Evaluation of Serum Progesterone Level on the Day of hCG Injection on Clinical Outcome of Antagonist Protocol in ICSI Cycles

Abstract

Progesterone's premature rise during late follicular phase will negatively affect the outcome of antagonist protocol in the Intracytoplasmic sperm injection (ICSI) cycles, on trigger day progesterone level above 1.5 ng/ml create different endometrial gene expression profiles, lead to asynchrony between the endometrium and the fresh embryo transfer. Enhanced FSH-stimulation only without LH support considers as the main cause for premature progesterone rise. To analyze the influence of progesterone rise on trigger day by hCG on clinical outcomes and pregnancy rates of fresh embryo transfer in the ICSI by the use of antagonist protocol. 60 Iraqi infertile women were enrolled in this interventional study stimulated by antagonist protocol, they were subdivided according to the level of serum progesterone on day of trigger by hCG into 30 infertile women with serum progesterone ≤1.5 ng/ml and thirty infertile women with serum progesterone >1.5 ng/ml. The maturation, fertilization, cleavage, implantation, biochemical and clinical pregnancy rates were all measured in both groups. women with serum progesterone level >1.5 ng/ml on hCG trigger day, showed longer stimulation days with significant difference (P < 0.02) and highly significant increment in the mean level of serum progesterone and mean P4/E2 ratio (P <0.001) and of serum LH (P <0.010). While there was significant decrease in implantation percentage (P =0.012) and in biochemical and clinical pregnancy rate (P =0.010) in comparison to women with serum progesterone level ≤ 1.5 ng/ml on day of hCG trigger. Measurement of serum progesterone and P4/E2 ratio on trigger day by hCG are considering as an important predictor factor for the clinical outcome (implantation rate; biochemical and clinical pregnancy).