Impact of blood levels of progesterone on the day of ovulation onset on clinical, laboratory and reproductive parameters of young patients undergoing assisted reproduction: a cross-sectional study

Fernandez, Renata Garcia Olmos; Barbosa, Caio Parente; Christofolini, Denise Maria; de Alcantara Sousa, Luiz Vinicius; de Oliveira, Renato; Bianco, Bianca

doi:10.31744/einstein_journal/2022AO6896

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Original Article • einstein (São Paulo) 20 • 2022 • https://doi.org/10.31744/einstein_journal/2022AO6896 copy

Impact of blood levels of progesterone on the day of ovulation onset on clinical, laboratory and reproductive parameters of young patients undergoing assisted reproduction: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To assess whether there is an association between the level of progesterone on the day of administration of human chorionic gonadotropin and clinical and laboratory characteristics, in addition to the results of in vitro fertilization of patients with a good prognosis.

Methods:

A cross-sectional study comprising 103 women who underwent intracytoplasmic sperm injection treatment, between November 2009 and May 2015, aged ≤35 years, with no comorbidities, with fresh embryo transfer. Data were collected from patient medical records.

Results:

There was a weak positive correlation between the level of progesterone on the day of human chorionic gonadotropin and the number of follicles larger than 14mm (ß=0.02, p=0.001), retrieved oocytes (ß=0.01, p=0.01) and oocytes in metaphase II (MII) (ß=0.02, p=0.02); that is, the increase in progesterone level has a slight association with increased values of these variables. Body mass index was inversely correlated with progesterone level on the day of human chorionic gonadotropin (ß=-0.01, p=0.02). No association was found between the level of progesterone on the day of human chorionic gonadotropin and the protocols used for controlled ovarian stimulation, quality of transferred embryos and the pregnancy rate.

Conclusion:

There is an association between the value of progesterone on the day of human chorionic gonadotropin administration with body mass index, number of follicles larger than 14mm, number of retrieved oocytes and oocytes in metaphase II. Unlike embryo quality and pregnancy rate, which do not have a statistically significant relation with this value in the population studied.

Keywords:
Chorionic gonadotropin; Fertilization in vitro; Infertility; Progesterone

Variables		Median (95%CI)
n		103
Age, years^* * variables were presented as median and 95% confidence interval.		33 (32-33)
BMI (kg/m²)^* * variables were presented as median and 95% confidence interval.		24.4 (23.1-25.0)
Infertility type, n (%)
	Primary	77 (74.8)
	Secondary	26 (25.2)
Cause of infertility, n (%)
	Male factor	79 (76.7)
	Tubal factor	4 (3.9)
	Male factor + tubal factor	12 (11.6)
	Idiopathic	8 (7.8)
TSH (IU/mL)^* * variables were presented as median and 95% confidence interval.		1.8 (1.50-1.90)
LH (mIU/mL)^* * variables were presented as median and 95% confidence interval.		4.9 (4.5-5.1)
FSH (IU/mL)^* * variables were presented as median and 95% confidence interval.		6.6 (6.3-6.9)
Prolactin (ng/mL)^* * variables were presented as median and 95% confidence interval.		14 (13.0-16.0)
AFC^* * variables were presented as median and 95% confidence interval.		10 (10-11)
COS protocol, n (%)
	Antagonist 100IU	34 (33.0)
	Antagonist 150IU	20 (19.4)
	Antagonist 200IU	48 (46.6)
	Agonist 100IU	1 (1.0)
COS days (days)^* * variables were presented as median and 95% confidence interval.		9 (9.0-9.4)
Total dose of rFSH^* * variables were presented as median and 95% confidence interval.		1,500 (1,350-1,650)
Progesterone in hCG day (ng/mL)^* * variables were presented as median and 95% confidence interval.		0.7 (0.6-0.8)
Follicles >14mm^* * variables were presented as median and 95% confidence interval.		8 (7-8)
Retrieved oocytes^* * variables were presented as median and 95% confidence interval.		7 (6-7)
MII^* * variables were presented as median and 95% confidence interval.		6 (4.1-6.0)
Embryos^* * variables were presented as median and 95% confidence interval.		3 (2-3)
Transferred embryos^* * variables were presented as median and 95% confidence interval.		2 (2-2)
Quality of transferred embryos, n (%)
	Absence of embryos	3 (2.9)
	D3	75 (72.8)
	D5	25 (24.3)
Pregnancy/cycle, n (%)		50 (48.5)

