Elevated basal progesterone levels are associated with increased preovulatory progesterone rise but not with higher pregnancy rates in ICSI cycles with GnRH antagonists

Abstract

Objective: To ascertain the association between basal progesterone (P) levels and the occurrence of preovulatory progesterone rise (PPR) and clinical pregnancy rates (CPRs) in ICSI cycles with GnRH antagonists. Study design: Serum P levels of 464 patients were measured on day 2 and day of hCG of cycles. Cycles with basal P levels > 1.6 ng/mL were cancelled. All embryos were cryopreserved in cycles with P levels >= 2 ng/mL on the day of hCG. The primary outcome measures were the incidence of PPR (P > 1.5 ng/mL) and CPR with regard to basal P. Results: Basal P levels were significantly higher in cycles with PPR than in those without PPR (0.63 +/- 0.31 vs. 0.48 +/- 0.28 ng/mL). Area under the curve for basal P according to ROC analysis to discriminate between elevated and normal P levels on the day of hCG was 0.65 (0.58-0.71 95% CI, p < 0.01). The cut-off value for basal P levels that best discriminates between cycles with and without PPR was 0.65 ng/mL. Cycles with basal P levels above 0.65 ng/mL had a significantly higher incidence of PPR (30.9% vs. 13.5%) but similar clinical and cumulative pregnancy rates (38.8% vs. 31.1% and 41.7% vs. 32.6%, respectively) in comparison to cycles with basal P levels below 0.65 ng/mL. In multivariate regression analysis, basal P levels, LH level on the first day of antagonist administration, and estradiol levels on the day of hCG trigger were the variables that predicted PPR. Conclusion: Basal P levels were associated with increased incidence of PPR but not with CPR. (C) 2017 Elsevier B.V. All rights reserved.