Controlled Ovarian hyperstimulation (COH) is generally used to obtain synchronous high quality oocytes in in vitro fertilization-embryo thansfer (IVF-ET). Many investigators have studied the relationship between serum hormone levels and outcomes
of
IVF-ET because there is no accurate estimation method of oocyte quality.
Early premature luteinization of follicles before oocyte retrieval is the most troublesome problem in COH for IVF-ET. Gonadotropin-releasing hormone agonists (GnRH-a) are used as adjuncts with gonadotropins for COH in patients undergoing in IVF.
The
possible benefits of GnRH-a pretreatment include improving oocyte quality, allowing a more synchronous cohort of follicles to be recruited, and preventing premature lueinization hormone surges. In COH of IVF cycles, we investigated whether an
elevated
progesterone (P4) level on the day of human chorionic gonadotropin (hCG) administration indicates premature luteinization and is associated with a lower fertilization rate. Many investigators have studied that the lower fertilization rates seen
in
patients with elevated P4 levels might result from an adverse effect of P4 on the oocytes. We hypothesizes that serum P4 levels around the day of hCG may be helpful prediction of out come in IVF-ET cycles.
Success rates after COH of IVF-ET cycles are dependent upon many variable factors. Follicular factors including the number of follicles, follicular diameters and especially serum estradiol (E2) levels as an indirect measurement of follicular and
guality
have been thought to influence the outcomes of IVF-ET.
To assess whether serum P4 and E2 levels affect the fertilization and pregnancy rate, we reviewed the stimulation cycles of 113 patients (119 cycles) undergoing IVF-ET with short protocol with GnRH-a, from March 1993 to August 1994
retrospectively.
The
serum P4 and E2 levels were compared on the day of hCG in the pregnant group, 45 patients (47 cycles) and in the non-pregnant group, 68 patients (72 cycles) respectively. The serum E2 level in non-pregnant group was 1367±875.8pg/ml which was
significantly lower than that of pregnant group, 1643±987.9pg/ml (p<0.01). And the serum p4 level in non-pregnant group was 2.1±1.4ng/ml which was significantly higher than that of pregnant group, 1.0±0.7ng/ml (p<0.001). The fertilization rate
was
61.3±21.3% in pregnant group which was higher than that of non-pregnant group, 41.1±20.2% (p<0.01).
We suggest that the serum levels of P4 and E2 on the day of hCG administration are additional parameters that predict the outcomes of IVF-Et cycles.
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