Follicular progesterone elevations with ovulation induction for IVF

Abstract

The purpose of this review is to analyse the sources and effects of follicular progesterone elevations during ovarian stimulation, with the underlying mechanisms and preventive strategies on the in vitro fertilisation pregnancy outcome. In the early follicular phase, a flare-up effect of gonadotrophin releasing hormone (GnRH) agonists and incomplete luteolysis in GnRH antagonist regimens can result in significant elevations of progesterone. In the late follicular phase, progesterone elevations in GnRH analogue cycles are the result of the ovarian stimulation itself, driven by high follicle stimulating hormone dosage, estradiol levels, the number of follicles and oocytes. It seems that progesterone elevations (> or = 1.5 ng/mL or 4.77 nmol/L) have a detrimental effect on the outcome of pregnancy, accelerating the endometrial maturation. The most appropriate choice to avoid the negative effects of follicular progesterone elevations is to cancel fresh embryo transfer and to transfer frozen–thawed embryos in natural cycles. To prevent follicular phase elevations it might be preferable to use milder stimulation protocols, earlier trigger of ovulation in high responders and single-blastocyst transfer on day 5. The optimal GnRH analogue protocols during the entire stimulation period appear to be the long agonist as well as “long” and long GnRH antagonist regimens.

Chinese abstract

这篇综述的目的是分析促排卵期间卵泡黄体激素的来源和作用，体外受精妊娠结局的机制及预防策略。在早卵泡期，促性腺激素释放激素（gonadotrophin releasing hormone，GnRH）激动剂的扳机效应和GnRH拮抗剂中不完整的黄体溶解效应会导致孕激素的升高。在晚卵泡期，GnRH类似物周期孕激素升高是促排卵本身，高卵泡刺激激素用量，雌二醇水平，卵泡和卵母细胞的数量驱动的结果。 孕激素升高似乎（>或=1.5ng/mL或4.77 nmol / L的）对妊娠结局产生不良影响，加速子宫内膜成熟。避免卵泡黄体激素升高的负面影响， 最合适的选择是取消新鲜胚胎移植，而在自然周期移植解冻的胚胎。为避免卵泡期卵泡黄体激素升高，可以使用温和的刺激方案，对高反应者进行较早的排卵诱发，并在第5天进行单个囊胚移植。在整个刺激周期最佳的GnRH类似物方案似乎是长激动剂“长”和长GnRH拮抗剂方案。

• Follicular progesterone elevation
• IVF
• ovarian stimulation
• prevention