Progesterone levels and IVF pregnancy: P-610

OBJECTIVE: Premature luteinizing hormone (LH) surge causes a 5-30% probability of preovulatory rise in serum progesterone (P4) during IVF cycle stimulation and is associated with negative outcome possibly due to premature endometrial maturation (poor uterine receptivity). Studies associating P4 measured on triggering day with pregnancy outcome are controversial. Significance of P4 measured 3-4 days before egg retrieval remains unknown. The objectives were: (1) to correlate P4 measured 3-4 days before IVF with pregnancy outcome and (2) to determine the ability of measuring P4 level 1-week after embryo transfer in predicting pregnancy outcome. DESIGN: Retrospective study in a tertiary academic center. MATERIALS AND METHODS:With IRB approval, chart reviews of 171 cases of IVF/ICSI cycles from 2013-2014 were carried out. 74 female patients were>35 years old. Day of P4 measurement either before egg retrieval or post-embryo transfer and the corresponding P4 levels were recorded and analyzed with pregnancy outcome. Exclusion criteria were missing data, P4 drawn>4 days before egg retrieval or>9 days post-embryo transfer. Clinical pregnancy was confirmed by ultrasound at 6 weeks. Data were analyzed by ANOVA and t-test adjusted for unequal variance. RESULT(S): The results were analyzed based on patient age and reproductive outcome. In pregnant patient who were 0.05). In pregnant patients who were > 35 years old, P4 were 1.1+/-0.5, 1.0+/-0.4, 1.3+/-0.9 ng/mL for 4, 3 or 2 days before egg retrieval respectively. In the non-pregnant group P4 were 0.6+/-1.2, 1.2+/-0.7, 1.0+/-0.6 ng/mL respectively. For the 35 years group, the P4 were 106.2+/-92.8 versus 45.3+/-21.2 ng/mL. The means were not significantly different. CONCLUSION(S): The results demonstrated P4 measurements 3-4 days before oocyte retrieval were not associated with pregnancy outcome. Furthermore, P4 levels on day 7 post-transfer were not useful in predicting outcome and testing considered wasted resource. The findings suggested either early follicular P4 was an ineffective marker for uterine receptivity or differences between local and systemic P4 existed. Limitations of the study included data from a single center, observational design and patient subpopulation residing in a Blue Zone region. In summary, P4 testing 3-4 days before retrieval was not useful in predicting outcome.