Luteal phase serum progesterone levels after GnRH-agonist trigger - how low is still high enough for an ongoing pregnancy?

Abstract

In the past years, individualization of assisted reproductive technique (ART)-treatment is increasingly common to customize the treatment protocol to the patient’s specific conditions. The use of GnRH-agonist for final oocyte maturation in a gonadotropin-releasing hormone (GnRH)-antagonist protocol is the best approach to reduce the risk for ovarian hyperstimulation in high responder patients. However, due to severe luteolysis, the reproductive outcome with this approach in combination with the use of vaginal progesterone as luteal phase support, was poor. Cycle segmentation as alternative to a fresh transfer requires embryo freezing which might not be applicable to all patients due to various reasons. The concept of luteal coasting monitors the progesterone-level closely and human chorionic gonadotropin (hCG) for rescue of the corpora lutea is administered when the progesterone-level drops below a certain threshold. However, the lower range of progesterone levels in the early luteal phase after GnRH-agonist trigger, which is compatible with achieving and maintaining a pregnancy, is unknown. This case-series demonstrates, that ongoing pregnancies can be achieved even with a progesterone-level below 15 ng/ml in the early luteal phase with the timely administration of an hCG-rescue bolus. With the concept of luteal coasting, individualization of the luteal phase support according to the patient’s specific luteolysis pattern is possible.

Chinese abstract

在过去这些年, 个体化的辅助生殖技术治疗越来越普遍的根据患者个人的情况制定治疗方案。在卵母细胞成熟中GnRH拮抗剂方案中GnRHa的使用是在高应答患者中减少卵巢过度刺激风险的最好办法。然而, 即使联合使经阴道用的孕酮作为黄体支持, 由于严重的黄体溶解导致的生育结局并不好。代替新鲜移植采用的周期分割需要胚胎冷冻, 由于多种原因可能不适合于所有患者。当孕酮水平下降到一定阈值时, 为了解救黄体溶解采用黄体滑行监测孕酮和hCG水平。然而, 在GnRHa诱发排卵后黄体早期的低范围的孕酮值与获得并维持妊娠的一致性还不清楚。这个病例系列证实, 在黄体早期及时使用hCG解救方案即使孕酮水平低于15ng/ml, 也可以获得持续的妊娠。黄体滑行和根据患者特异性的黄体溶解方式进行个体化的黄体支持是必要的。

Keywords:

• GnRH-agonist trigger
• luteolysis
• progesterone level
• pregnancy

Disclosure statement

The authors report no declarations of interest.