Premature progesterone rise incidence & its effects on in vitro fertilization cycles

Background: Ovarian stimulation using gonadotropins is associated with premature progesterone rise (PPR) in late follicular phase compared to natural  cycle. Two schools of thoughts exist concerning implications of PPR during late follicular phase with one insisting that outcome of in vitro fertilization  (IVF) is adversely affected when PPR occurs while the second school of thought argues that PPR has no adverse effect on IVF outcome. The study is aimed  at determining the incidence of PPR in the cohort data evaluated; pregnancy rates across the sides of adopted cut-off level of progesterone and  association if any between PPR & pregnancy rates. Methods: It was a descriptive retrospective cohort study of data of 114 patients and egg donors.. Analysis of continuous & categorical data was done  using IBM SPSS Statistics 25. Results: Mean serum progesterone on HCG day of IVF cycle among the cohort was 2.490±1.355 with a PPR incidence of 55%.  The odds of having PPR was 6.7 times higher among subjects with follicular number more than 13 compared to subjects with follicular numbers ≤13 .  Number of follicles retrieved & age of subjects were strongly associated with progesterone level. The odds of subject with PPR getting pregnant was  found to be 1.5 times less compared to the subjects with pre-HCG P4 < 1.5ng/ml. Conclusion: Pre-HCG progesterone level is positively associated with  pregnancy outcome in IVF cycles