The relationship between the changes in the level of progesterone and the outcome of in vitro fertilization-embryo transfer

Figures & data

Figure 1. The relation between serum progesterone (P) level on the day of hCG administration and clinical pregnancy rate in each group. The response was considered as a function of the P levels on the day of hCG administration. Samples were divided into the following 8 intervals: ≤1.00, 1.00–1.25, 1.25–1.5, 1.5–1.75, 1.75–2.00, 2.00–2.25, 2.25–2.5, and >2.5 ng/ml. The clinical pregnancy rate in each P interval was calculated to observe the relation between P level and clinical pregnancy rate in these patients. (A) intermediate ovarian response group (Mantel-Haenszel test: χ²= 74.1721, p < 0.0001); (B) high ovarian response group (Mantel-Haenszel test: χ²= 16.6985, p < 0.0001); (C) poor ovarian response group (Mantel-Haenszel test: χ²= 0.1936, p < 0.66).

Figure 2. Cut-off values of the level of serum progesterone (P) on the day of hCG administration and duration of elevated pre-hCG P in the intermediate and high ovarian response groups. (A) Cut-off values of serum P level on the day of hCG administration in the intermediate ovarian response group. P levels were divided into the following 8 intervals: ≤1.00, 1.00–1.25, 1.25–1.5, 1.5–1.75, 1.75–2.00, 2.00–2.25, 2.25–2.5, and >2.5 ng/ml according to the level of P on the day of hCG administration. *p < 0.05 for comparison with preceding progesterone level interval; data are expressed as OR (95% CI) for each of the serum progesterone levels compared with the preceding progesterone group (<1.0 ng/ml). (B) Cut-off values of serum P level on the day of hCG administration in high ovarian response group. Response of the patients on the basis of the level of P on the day of hCG administration were divided into the following 8 intervals: ≤1.00, 1.00–1.25, 1.25–1.5, 1.5–1.75, 1.75–2.00, 2.00–2.25, 2.25–2.5, and >2.5 ng/ml. *p < 0.05 for comparison with preceding progesterone level interval; data are expressed as OR (95% CI) for each of the serum progesterone levels compared with the preceding progesterone group (<1.0 ng/ml). (C) Cut-off value of duration of pre-hCG P elevation in intermediate ovarian response group. According to different duration of elevated pre-hCG P, the following 5 intervals: 0, 1, 2, 3, and ≥4-day groups in these patients were considered. *p < 0.05 for comparison with preceding duration of pre hCG P rise interval; data are expressed as OR (95% CI) for each of the pre-hCG P elevation rise duration compared with the preceding duration of pre hCG P rise group (0 day). (D) Cut-off value of duration of pre-hCG P elevation in high ovarian response group. Patients were divided according to the duration of elevation of pre-hCG P; the durations of pre-hCG P elevation are divided into the following 5 intervals: 0, 1, 2, 3, and ≥4-day groups in these patients. *p < 0.05 for comparison with preceding duration of pre hCG P rise interval; data are expressed as OR (95% CI) for each of the pre-hCG P elevation rise duration compared with the preceding duration of pre -hCG P rise group (0 day). hCG: chorionic gonadotropin; on the day of hCG administration: the day of human chorionic gonadotropin administration; P: progesterone; OR:odds ratio; CI: confidence interval.

Table 1. General data of the 8575 patients undergoing their first IVF/ICSI cycle.

Parameters
Age (year)	30.88 ± 4.92
BMI (kg/m^2)	22.37 ± 3.2
Duration of infertility (year)	4.51 ± 3.56
Basal FSH (IU/L)	7.68 ± 2.65
IVF (n)	6681
ICSI (n)	1811
Rescue ICSI (n)	83
Causes of infertility
Tubal factor	4102 (47.8%)
Ovulation disorder	105 (1.2%)
Endometriosis pelvic and uterine factors	94 (1.1%)
Diminished ovarian reserve	172 (2%)
Compounded factor	3580 (41.7%)
Unexplained and other	522(6.1%)
Primary infertility	4456(51.9%)
Secondary infertility	4119(48.1%)
Gn duration (day)	12.12 ± 4.39
Gn dosage (IU)	2151.3 ± 869.4
E2 level on hCG day (IU/L)	5045.2 ± 3206.1
P level on hCG day (IU/L)	0.87 ± 0.49
Duration of pre-hCG P elevation (day)	0.84 ± 1.26
No. of retrieved oocytes	10.97 ± 5.69
No. of available embryos	5.65 ± 3.45
No of transferred embryos	1.93 ± 0.46
Endometrial thickness (mm)	12.21 ± 2.35
Clinical pregnancy rate (%)	51.5%
Abortion rate (%)	11.3%
Ectopic pregnancy rate (%)	2.92%

Values are expressed as mean ± SD, number or %. IVF: in vitro fertilization; ICSI: intracytoplasmic sperm injection; BMI: body mass index; FSH: follicle-stimulating hormone; Gn: gonadotropin; hCG: human chorionic gonadotropin; P: progesterone; E₂: estrogen.