Variables	β	p value^* * Spearman correlation;
Age	-0.01	0.267
BMI	-0.01	0.02
Type of infertility	0.32	0.14^† † Kruskal-Wallis test.
FSH	0.01	0.4
LH	0.01	0.39
TSH	-0.015	0.59
Prolactin	0.006	0.06
Blood glucose	0.003	0.378
AFC	-0.004	0.53
COS duration	-0.006	0.76
Total dose of rFSH	0	0.32
Visualized follicles	0.02	0.001
Retrieved oocytes	0.01	0.01
MII	0.02	0.02
Embryos	0.015	0.297

Variables		Progesterone (ng/mL)^* * progesterone level was presented as median and 95% confidence interval;	p value
COS protocols			0.40^† † Kruskal-Wallis test;
	Antagonist 100IU	0.65 (0.5-0.8)
	Antagonist 150IU	0.6 (0.51-0.72)
	Antagonist 200IU	0.8 (0.6-0.9)
	Agonist 100IU	0.6 (0.6-0.6)
Embryo quality
	Absence of embryos	0.67 (0.33-0.8)	0.74^† † Kruskal-Wallis test;
	D3	0.73 (0.59-0.8)
	D5	0.7 (0.6-0.8)
Pregnancy
	Positive	0.7 (0.59-0.77)	0.477^# # Mann-Whitney.
	Negative	0.73 (0.59-0.9)	0.477^# # Mann-Whitney.

Variables		Response to controlled ovarian stimulation		p value
Variables		Low	Satisfactory	p value
n		13	90
Age, years		33 (32.4-34)	33 (32-33)	0.302^† † Kruskal-Wallis test;
BMI (kg/m²)		26.9 (24.73-30.11)	24.0 (22.53-24.88)	0.017^† † Kruskal-Wallis test;
Infertility type (%)
	Primary	76.92	74.44	0.045^# # χ2 Test;
	Secondary	23.08	25.56
TSH (IU/mL)^* * variables were presented as median and 95%CI.		1.7 (1.33-2.45)	1.8 (1.5-1.9)	0.988^† † Kruskal-Wallis test;
LH (mIU/mL)^* * variables were presented as median and 95%CI.		4.7 (3.39-5.50)	4.95 (4.43-5.28)	0.413^† † Kruskal-Wallis test;
FSH (IU/mL)^* * variables were presented as median and 95%CI.		6.4 (5.97-7.14)	6.7 (6.3-6.98)	0.736^† † Kruskal-Wallis test;
Prolactin (ng/mL)^* * variables were presented as median and 95%CI.		14 (13.23-17.45)	13.9 (11.41-16.36)	0.644^† † Kruskal-Wallis test;
AFC^* * variables were presented as median and 95%CI.		11 (5.78-12)	10 (10-11)	0.531^† † Kruskal-Wallis test;
COS days (days)^* * variables were presented as median and 95%CI.		9 (8-10)	9 (9-10)	0.588^† † Kruskal-Wallis test;
Total dose of rFSH^* * variables were presented as median and 95%CI.		1,350 (1,050-1,660)	1,500 (1,350-1,744)	0.132^† † Kruskal-Wallis test;
Progesterone on the day of hCG (ng/mL)^* * variables were presented as median and 95%CI.		0.5 (0.33-0.82)	0.73 (0.6-0.8)	0.036^† † Kruskal-Wallis test;
Oocytes ^* * variables were presented as median and 95%CI.		2 (2-3)	7 (7-8)	<0.001^† † Kruskal-Wallis test;
MII^* * variables were presented as median and 95%CI.		2 (1-3)	6 (5-7)	<0.001^† † Kruskal-Wallis test;
Embryos^* * variables were presented as median and 95%CI.		2 (1-2)	3 (2-3)	0.001^† † Kruskal-Wallis test;
Transferred embryos		2 (1-2)	2 (2-2)	0.491^† † Kruskal-Wallis test;
Quality of transferred embryos, n (%)
	Absence of embryos	1 (7.69)	3 (3.33)	0.105^& & Mann-Whitney test.
	D3	12 (92.31)	62 (68.89)
	D5	0	25 (27.78)
Pregnancy/cycle, n (%)		7 (53.85)	43 (47.78)	0.710^# # χ2 Test;

Embryo quality	Biochemical pregnancy		p value^* * χ² test.
Embryo quality	Positive	Negative	p value^* * χ² test.
D3	0.71 (0.56-0.8)	0.73 (0.52-0.9)	0.404
D5	0.60 (0.50-0.81)	0.80 (0.47-0.97)	0.404

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[1] Corresponding author: Bianca Bianco, Centro Universitário FMABC Avenida Lauro Gomes, 2.000 Vila Príncipe de Gales Zip code: 09060-650 – Santo André, SP, Brazil. Phone: (55 11) 4993-5464 E-mail: bianca.bianco@fmabc.br