Does the E2/P Ratio Predictor have a Role in the IVF Outcome during Ovulation İnduction?
DOI:
https://doi.org/10.20941/2309-4400.2019.07.4Keywords:
Gonadotropin-releasing hormone agonist protocol, hCG-day, progesterone, progesterone/estradiol ratio.Abstract
Objective: The present study investigates the role of hCG day serum P/E ratio in predicting the chemical pregnancy rate in cycles subject to in vitro fertilization - intracytoplasmic sperm injection - embryo transfer (IVF-ICSI-ET) following controlled ovarian stimulation (COS) accompanied by gonadotropin-releasing hormone agonists (GnRH).
Methods: The study retrospectively examined a total of 2,517 patients treated with IVF.All patients underwent an oocyte pick-up (OPU) procedure, and subjects were included in the GnRH-agonist short protocol study upon a total of 140 fresh embryo transfers based on inclusion/exclusion criteria.
Findings: The hCG day P/E ratio of the patients that did not end in chemical pregnancy was found 0.7415 ± 0.0010285, which was 2.4637 ± 0.0099075 for those ended in chemical pregnancy. The P/E ratio of patients with and without chemical pregnancy was not statistically significant (p=0.718).
Conclusion: In IVF patients subject to fresh embryo transfer and administered an agonist cycle, the ratio of serum P level to the E level on the same day does not seem to be an effective parameter in predicting the rate of chemical pregnancy.Further studies with wider series of patient populations are required to clarify this matter.
References
Soliman S, Daya S, Collins J, et al. The role of luteal phase support in infertility treatment: a meta-analysis of randomized trials. Fertil Steril 1994; 61: 1068-1076. https://doi.org/10.1016/S0015-0282(16)56758-2
Janssens RM, Lambalk CB, Vermeiden JP, et al. Dosefinding study of triptorelin acetate for prevention of a premature LH surge in IVF: a prospective, randomized, double-blind, placebo- controlled study. Hum Reprod 2000; 15: 2333-40. https://doi.org/10.1093/humrep/15.11.2333
Templeton A, Morris JK. Reducing the risk of multiple births by transfer of two embryos after in vitro fertilization. N Engl J Med 1998; 339: 573-7. https://doi.org/10.1056/NEJM199808273390901
Smitz J, Ron-El R, Tarlatzis BC. The use of gonadotrophin releasing hormone agonists for in vitro fertilization and other assisted procreation techniques: experience from three centres. Hum Reprod 1992; 7 Suppl 1: 49-66. https://doi.org/10.1093/humrep/7.suppl_1.49
Pritts EA, Atwood AK. Luteal phase support in infertility treatment: A meta-analysis of the randomized trials. Hum Reprod 2002; 17: 2287-99. https://doi.org/10.1093/humrep/17.9.2287
Fauser BC, Devroey P. Reproductive biology and IVF: ovarian stimulation and luteal phase consequences. Trends in Endocrinology and Metabolism 2003; 14: 236-42. https://doi.org/10.1016/S1043-2760(03)00075-4
Hugues JN, Cedrin-Dunerin I. Revisiting gonadotropin releasing hormane agonist protokols and management of poor responses to gonadotropins. Hum Reprod Update 1998; 4: 83-101. https://doi.org/10.1093/humupd/4.1.83
Younis JS, Matilsky M, Radin O, et al. Increased progesterone/estradiol ratio in the late follicular phase could be related to low ovarian reserve in in vitro fertilizationembryo transfer cycles with a long gonadotropin-releasing hormone agonist. Fertil Steril 2001; 76: 294-9. https://doi.org/10.1016/S0015-0282(01)01918-5
