PREMATURE LUTEINIZATION AS DETECTED BY ELEVATED SERUM PROGESTERONE ISASSOCIATED WITH A HIGHER PREGNANCY RATE IN DONOR OOCYTE IN-VITRO FERTILIZATION

Premature luteinization has been reported to be associated with decrea sed pregnancy rates in patients undergoing in-vitro fertilization. How ever, the detrimental effect created by a pre-aspiration rise in proge sterone is difficult to assess since ovarian stimulation affects both oocyte quality and endometrial receptivity. Therefore, the relationshi p between premature luteinization and pregnancy rates remains uncertai n. To achieve improved control for confounding variables, we studied p remature luteinization in ovum donors of proven fertility. A total of 114 consecutive ovum donation cycles using pituitary suppression with a gonadotrophin-releasing hormone agonist followed by gonadotrophin st imulation were examined. Serum progesterone concentration on the day o f administration of human chorionic gonadotrophin (HCG) was > 1.2 ng/m l in 29% of patients. Patients were divided into two groups based on t his value. There was a significant increase in clinical pregnancy rate s per embryo transfer in the group with higher progesterone concentrat ions (53 versus 25%, P = 0.012), as well as significantly more oocytes obtained at aspiration (19.6 +/- 10.4 versus 13.3 +/- 5.4, P < 0.001) , and significantly higher peak serum oestradiol values (3903 +/- 1787 versus 2453 +/- 1232 pg/ml, P < 0.001). There were no significant dif ferences between groups due to age, degree of stimulation or the numbe r of embryos transferred. We conclude that premature luteinization as based on elevated serum progesterone concentration is a common occurre nce in oocyte donors, reflects healthy follicular development, and is associated with increased pregnancy rates.