Elevated serum progesterone on the day of HCG administration in IVF is associated with a higher pregnancy rate in polycystic ovary syndrome

Our study compared 84 patients with polycystic ovary syndrome (PCOS) with 8 4 control patients who had normal ovaries and who were matched for the main determinants of success in in-vitro fertilization (IVF) and embryo transfe r. Serum concentrations of oestradiol and progesterone on the day of human chorionic gonadotrophin (HCG) injection were significantly higher in PCOS t han in normal patients (oestradiol 2016 +/- 1.8 pg/ml versus 1456 +/- 40.9 pg/ml, P < 0.01; progesterone 1.6 +/- 0.1 ng/ml versus 1.2 +/- 0.1 ng/ml, P = 0.03). Furthermore despite oocytes from PCOS patients having a reduced f ertilization rate compared with normal patients (61.8 +/- 4.1% versus 73.5 +/- 4.3%, P = 0.03), the differences in pregnancy rate (22.6 versus 19%) an d miscarriage (31.5 versus 18.7%) were not statistically significant. In PC OS patients, a critical breakpoint was identified at serum progesterone con centrations of 1.2 ng/ml on the day of HCG injection. The PCOS patients wit h progesterone greater than or equal to 1.2 ng/ml showed a higher pregnancy and miscarriage rate than PCOS patients with progesterone <1.2 ng/ml (26.6 versus 17.9%, P < 0.01; and 41.7% versus 14.3%, P < 0.01 respectively). Th ese findings suggest that premature progesterone production does not have a n adverse effect on pregnancy rate in PCOS, but on the contrary, may be a p redictor for success in IVF/embryo transfer.