Cetinkaya ES, Berker B, Aytac R, et al. The value of the progesterone-to-estradiol ratio on the day of hCG administration in predicting ongoing pregnancy and live birth rates in normoresponders undergoing GnRH antagonist cycles. Eur J Obstet Gynecol Reprod Biol 2013; 170: 452-7. https://doi.org/10.1016/j.ejogrb.2013.07.033
Engel JB, Griesinger G, Schultze-Mosgau A, et al. GnRH agonists and antagonists in assisted reproduction: pregnancy rate. Reprod Biomed Online 2006; 13: 84-7. https://doi.org/10.1016/S1472-6483(10)62019-6
Huang JC, Jackson KV, Hornstein MD, et al. The effect of elevated serum progesterone during ovulation induction in in vitro fertilization-embryo transfer. J Assist Reprod Genet 1996; 13: 617-24. https://doi.org/10.1007/BF02069639
Faber BM, Mayer J, Cox B, et al. Cessation of gonodotropin releasing hormone agonist therapy combined with high dose gonodotropin stimulation yields favorable pregnancy results in low responders. Fertil Steril 1998; 69: 826-830. https://doi.org/10.1016/S0015-0282(98)00040-5
Bosch E, Valencia I, Escudero E, et al. Premature luteinization during gonadotropin-releasing hormone antagonist cycles and its relationship with in vitro fertilization outcome. Fertil Steril 2003; 80: 1444-9. https://doi.org/10.1016/j.fertnstert.2003.07.002
Andersen AN, Devroey P, Arce JC. Clinical outcome following stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF: a randomized assessorblind controlled trial. Hum Reprod 2006; 21: 3217-27. https://doi.org/10.1093/humrep/del284
Younis JS, Haddad S, Matilsky M, et al. Premature luteinization: could it be an early manifestation of low ovarian reserve? Fertil Steril 1998; 69: 461-5. https://doi.org/10.1016/S0015-0282(97)00561-X
Elgindy EA. Progesterone level and progesterone/estradiol ratio on the day of hCG administration: detrimental cutoff levels and new treatment strategy. Fertil Steril 2011; 95: 1639-44. https://doi.org/10.1016/j.fertnstert.2010.12.065
Mascarenhas M, Kamath MS, Chandy A, et al. Progesterone/Estradiol Ratio as a Predictor in the ART Cycles with Premature Progesterone Elevation on the Day of hCG Trigger. J Reprod Infertil 2015; 16: 155-61.
Cicek MN, Kahyaoglu I, Kahyaoglu S. The comparison of microdose flare-up and multiple dose antagonist protocols based on hCG day estradiol (E2), progesterone (P) and P/E2 ratio among poor responder patients in ICSI-ET cycles. Eur Rev Med Pharmacol Sci 2015; 19: 539-44.
Kolibianakis EM, Venetis CA, Bontis J, et al. Significantly lower pregnancy rates in the presence of progesterone elevation in patients treated with GnRH antagonists and gonadotrophins: a systematic review and meta-analysis. Curr Pharm Biotechnol 2012; 13: 464-470. https://doi.org/10.2174/138920112799361927
Kyrou D, Al-Azemi M, Papanikolaou EG, et al. The relationship of premature progesterone rise with serum estradiol levels and number of follicles in GnRH antagonist/recombinant FSH-stimulated cycles. Eur J Obstet Gynecol Reprod Biol 2012; 162: 165-168. https://doi.org/10.1016/j.ejogrb.2012.02.025
Al-Azemi M, Bernal AL, Steele J, et al. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis. Hum Reprod 2000 Jan; 15(1): 72-5. https://doi.org/10.1093/humrep/15.1.72
Melo MA, Meseguer M, Garrido N, et al. The significance of premature luteinization in an oocyte-donation programme. Hum Reprod 2006; 21(6): 1503-7. https://doi.org/10.1093/humrep/dei474
Shalom-Paz E, Aslih N, Samara N, et al. Late follicular progesterone to estradiol ratio is not influenced by protocols or gonadotropins used. Reprod Biol Endocrinol 2015; 13: 119. https://doi.org/10.1186/s12958-015-0116-y