Estimating the net effect of progesterone elevation on the day of hCG on live birth rates after IVF: a cohort analysis of 3296 IVF cycles

Venetis, Christos A.; Kolibianakis, Efstratios M.; Bosdou, Julia K.; Lainas, George T.; Sfontouris, Ioannis A.; Tarlatzis, Basil C.; Lainas, Tryfon G.
March 2015
Human Reproduction;Mar2015, Vol. 30 Issue 3, p684
Academic Journal
STUDY QUESTION What is the proper way of assessing the effect of progesterone elevation (PE) on the day of hCG on live birth in women undergoing fresh embryo transfer after in vitro fertilization (IVF) using GnRH analogues and gonadotrophins? SUMMARY ANSWER This study indicates that a multivariable approach, where the effect of the most important confounders is controlled for, can lead to markedly different results regarding the association between PE on the day of hCG and live birth rates after IVF when compared with the bivariate analysis that has been typically used in the relevant literature up to date. WHAT IS KNOWN ALREADY PE on the day of hCG is associated with decreased pregnancy rates in fresh IVF cycles. Evidence for this comes from observational studies that mostly failed to control for potential confounders. STUDY DESIGN, SIZE, DURATION This is a retrospective analysis of a cohort of fresh IVF/intracytoplasmic sperm injection cycles (n = 3296) performed in a single IVF centre during the period 2001–2013. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients in whom ovarian stimulation was performed with gonadotrophins and GnRH analogues. Natural cycles and cycles where stimulation involved the administration of clomiphene were excluded. In order to reflect routine clinical practice, no other exclusion criteria were imposed on this dataset. The primary outcome measure for this study was live birth defined as the delivery of a live infant after 24 weeks of gestation. We compared the association between PE on the day of hCG (defined as P > 1.5 ng/ml) and live birth rates calculated by simple bivariate analyses with that derived from multivariable logistic regression. The multivariable analysis controlled for female age, number of oocytes retrieved, number of embryos transferred, developmental stage of embryos at transfer (cleavage versus blastocyst), whether at least one good-quality embryo was transferred, the woman's body mass index, the total dose of FSH administered during ovarian stimulation and the type of GnRH analogues used (agonists versus antagonists) during ovarian stimulation. In addition, an interaction analysis was performed in order to assess whether the ovarian response (<6, 6–18, >18 oocytes) has a moderating effect on the association of PE on the day of hCG with live birth rates after IVF. MAIN RESULTS AND THE ROLE OF CHANCE Live birth rates were not significantly different between cycles with and those without PE when a bivariate analysis was performed [odds ratio (OR): 0.78, 95% confidence interval (CI): 0.56–1.09]. However, when a multivariable analysis was performed, controlling for the effect of the aforementioned confounders, live birth rates (OR: 0.68, 95% CI: 0.48–0.97) were significantly decreased in the group with PE on the day of hCG. The number of oocytes retrieved was the most potent confounder, causing a 29.4% reduction in the OR for live birth between the two groups compared. Furthermore, a moderating effect of ovarian response on the association between PE and live birth rates was not supported in the present analysis since no interaction was detected between PE and the type of ovarian response (<6, 6–18, >18 oocytes). LIMITATIONS, REASONS FOR CAUTION This is a retrospective analysis of data collected during a 12-year period, and although the effect of the most important confounders was controlled for in the multivariable analysis, the presence of residual bias cannot be excluded. WIDER IMPLICATIONS OF THE FINDINGS This analysis highlights the need for a multivariable approach when researchers or clinicians aim to evaluate the impact of PE on pregnancy rates in their own clinical setting. Failure to do so might explain why many past studies have failed to identify the detrimental effect of ...


Related Articles

  • Relationship between Progesterone Levels and IVF Outcome.  // Fertility Weekly;11/22/2010, p8 

    The article discusses a study which aims to investigate the association between the serum progesterone levels during human chorionic gonadotropin (hCG) administration and the pregnancy outcome among patients under in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). The study...

