THE SIGNIFICANCE OF PLASMA PROGESTERONE LEVELS DURING EARLY PREGNANCIES ACHIEVED AFTER IN-VITRO FERTILIZATION (IVF) TREATMENT

Objective: Corpus luteum steroidogenesis is lower for in vivo ectopic pregnancy than for intrauterine pregnancy. There is a progresterone ha llmark level distinguishing between viable intrauterine pregnancy and nonviable or ectopic pregnancy. This study attempts to answer whether this is also true for in vitro fertilization-treated patients. Study D esign: Using information retrieved from a computerized database, we co mpared the plasma 17beta-estradiol (E2) and progesterone during the lu teal phase and for every 2 to 3 days for several weeks during early pr egnancy between those patients with proven ectopic pregnancies and tho se with singleton and multiple intrauterine pregnancies. Vaginal ultra sonography to detect an intrauterine gestational sac was performed fro m day 19. A total of 73 pregnancies resulted from the replacement of f resh embryos in our in vitro fertilization-embryo transfer program. Re sults: Only at day 10 post embryo transfer did those patients with ect opic pregnancy show statistically lower mean (SD) serum levels of E2 [ 2257 (SD, 2351) pmol/L] and plasma progesterone [PP; 221 (SD, 283) nmo l/L] compared with patients with intrauterine pregnancy, whose mean E2 was 8846 (SD, 5871) pmol/L and mean PP was 805 (SD, 582) nmol/L (P = 0.008). For the rest of the follow-up until surgery was performed in e ctopic pregnancy, there were no differences of statistical significanc e between extrauterine pregnancy and the intrauterine pregnancy groups . Furthermore, only on day 10 post embryo transfer, did we find a disc riminatory zone (confidence interval, 95%) for E2 levels (903 to 3502 pmol/L for EP vs 6116 to 9493 pmol/L for a singleton and 4875 to 9493 pmol/L for multiple pregnancies). PP levels were 26 to 283 nmol/L for ectopic pregnancy versus 496 to 1096 nmol/L for both singleton and mul tiple pregnancies. An intrauterine gestational sac was visualized at a mean of 23.2 (SD, 4) days after embryo transfer. On this day, the mea n P levels were 982.6 (SD, 286.2) nmol/L for intrauterine and 804.5 (S D, 502.4) nmol/L for ectopic pregnancies (P = NS). Conclusions: Except for day 10 post embryo transfer, the steroidogenesis in ectopic pregn ancy after in vitro fertilization treatment does not differ from succe ssful intrauterine pregnancy. This observation negates an impaired ste roidogenesis for ectopic pregnancy after in vitro fertilization and ma kes the PP level irrelevant in the diagnosis of pregnancy implantation .