in the poorresponsers while it has no predictive value for the outcome of patients withgood ovarian response. The demarcation value of Group A was0.34.Thesensitivity and specificity were0.372and0.929, area under ROC curve was0.676（95%CI:0.552-0.801）. According to the demarcation value, Group Awas divided into two groups, Group A1（P/O≤0.34，53cycles） and Group A2（P/O>0.34,18cycles）. The demarcation value of Group B was1.04ng/ml.Thesensitivity and specificity were0.516and0.578, area under ROC curve was0.550（95%CI:0.509-0.592）. According to the demarcation value, Group Bwas divided into two groups,Group B1（P≤1.04ng/ml,404cycles） and GroupB2（P>1.04ng/ml,350cycles）.We compared between Group A1and GroupA2,Group B1and Group B2. There was no significant difference in patients’age, duration of infertility, distribution of infertility types, infertility causesand the rate of IVF and ICSI，number of basal antral follicles, basal E₂, FSH,LH levels between Group A1and Group A2（P>0.05）. There was nodifference in gonadotrophin dosage between the two groups. There was nosignificant difference in the cleavage rate （98.54%vs96.13%） between thetwo groups （P>0.05）. Compared with Group A1, the duration ofgonadotrophin was significantly longer in Group A2（9.81±2.74days vs11.56±2.55days）（P<0.05）. Serum E₂level on the day of HCG administrationin Group A1was significantly higher than that of Group A2（1189.23±592.43mIu/ml vs592.17±329.24mIu/ml）（P<0.05）. The number of retrievedoocytes （4.09±0.99vs2.39±1.04）, number of2PN embryos （2.57±1.14vs1.5±1.04）, number of transferable embryos （2.11±0.93vs1.67±0.69）, numberof good quality embryos （1.40±1.23vs0.44±0.71）, implantation rate （30.1%vs6.7%）, clinical pregnancy rate （49.1%vs11.1%） and frozen embryo rate （18.9%vs0） was significantly higher in Group A1（P<0.05）. No significantdifference in patients’ age, distribution of infertility types,infertility causesand the rate of IVF and ICSI, number of basal antral follicles, basal FSH leveland LH level was found between GroupB1and Group B2（P>0.05）.Nosignificant difference was found in the dosage of gonadotrophin（P>0.05）. Thecleavage rate of the two groups was nearly the same （98.65%vs98.76%）（P>0.05）.The duration of infertily was significantly longer in Group B1（4.48±3.10years vs4.01±2.64years）（P<0.05）. The basal E₂level wassignificantly lower in Group B1（43.15±25.72mIU/ml vs50.24±49.01mIU/ml）（P<0.05）.The duration of gonadotrophin was significantlyshorter in Group B1（10.00±1.95days vs10.58±1.68days）.Serum E₂level onthe day of HCG administration in Group B1was significantly lower than thatof Group B2（3447.15±2014.48mIU/ml vs4010.45±2297.13mIU/ml）（P<0.05）.The number of retrieved oocytes （12.86±5.01vs14.78±5.34）,number of2PN embryos（8.13±4.08vs9.21±4.34）, the number of transferrableembryos （5.37±3.57vs6.46±4.08） and the number of good quality embryos（3.35±3.35vs4.36±3.84）were significantly lower in Group B1（P<0.05）. Wecompared the pregnancy outcome and found that the implantation rate （39.1%vs33.1%） and clinical pregnancy rate （59.4%vs49.9%） was significantlyhigher while the frozen embryo rate （61.4%vs71.8%） was significantly lowerin Group B1（P<0.05）. We studied possible factors related to progesteronelevel and found that progesterone level on the day of HCG administration waspositively related to dosage of Gn, number of retrieved oocytes and E₂levelof that day while being negatively related to the LH level on the day of HCGadministration（P<0.01）.Conclusions: The serum progesterone level on the day of HCGadministration can predict the outcome of patients with good ovarian response.The demarcation value was1.04ng/ml. Beyond the demarcation value, withina certain range, the number of retrieved oocytes,2PN embryos, good qualityembryos and transferrable embryos increased with the increase in serumprogesterone level on the day of HCG administration, cleavage rate was not affected, but the clinical pregnancy rate dropped significantly. This may bebecause of the negative effect of progesterone on endometrial receptivity.These fingdings may help us to decide when to trigger oocyte ovulation andwhether perform fresh embryo transfer.Progesterone and number of retrieved oocytes ratio can be applied in thepoor responsers to predict the outcome. The demarcation value was0.34.Beyond the demarcation value, as the ratio got higher, the number of oocytesretrieved,2PN embryos, good quality embryos and implantation rate, clinicalpregnancy rate, frozen embryo rate significantly decreased. The clinicaloutcome was negatively affected.