Background: The embryo-endometrium dialogue remains
incompletely understood. During conventional in vitro fertilisation cycles,
progesterone elevation on the day of human chorionic gonadotropin
administration refers to rising progesterone levels in the absence of either
premature or a luteinizing hormone surge. Most research has reported that
elevated progesterone had an adverse impact on the endometrial environment of
fresh cycles, leading to a decrease in pregnancy rates. High progesterone
levels on the day of Human Chorionic Gonadotropin trigger induce advanced
endometrial histological maturation and differential endometrial gene
expression, which lead to implantation failure.
Aim: The aim of the study is to investigate the impact of
elevated progesterone levels on the clinical outcomes of in vitro
fertilisation.
Methods: The current study was undertaken at Swagat Hospital
and Research Centre, Bongaigaon, Assam (India). Fifty patients undergoing in
vitro fertilisation (IVF) were selected for the study. Baseline estimation of
follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Mullerian
hormone (AMH), (estrogen) E2 and (transvaginal sonography) TVS was done. The
patients were grouped on the basis of their progesterone levels on the day of hCG
trigger, with the cutoff for defining premature progesterone rise being
(progesterone) P4≥ 3ng/ml. Final oocyte maturation was induced with hCG. Oocyte
retrieval was performed 34-36 h after hCG. Two to three embryos of the day 3
cleavage stage were transferred under TVS guidance. The parameters obtained
from each cycle were recorded. Statistical analysis was performed. A
probability (P) value <0.05 was considered statistically significant. A
sonographic confirmation of pregnancy was performed 2 weeks after a β-hCG
positive. Statistical analysis was conducted using SPSS v23.0, with the
Chi-square test for categorical data, ANOVA for quantitative variables, and
significance set at P<0.05.
Results: On dividing the patients into two groups based on
the cut-off of P4 as 3ng/ml, it was observed that the no of cases that
conceived was significantly higher in the subjects whose P4 level was less than
or equal to 3ng/ml than in the subjects whose P4 level was more than 3ng/ml.
Conclusions: The present study showed an adverse
relationship between higher circulating serum concentration of P4 and clinical
pregnancy rate. Elevated P4 level just before trigger is a reflection of
endometrial maturity that can cause disparity between endometrial and embryonic
ageing and therefore hamper implantation or cause failure in assisted
reproductive technology (ART).
Author(s) Details
Sankar Kumar Das
Department of Obstetrics and Gynecology, Swagta Hospital and Research
Center, Bongaigaon Assam, India and Department of Obstetrics and Gynecology,
Gauhati Medical College and Hospital, Guwahati, Assam, India.
Priyanka Roy
Department of Obstetrics and Gynecology, Swagta Hospital and Research
Center, Bongaigaon Assam, India and Department of Obstetrics, Assam Medical
College and Hospital, Dibrugarh, Assam, India.
Krishna Kalita
Department of Obstetrics and Gynecology, Swagta Hospital and Research
Center, Bongaigaon Assam, India and Department of Obstetrics and Gynecology,
Assam Agricultural University, Jorhat, Assam, India.
Please see the book here:- https://doi.org/10.9734/bpi/msraa/v9/5481
