ELEVATED SERUM PROGESTERONE LEVELS DURING PITUITARY SUPPRESSION MAY SIGNIFY ADRENAL HYPERANDROGENISM

Objective: To investigate whether elevated serum P levels after pituit ary down-regulation signify adrenal enzyme defects or hyperandrogenism . Design: Prospective study. Setting: Assisted reproduction unit in a university medical center. Patient(s): Two hundred twenty-seven IVF pa tients treated by the long down-regulation protocol. Intervention(s): Oral dexamethasone (DEX) administration if P level exceeded 0.8 ng/mL (conversion factor to SI unit, 3.180) after pituitary suppression. Mai n Outcome Measure(s): Serum concentrations of P, E-2, LH, DHEAS, and 1 7 alpha-hydroxyprogesterone and ACTH stimulation tests. Result(s): In eight patients (3.5%), serum P levels exceeded 0.8 ng/mL and E-2 and L H levels confirmed pituitary down-regulation. Mean DHEAS levels in the patients in this group were significantly higher than in the other pa tients. All eight patients demonstrated a significant decrease in seru m P level after DEX administration. In five patients the ACTH stimulat ion test suggested an adrenal defect. Five pregnancies were achieved a fter the addition of DEX to the treatment protocol. Conclusion(s): Hig h serum P levels after pituitary down-regulation appear to be of adren al origin and may be the first indication of an adrenal enzyme defect. Further investigation such as an ACTH stimulation test is recommended , followed by treatment with DEX if indicated. (C) 1997 by American So ciety for Reproductive Medicine.