CONSEQUENCES OF PREMATURE PROGESTERONE ELEVATION ON THE OUTCOME OF IN-VITRO FERTILIZATION - INSIGHTS INTO A CONTROVERSY

Objective: To investigate whether the consequences of premature P elev ation on IVF-ET outcome are modulated by the quality of the ovarian re sponse to controlled ovarian hyperstimulation (COH). Design: Retrospec tive analysis. Setting: Assisted Reproduction Unit, Clamart, France. P atient(s): One thousand twelve women undergoing 1,189 IVF-ET cycles. I ntervention(s): Patients underwent COH with a time-released GnRH agoni st and hMG. The ovarian response to COH was classified as strong (less than or equal to 50 hMG ampules, peak E-2 levels >2,500 pg/mL, and gr eater than or equal to 10 mature oocytes; n = 340), weak (>50 hMG ampu les, peak E-2 levels less than or equal to 1,500 pg/mL, and less than or equal to 5 mature oocytes; n = 285), or intermediate (remaining cas es; n = 564). The IVF-ET outcome in each group was analyzed according to whether or not plasma P levels exceeded 0.9 ng/mL. Main Outcome Mea sure(s): Pregnancy rates (PRs). Result(s): Clinical PRs were similar i rrespective of low or high P levels in the strong (30% and 34%, respec tively) and intermediate (31% and 30%, respectively) groups. However, in the weak group, P levels >0.9 ng/mL were associated with lower PRs (3.2% and 23%, respectively). Conclusion(s): In the presence of an ade quate response to COH, P levels >0.9 ng/mL were not associated with lo wer PRs, indicating that good embryo quality may compensate for the ad verse endometrial effects of P. Conversely, when the response to COH w as weak, premature P elevation led to drastically reduced PRs. (C) 199 7 by American Society for Reproductive Medicine.