Figure 3. The relationship of duration of elevated pre-hCG P with the clinical pregnancy rate and miscarriage rate in each group. According to different durations of pre-hCG P elevation, the durations of pre-hCG P elevation are divided into the following 5 intervals: 0, 1, 2, 3, and ≥4-day groups in these patients. The clinical pregnancy rate and miscarriage rate in each pre-hCG P elevation group is calculated to observe the relation between duration of pre-hCG P elevation and clinical pregnancy rate in these patients. (A) intermediate ovarian response group (Clinical pregnancy rate: χ²= 70.4634, p < 0.0001; miscarriage rate: χ²= 13.237, p = 0.011); (B) high ovarian response group (Clinical pregnancy rate: χ²= 21.4188, p < 0.0001; miscarriage rate: χ²= 0.779, p = 0.943); (C) poor ovarian response group (Clinical pregnancy rate: χ²= 1.7379, p = 0.1874; miscarriage rate: χ²= 2.926, p = 0.373). hCG: human chorionic gonadotropin; P: progesterone.

Table 2. Logistic regression analysis of clinical pregnancy rate-related factors in different ovarian response groups.

	High ovarian response group		Intermediate ovarian response group		Poor ovarian response group
	COR (95% CI)	AOR (95% CI)	COR (95% CI)	AOR (95% CI)	COR (95% CI)	AOR (95% CI)
Age (year)	0.79 (0.71–0.88)**	0.82 (0.73–0.92)**	0.74 (0.70–0.78)**	0.83 (0.77–0.89)**	0.62 (0.55–0.70)**	0.64 (0.55–0.73)**
BMI (Kg/m^2)	0.99 (0.97–1.03)		0.98 (0.96–0.99)**		0.98 (0.93–1.02)
Duration of infertility (year)	0.98 (0.95–1.01)		0.95 (0.93–0.96)**	0.98 (0.96–0.99)**	0.93 (0.90–0.96)**	0.95 (0.92–0.99)*
Basal FSH (IU/L)	1.01 (0.95–1.08)		0.99 (0.97–1.02)		0.96 (0.93–0.99)*
Gn duration (days)	0.69 (0.96–1.07)		0.97 (0.95–1.00)*		0.97 (0.92–1.02)
Gn dosage (IU)	0.85 (0.74–0.99)*		0.74 (0.70–0.79)**	0.88 (0.82–0.95)**	0.71 (0.63–0.80)**
E2 level on HCG day (IU/L)	0.97 (0.93–1.02)		0.99 (0.96–1.01)		1.15 (1.04–1.28)**
No. of retrieved oocytes	0.99 (0.96–1.01)		1.03 (1.01–1.04)**		1.03 (1.35–1.76)**
Fertilization rate (%)	1.45 (0.81–2.58)		2.38 (1.82–3.12)**	2.79 (2.1–3.7)**	1.71 (0.98–2.71)
Cleavage rate (%)	3.53 (1.19–10.49)*	3.13 (1.04–9.46)*	1.48 (0.92–2.37)		1.22 (0.40–3.71)
High quality embryos rate (%)	2.09 (1.43–3.04)**	1.98 (1.35–2.92)**	2.41 (1.97–2.93)**	2.27 (1.85–2.79)**	1.57 (1.03–2.40)*	2.59 (1.59–4.19)**
Embryonic type (D3 or D5)	1.32 (1.07–1.63)**	1.28 (1.04–1.59)*	1.54 (1.15–2.06)**	1.65 (1.22–2.23)**	1.59 (0.97–2.6)
Endometrial thickness (mm)	1.10 (1.05–1.15)**	1.1 (1.05–1.15)**	1.1 (1.08–1.13)**	1.1 (1.08–1.13)**	1.16 (1.09–1.21)**	1.14 (1.07–1.20)**
Endometrial type	1.36 (1.04–1.77)*	1.33 (1.01–1.75)*	1.47 (1.26–1.71)**	1.42 (1.21–1.67)**	1.26 (0.86–1.84)
No. of transfer embryos	1.15 (0.95–1.39)		1.12 (0.98–1.29)		2.30 (1.82–2.90)**	2.61 (2.03–3.36)**
P level on HCG day (IU/L)	0.88 (0.83–0.94)**		0.84 (0.81–0.88)**		0.96 (0.83–1.13)
Duration of pre-hCG P elevation (day)	0.84 (0.78–0.90)**	0.88 (0.81–0.95)**	0.81 (0.78–0.86)**	0.88 (0.84–0.93)**	0.88 (0.72–1.06)

BMI: body mass index; FSH: follicular stimulation hormone; Gn, gonadotropin; E₂, estrogen; hCG: human chorionic gonadotropin; P: progesterone; COR: crude odds ratio; AOR: adjusted odds ratio; CI: confidence interval. *p < 0.05, **p < 0.01

Table 3. Analysis of pre-hCG P elevation duration-related factors in the 8575 cycles.

Parameters	Pearson Correlation	p Value
Age (year)	0.052	0.000
BMI (Kg/m^2)	−0.062	0.000
Duration of infertility (year)	0.018	0.097
Basal FSH (IU/L)	−0.109	0.000
Basal P (IU/L)	0.027	0.013
Gn duration (days)	0.023	0.034
Gn dosage (IU)	0.065	0.000
E2 level on HCG day (IU/L)	0.318	0.000
LH level on HCG day (IU/L)	−0.064	0.000
P level on HCG day (IU/L)	0.763	0.000
No. of retrieved oocytes	0.259	0.000

BMI: body mass index; FSH: follicular stimulation hormone; P: progesterone; Gn: gonadotropin; E₂: estrogen; LH: luteinizing hormone.