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The effect of elevated progesterone levels before HCG triggering in modified natural cycle frozen-thawed embryo transfer cycles

Reproductive BioMedicine Online, Volume 34, Issue 5, May 2017, Pages 546 - 554

Abstract

Recent studies suggest that elevated late follicular phase progesterone concentrations after ovarian stimulation for IVF may result in embryo–endometrial asynchrony, reducing the chance of successful implantation after fresh embryo transfer. It remains unclear to what extent elevated late follicular phase progesterone levels may occur in unstimulated cycles before frozen–thawed embryo transfer, or what affect they may have on outcomes. In this cohort study, 271 patients randomized to the modified natural cycle arm of a randomized controlled trial comparing two endometrial preparation regimens underwent late follicular phase progesterone and LH testing. A receiver operating characteristic curve was constructed to identify a progesterone cut-off level with the best predictive value for live birth (progesterone level ≥4.6 nmol/l). A total of 24.4% of patients revealed an isolated elevated serum progesterone of 4.6 nmol/l or greater, and 44.3% showed an elevated progesterone level in association with a rise in LH. Neither endocrine disruption affected outcomes, with live birth rates of 12.9% versus 10.6% (OR 0.6, 95% CI 0.19 to 1.9) and 11.9% versus 17.5% (OR 1.6, 95% CI 0.79 to 3.1), respectively. Whether monitoring of progesterone and LH in natural cycle frozen–thawed embryo transfer has added clinical value should studied further.

Keywords: Frozen-thawed embryo transfer, Live birth rate, Modified natural cycle, Progesterone.

Footnotes

e Amphia Hospital, Department of Obstetrics and Gynaecology, Breda, The Netherlands

f Meander Medical Center, Department of Obstetrics and Gynecology, Amersfoort, The Netherlands

g University Medical Centre Utrecht, Department for Reproductive Medicine, Utrecht, The Netherlands

h Jeroen Bosch Hospital, Department of Obstetrics and Gynaecology, ‘s Hertogenbosch, The Netherlands

i Albert Schweitzer Hospital, Department of Obstetrics and Gynaecology, Zwijndrecht, The Netherlands

j University Medical Center Nijmegen, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands

k Noordwest Ziekenhuis, Department of Obstetrics and Gynecology, Den Helder, The Netherlands

l Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands

m Department of Obstetrics and Gynecology, University Medical Center Groningen, The Netherlands

n Medisch Spectrum Twente, Department of Obstetrics and Gynaecology, Enschede, The Netherlands

o Onze Lieve Vrouwe Gasthuis, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands

p Máxima Medical Centre, Department of Obstetrics and Gynaecology, Veldhoven, Netherlands

q Department of Obstetrics and Gynecology, Erasmus Medical Center Rotterdam, The Netherlands

r Deventer Hospital, Department of Obstetrics and Gynecology, Deventer, The Netherlands

s Diakonessenhuis, Department of Obstetrics and Gynecology, Utrecht, The Netherlands

t Catharina Hospital, Department of Obstetrics and Gynaecology, Eindhoven, The Netherlands

u Medisch Centrum Leeuwarden, Department of Obstetrics and Gynecology, Leeuwarden, The Netherlands

a Department of Obstetrics and Gynecology, Noordwest Ziekenhuis, Location Den Helder, PO box 501, 1800 AM Alkmaar, The Netherlands

b Department of Obstetrics and Gynecology, Academic Unit of Human Development and Health, University of Southampton, University Road, Southampton SO17 1BJ, UK

c Department of Obstetrics and Gynaecology, University Hospital Zealand, Roskilde, Denmark

d Isala Fertility Center, Isala Clinics. PO box 10400, 8000 GK, Zwolle, The Netherlands

* Corresponding author.

1 ANTARTICA Study Group: Amani Al-Oraiby, Amphia Hospital, Department of Obstetrics and Gynaecology, Breda, The Netherlands; Egbert A Brinkhuis, Meander Medical Center, Department of Obstetrics and Gynecology; Amersfoort, The Netherlands; Frank JM Broekmans, University Medical Centre Utrecht, Department for Reproductive Medicine, Utrecht, The Netherlands; Jan-Peter de Bruin, Jeroen Bosch Hospital, Department of Obstetrics and Gynaecology, ‘s Hertogenbosch, Netherlands; Grada van der Dool, Albert Schweitzer Hospital, Department of Obstetrics and Gynaecology, Zwijndrecht, The Netherlands; Kathrin Fleisher, University Medical Center Nijmegen, Department of Obstetrics and Gynecology. Nijmegen, The Netherlands; Jaap Friederich, Noordwest Ziekenhuis, Department of Obstetrics and Gynecology, Den Helder, The Netherlands; Mariëtte Goddijn, Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands; Annemieke Hoek, Department of Obstetrics and Gynecology, University Medical Center Groningen, The Netherlands; Diederik A Hoozemans, Medisch Spectrum Twente, Department of Obstetrics and Gynaecology, Enschede, The Netherlands; Eugenie M Kaaijk, Onze Lieve Vrouwe Gasthuis, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands; Carolina AM Koks, Máxima Medical Centre, Department of Obstetrics and Gynaecology, Veldhoven, Netherlands; Joop SE Laven, Department of Obstetrics and Gynecology, Erasmus Medical Center Rotterdam, The Netherlands; Paul JQ van der Linden, Deventer Hospital, Department of Obstetrics and Gynecology, Deventer, The Netherlands; A Petra Manger, Diakonessenhuis, Department of Obstetrics and Gynecology, Utrecht, The Netherlands; Minouche van Rumpste, Catharina Hospital, Department of Obstetrics and Gynaecology, Eindhoven, Netherlands; Taeke Spinder, Medisch Centrum Leeuwarden, Department of Obstetrics and Gynecology, Leeuwarden, The Netherlands.