The relationship of premature progesterone rise with serum estradiol levels and number of follicles in GnRH antagonist/recombinant FSH-stimulated cycles

Objective(s): To investigate the relationship between premature progesterone (P) rise and serum estradiol (E-2) levels and the number of follicles in GnRH antagonist/rec-FSH stimulated cycles. Study design: Two hundred and seven patients treated by IVF/ICSI at the Centre for Reproductive Medicine of the Dutch-Speaking Brussels Free University were included in this observational study. They received 200 IU/day rec-FSH from day 2 of the cycle and daily GnRH antagonist starting on day 6 of stimulation. The criteria for hCG administration included the presence of >= 3 follicles of >= 17 mm diameter. Serum P, E-2 and LH were determined on the day of hCG administration. The outcome measure was to identify a threshold of E-2 and number of follicles on the day of hCG administration which would define a progesterone rise on the day of hCG administration (cut-off value of 1.5 ng/ml). Result(s): Patients with a P >1.5 ng/ml had significantly higher concentrations of E-2 and increased number of follicles on the day of hCG administration compared to those with P <= 1.5 ng/ml. However, patients with a P >1.5 ng/ml the day of hCG showed lower pregnancy rates than those with P <1.5 ng/ml (17.8 vs. 32.7%, respectively; p < 0.05). A ROC curve was employed in order to estimate a cut-off for E-2 on day of hCG >1790.5 pg/ml and more than 9.5 follicles of >= 11 mm in diameter for progesterone rise over 1.5 ng/ml. Conclusion(s): A significant impact is shown on progesterone rise by E-2 and number of follicles on the day of hCG administration in GnRH antagonist/rec-FSH-stimulated cycles. With this knowledge, an upcoming progesterone rise during follicular phase can be anticipated and prevented. (C) 2012 Elsevier Ireland Ltd. All rights reserved.