Serum progesterone concentration on day of embryo transfer in donor oocyte cycles

Abstract

Purpose: To evaluate the association between serum progesterone (P) levels on the day of embryo transfer (ET) and pregnancy rates in fresh donor IVF/ICSI cycles. Methods: Fresh donor cycles with day 3 ET from 10/2007 to 8/2012 were included (n=229). Most cycles (93 %) were programmed with a gonadotropin releasing hormone (GnRH) agonist; oral, vaginal or transdermal estradiol was used for endometrial priming, and intramuscular P was used for luteal support (50-100 mg/day). Recipient P levels were measured at ET, and P dose was increased by 50-100 % if <20 ng/mL per clinic practice. The main outcome measure was rate of live birth (>=24 weeks gestational age). Generalized estimating equations were used to account for multiple cycles from the same recipient, adjusted a priori for recipient and donor age. Results: Mean recipient serum P at ET was 25.5±10.1 ng/mL. Recipients with P<20 ng/mL at ET, despite P dose increases after ET, were less likely to achieve clinical pregnancy (RR=0.75, 95 % CI=0.60-0.94, p=0.01) and live birth (RR=0.77, 95 % CI=0.60-0.98, p=0.04), as compared to those with P≥20 ng/mL. P dose increases were more often required in overweight and obese recipients. Conclusions: Serum P levels on the day of ET in fresh donor IVF/ICSI cycles were positively correlated with clinical pregnancy and live birth rates. An increase in P dose after ET was insufficient to rescue pregnancy rates. Overweight and obese recipients may require higher initial doses of P supplementation. Future research is needed to define optimal serum P at ET and the interventions to achieve this target. © 2014 Springer Science+Business Media.