The dosage of human chorionic gonadotropins influences the relationship between progesterone and cycle outcome during in vitro fertilization-embryo transfer

Objective-To determine if the dose of hCG affects the initial rise in proge sterone seen in patients undergoing IVF-ET and therefore affects it usefuln ess as a predictor of cycle outcome. Design-Comparison of the rise in proge sterone with cycle outcomes for IVF patients receiving 5,000 or 10,000 mIU hCG to stimulate oocyte maturation. Setting-University-based infertility pr ogram. Patients-One hundred six patients undergoing IVF-ET on a long protoc ol of down-regulation with GnRH, hMG stimulation, and hCG to stimulate oocy te maturation. Stimulation protocol varied only in dose of hCC [5,000 mIU ( N = 72) vs. 10,000 mIU (N = 34)]. Main Outcome Measure(s)-Rise in progester one from 12 hours before to 12 hours after hCG administration and its relat ionship with cycle outcome. Results-All 106 women exhibited a rise in proge sterone following the administration of hCG. As seen in earlier studies, th ere appeared to be a relationship between minimal progesterone increases (< 3-foldl) and cycle failure in patients receiving 5,000 mIU (P < .02). Howev er, using the criteria of the previous study, there appears to be no relati onship between progesterone and cycle outcome in patients receiving 10,000 mIU (P = .30). Further, the higher dose of hCG appeared to induce greater i ncreases in progesterone over the 24-hour period examined (P < .02). After readjustment of the critical value to 3.5-fold, there was an increased tend ency toward cycle failure in women exhibiting a minimal progesterone increa se. Unlike the relationship associated with 5,000 mIU hCC;, though, the rel ationship between 10,000 mIU hCG and progesterone levels was not statistica lly different (P = .10). Conclusions-Increasing the dose of hCG used to sti mulate oocyte maturity shifts the previously described relationship between progesterone and IVF-ET-cycle outcome. However, while it remains unclear i f progesterone can be used as a predictor of outcome at the higher hCG dose , it appears clear that a relationship exists between minimal progesterone response to hCG and cycle failure.