  • Luteal phase characteristics following GnRH antagonist or agonist treatment--a comparative study. Friedler, Shevach; Gilboa, Sarit; Schachter, Morey; Raziel, Arieh; Strassburger, Devorah; El, Raphael Ron // Reproductive BioMedicine Online (Reproductive Healthcare Limited;Jan2006, Vol. 12 Issue 1, p27 

    Due to inherent differences between gonadotrophin-releasing hormone (GnRH) antagonists and agonists, their late effect on ovarian steroidal production during the luteal phase of IVF cycles may differ. The aim of this study was to characterize and compare the luteal phase hormonal profile after...

  • Pre-stimulation parameters predicting live birth after IVF in the long GnRH agonist protocol. Pettersson, Göran; Andersen, Anders Nyboe; Broberg, Per; Arce, Joan-Caries // Reproductive BioMedicine Online (Reproductive Healthcare Limited;May2010, Vol. 20 Issue 5, p572 

    This retrospective study aimed to identify novel pre-stimulation parameters associated with live birth in IVF and to develop a model for prediction of the chances of live birth at an early phase of the treatment cycle. Data were collected from a randomized trial in couples with unexplained...

  • Human chorionic gonadotrophin stimulation test as a predictor of ovarian response and pregnancy in IVF cycles stimulated with GnRH agonist gonadotrophin treatment: a pilot study. Fábregues, Francisco; Iraola, Ainara; Casamitjana, Roser; Carmona, Francisco; Balasch, Juan // Human Reproduction;Apr2012, Vol. 27 Issue 4, p1122 

    BACKGROUND Recent evidence supports a specific and broad role of androgen produced by theca cells in reproductive physiology. This pilot study evaluated the usefulness of hCG theca stimulation test in predicting ovarian response and pregnancy. METHODS Prospective cohort study including 80...

  • Benefits of luteinizing hormone activity in ovarian stimulation for IVF. Venetis, C. A; Kolibianakis, E. M.; Tarlatzi, T. B.; Tarlatzis, B. C. // Reproductive BioMedicine Online (Reproductive Healthcare Limited;2009 Supplement 2, Vol. 18 Issue S2, pS31 

    Knowledge of the physiology of folliculogenesis has led to a better understanding of the role of LH activity in this process. This role has been investigated in the setting of ovarian stimulation and several treatment modalities have been proposed. LH activity can be provided in the forms of:...

  • Premature progesterone rise and gene expression. Van Vaerenbergh, I.; Fatemi, H.M.; Bourgain, C. // Human Reproduction;Oct2011, Vol. 26 Issue 10, p2913 

    No abstract available.

  • The Benefits of Adding GnRH Agonist for Luteal Support.  // Fertility Weekly;5/21/2012, p5 

    The article presents a study conducted by researchers D. Kyroue and colleagues which focuses on the benefits of adding luteinizing hormone releasing hormone (GnRH) agonist for luteal support. The study shows that adding GnRH agonist during the luteal phase as part of intracytoplasmic sperm...

  • First live birth following IVF-embryo transfer and use of GnRHa alone for ovarian stimulation. Azem, Foad; Almog, Beni; Ben-Yosef, Dalit; Kapustiansky, Rita; Wagman, Israel; Amit, Ami // Reproductive BioMedicine Online (Reproductive Healthcare Limited;Aug2009, Vol. 19 Issue 2, p162 

    Several case reports have shown that some patients may develop ovarian cysts or ovarian hyperstimulation syndrome following the administration of gonadotrophin-releasing hormone agonist (GnRHa). This is the first report of a live birth following ovarian stimulation and IVF-embryo transfer using...

  • Low-dose HCG may improve pregnancy rates and lower OHSS in antagonist cycles: a meta-analysis. Kosmas, I. P.; Zikopoulos, K.; Georgiou, I.; Paraskevaidis, E.; Blockeel, C.; Tournaye, H.; Van der Elst, J.; Devroey, P. // Reproductive BioMedicine Online (Reproductive Healthcare Limited;Nov2009, Vol. 19 Issue 5, p619 

    Human chorionic gonadotrophin (HCG) may substitute FSH to complete follicular growth in IVF cycles. This may be useful in the prevention of ovarian hyperstimulation syndrome. Relevant studies were identified on Medline. To evaluate outcomes, a meta-analysis of low-dose HCG-supplemented IVF...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics