控制性促排卵过程中HCG日孕酮水平对胚胎发育及全胚冷冻周期累积活产的影响研究

目的:探讨辅助生殖技术控制性促排卵过程HCG日孕酮水平对全胚冷冻患者胚胎发育及累积活产的影响。方法:回顾收集2015年1月1日至2017年12月30日于唐都医院妇产科生殖医学中心行全胚冷冻的患者的临床资料,共计6414个首次促排卵周期纳入研究。根据既往文献,将患者按HCG日孕酮水平分为3个浓度组:0.5ng/ml、0.5～1.5ng/ml和≥1.5ng/ml。采用单因素和多因素回归分析方法探讨HCG日孕酮水平对胚胎发育和累积活产率的影响。结果:患者的总累积活产率为56.27%。HCG日孕酮0.5ng/ml、0.5～1.5ng/ml和≥1.5ng/ml组的卵裂率分别为(93.57±18.40)%、(92.07±19.92)%和(90.45±21.76)%,可用胚胎率分别为(0.62±0.25)%、(0.56±0.20)%和(0.53±0.23)%,囊胚形成率分别为(23.83±34.15)%、(28.00±34.03)%和(27.16±32.86)%,累积活产率分别为61.86%、56.29%和52.30%;3组比较,差异均有统计学意义(P0.05)。多因素回归分析结果显示,3组的卵裂率、囊胚形成率和累积活产率无统计学差异(P0.05)。0.5～1.5ng/ml、≥1.5ng/ml组与0.5ng/ml组比较,可用胚胎率显著下降,差异有统计学意义(0.5～1.5ng/ml组:β=-0.04,95%CI为-0.06～-0.02;≥1.5ng/ml组:β=-0.05,95%CI为-0.08～-0.02,P均0.05)。结论:促排卵过程中HCG日孕酮水平升高可降低可用胚胎率,但对全胚冷冻后续累积活产率并未发现明显影响。对于促排卵过程中HCG日孕酮提前升高的患者,全胚冷冻仍是第一选择的移植策略。     

卵泡期长效长方案扳机日孕酮水平对IVF/ICSI临床结局的影响

目的:探讨卵泡期长效长方案扳机日孕酮水平对体外受精(IVF)/卵胞浆内单精子注射(ICSI)临床结局的影响及孕酮升高的相关因素。方法:回顾分析2018年1月至2022年12月在烟台毓璜顶医院生殖医学科行卵泡期长效长方案IVF/ICSI助孕患者的临床资料,共纳入577个周期。根据扳机日孕酮(P)水平分为3组：P<1ng/mL(组1,342个周期),1ng/mL≤P≤1.5ng/mL(组2,155个周期),P>1.5ng/mL(组3,80个周期)。采用Kruskal-Wallis检验、单因素方差分析和卡方检验比较3组患者的IVF/ICSI临床结局,利用多元线性回归分析扳机日孕酮升高的相关因素。结果:组3患者的临床妊娠率、胚胎种植率、活产率和囊胚形成率显著低于组1和组2(P<0.05);但扳机日雌二醇(E₂)水平和获卵数显著高于组1和组2,差异均有统计学意义(P<0.05);3组患者的优胚率、流产率和多胎妊娠率比较,差异均无统计学意义(P>0.05)。扳机日孕酮水平升高与Gn用量、获卵数、扳机日E₂和LH水平呈正相关(...     

人绒毛膜促性腺激素注射日血清孕酮水平对体外受精妊娠结局的影响

目的:探讨在控制性超排卵中,HCG注射日孕酮水平与体外受精妊娠结局的关系。方法:回顾性分析2009年6月~2010年5月在我院生殖中心采用长方案垂体降调节行体外受精助孕的1145个周期。按照HCG注射日血清孕酮水平的不同分为四组,A组:血清孕酮<0.9ng/ml者313周期;B组:血清孕酮0.9~1.5ng/ml者411周期;C组:血清孕酮1.5~2.5ng/ml者337周期;D组:血清孕酮≥2.5ng/ml者84周期。结果:D组(P≥2.5ng/ml)种植率和临床妊娠率明显降低,异位妊娠率明显升高,与其余各组比较有统计学意义(P<0.05),而各组间受精率、卵裂率、优胚形成率及冻融胚胎移植周期临床妊娠率差异无统计学意义。结论:控制性超排卵中,HCG注射日孕酮升高仅影响了新鲜周期的妊娠结局,而不影响解冻周期的妊娠率。因此,高孕酮水平患者可考虑放弃新鲜胚胎移植,行全胚胎冷冻。     

绒促性素日孕酮水平对体外受精-胚胎移植结局预测价值研究

目的:探讨促性腺激素释放激素(GnRH)激动剂与拮抗剂方案中注射人绒促性素(HCG)日孕酮(P)对体外受精-胚胎移植(IVF-ET)妊娠结局的预测价值。方法:回顾性分析635例IVF-ET助孕患者的临床资料,采用多因素Logistic回归分析和受试者工作特征曲线(ROC)探讨HCG日P对妊娠结局的预测价值,依据截断值将患者分为两组,比较不同HCG日P水平的临床资料及妊娠情况;并比较采用GnRH激动剂方案和拮抗剂方案的妊娠结局及HCG日P水平。结果:Logistic回归显示HCG日P是影响活产的危险性因素(OR 0.612,95%CI 0.480～0.780,P0.05),其截断值为5.29 nmol/L。HCG日P≥5.29 nmol/L组临床妊娠率(32.70%)与活产率(25.16%)显著低于P5.29 nmol/L组(56.93%,45.59%),差异有统计学意义(P0.05)。GnRH拮抗剂方案中HCG日P≥5.29 nmol/L的患者比例明显高于激动剂组(35.21%vs 21.50%,P0.05),而临床妊娠率、活产率及流产率比较,差异无统计学意义(P0.05)。结论:升高的HCG日P水平降低了IVF-ET的临床妊娠率和活产率,是影响新鲜周期妊娠结局的危险因素,对IVF-ET妊娠结局具有一定的预测价值。GnRH激动剂与拮抗剂两种方案对HCG日P水平的影响程度尚需进一步研究。     

晚卵泡期血清孕酮升高对卵裂期胚胎移植的临床妊娠结局的影响

目的:探讨晚卵泡期血清孕酮(P)升高对卵裂期胚胎移植的临床妊娠结局的影响.方法:我院2010年1月至2011年12期行体外受精-胚胎移植(IVF-ET)的卵裂期胚胎移植2345个周期,根据注射人绒毛膜促性腺激素(HCG)日P水平分为P正常组(P≤4.77 nmol/L) 2045个周期,P升高组(P ＞4.77 nmoL/L)300个周期,比较两组的IVF-ET的临床妊娠结局.结果:P正常组与P升高组获卵数分别为10.72±4.67、12.94±5.30;临床妊娠率分别为55.35％(1132/2045)、46.67％ (140/300);异位妊娠率分别为2.83％ (32/1132)、7.86％ (11/140),差异均有统计学意义(P＜0.01).P正常组与P升高组的受精率、胚胎种植率及早期流产率差异均无统计学意义(P＞0.05).结论:晚卵泡期P升高可降低卵裂期胚胎移植的临床妊娠率,并增加其异位妊娠风险.     

控制性卵巢刺激周期中取卵日血清孕酮值与获卵数及妊娠结局的关系

目的:探讨取卵日患者血清孕酮水平与体外受精胚胎移植(IVF-ET)临床参数之间的关系,为优化控制性卵巢刺激(COS)方案、提高IVF成功率提供理论基础。方法:回顾性分析218例黄体期长方案垂体降调患者的临床资料,根据ROC曲线临界值将患者按取卵日血清孕酮值分为:低孕酮组(95例),P<10.50ng/ml;中孕酮组(70例),P为10.50～17.50ng/ml;高孕酮组(53例),P>17.50ng/ml。分析三组间获卵数、受精率、卵裂率、优质胚胎率、临床妊娠率的差异。结果:三组间受精率、卵裂率的差异无显著性(P>0.05);三组患者的获卵数、优质胚胎率的差异显著(P<0.05);高、中、低孕酮组患者的临床妊娠率分别为34.0%,45.0%,26.9%,中孕酮组的临床妊娠率显著高于其它两组(P<0.05)。结论:取卵日血清孕酮值可能存在一个适度范围,孕酮值过低(P<10.50ng/ml)或过高(P>17.50ng/ml)均可影响IVF-ET胚胎质量和妊娠结局,推测临床妊娠率的降低可能与子宫内膜种植窗启闭时间改变有关。     

HCG日孕酮升高对妊娠结局的影响及其早期预测因素的探讨

目的:探讨注射人绒促性素(HCG)日孕酮(P)升高对妊娠结局的影响及基础P水平对HCG日P升高的早期预测情况。方法:对本中心行体外受精-胚胎移植(IVF-ET)患者有基础P水平检测结果的734个周期进行回顾性分析。将HCG日P为4.77 nmol/L设为临界值分为P升高组(204个周期)和P未升高组(530个周期),比较两组各项临床参数指标。釆用Logistic回归分析探讨影响注射HCG日P升高的相关因素,并对其相关指标进行预测HCG日P升高的最佳判断点的统计,根据最佳判断点探讨其与妊娠结局的关系。结果:两组间正常受精率、优质胚胎率比较,差异无统计学意义(P0.05),但与P未升高组比较,P升高组的胚胎着床率和临床妊娠率较低(P0.05),流产率较高(P0.05)。基础P水平与HCG日P升高多元回归分析显示有相关性(OR=20.5,95%CI 4.73~89.01,P=0.000)。基础P预测HCG日P升高的最佳判断点为2.38 nmol/L,对应的敏感度为46.1%,特异度为79.2%。但以此为界值将P升高组细分为两组,其与妊娠结局有关的各项指标间比较,差异均无统计学意义(P0.05)。结论:HCG日P升高对妊娠结局不利,但不影响卵母细胞及胚胎质量。基础P水平可作为HCG日P升高的早期预测因素,但不是直接影响妊娠结局的独立决定性因子。     

解冻周期移植日血清孕酮水平与妊娠结局的关系研究

目的:探讨解冻周期移植日血清孕酮(P)水平与妊娠结局的关系。方法:选取在我院生殖内分泌科自然周期准备内膜的932个解冻周期,其中宫内活胎组348个、未妊娠组(包括生化妊娠)484个、妊娠结局不良组(3个月内流产者)100个。分析患者的移植日血清P水平对妊娠率和早期流产率的影响。结果:宫内活胎组和妊娠结局不良组的移植日血清P水平显著高于未妊娠组[(35.4±21.4)ng/ml、(25.6±19.5)ng/ml vs(18.2±17.4)ng/ml,P0.05)]。移植日血清P5ng/ml组和5ng/ml≤P15ng/ml组的临床妊娠率显著低于P≥15ng/ml组(25%、27%vs 42%,P0.05)。P5ng/ml组和5ng/ml≤P15ng/ml组的流产率显著高于P≥15ng/ml组(100%、46%vs 21%,P0.05);P5ng/ml组显著高于5ng/ml≤P15ng/ml组(P0.05)。结论:解冻周期移植日检测血清P水平对妊娠结局有一定的预测价值。     

卵泡液中PAF水平与体外受精结局的关系

目的:研究不孕妇女接受IVF-ET治疗过程中取卵日卵泡液中PAF水平与IVF-ET结局的关系。方法:回顾分析于我院首次接受IVF-ET助孕、当日移植新鲜胚胎的68例患者的临床资料。根据取卵日卵泡液中PAF水平分为3组:低PAF组(≤5.9ng/ml)、中PAF组(5.9~11ng/ml)和高PAF组(≥11ng/ml)。结果:取卵日卵泡液中PAF水平与年龄呈明显负相关(r=-0.313,P0.05)。卵泡液中PAF水平与HCG日血清E_2水平的关系:当E_2≤1000pg/ml时,PAF水平与之呈明显正相关(r=0.800,P0.05);当E_2水平1000pg/ml时,PAF与之呈明显负相关(r=-0.378,P0.05)。卵泡液中PAF水平与获卵数呈明显正相关(r=0.249,P0.05);3组患者的2PN形成率、优胚率比较,差异均有统计学意义(P0.05)。结论:卵泡液中PAF水平对IVF-ET结局有一定的影响。     

短方案超促排卵中过早黄素化与IVF结局的关系

目的:研究短方案超促排卵过程中过早黄素化对IVF结局的影响。方法:回顾性分析299个促排卵周期。结果:孕酮(P)水平随促排卵的进程呈上升趋势,在hCG注射后d1达峰值;P水平与E2和卵子数目有关,与LH无明显相关;当hCG注射日P>1.6 ng/ml时,临床妊娠率显著下降[40.4% vs 54.5%(P≤1.6 ng/ml)],而且随着P的进一步升高,临床妊娠率进一步下降;P升高并未影响受精率、优质胚胎率和胚胎数量。结论:P>1.6ng/ml提示了过早黄素化的出现,预示了临床妊娠率降低。     

Progesterone rise on HCG day in GnRH antagonist/rFSH stimulated cycles affects endometrial gene expression

Premature progesterone rise during gonadotrophin-releasing hormone (GnRH) antagonist cycles for IVF is a frequent phenomenon and has been associated with lower pregnancy and implantation rates. This study evaluated endometrial gene expression on the day of oocyte retrieval according to the concentration of serum progesterone on the day of human chorionic gonadotrophin (HCG) administration in GnRH-antagonist/recombinant FSH IVF cycles with fresh embryo transfer. Endometrial biopsies (n=14) were analysed with Affymetrix HG U133 Plus 2.0 Arrays. Patients were divided into three groups according to their progesterone serum concentration on the day of HCG administration: ≤ 0.9 ng/ml (group A), 1-1.5 ng/ml (group B) and >1.5 ng/ml (group C). Gene expression analysis showed a small number of significantly differentially expressed probe sets between groups A and B (five up/23 down in B) and a large difference between groups B and C (607 up/212 down; P ≤ 0.05, fold change ≥ 1.4). Validation was performed with quantitative real-time PCR on selected genes. As far as is known, this is the first study to demonstrate a distinct difference in endometrial gene expression profile between patients with a progesterone serum concentration above and below the threshold of 1.5 ng/ml on the day of HCG administration.     

Low serum progesterone the day prior to frozen embryo transfer of euploid embryos is associated with significant reduction in live birth rates

Abstract

A retrospective cohort study was performed to examine whether, in artificial endometrial preparation for frozen embryo transfer (FET) cycles, progesterone (P) levels the day prior to embryo transfer of euploid embryos have an impact on pregnancy outcomes. In a private university clinic, 244 FETs between January 2016 and June 2017 were analyzed. Endometrial preparation was achieved with estradiol valerate and vaginal micronized progesterone. Serum P and estradiol levels the day prior to embryo transfer were measured. A multivariable analysis to assess the relationship between serum P level and pregnancy outcomes was performed, adjusted for confounding variables. Mean P value was 11.3?±?5.1?ng/ml. Progesterone levels were split in quartiles: Q1: ≤ 8.06?ng/ml; Q2: 8.07–10.64?ng/ml; Q3: 10.65–13.13?ng/ml; Q4: > 13.13?ng/ml. Patients included in the lower P quartile had a significantly higher miscarriage rate and significantly lower live birth rate (LBR) compared to the higher ones. A low serum P level (≤ 10.64?ng/ml) one day before FET is associated with a lower pregnancy and LBR following FET of euploid embryos.     

The effect of elevated serum progesterone during ovulation induction in in vitro fertilization-embryo transfer

Objective: Our purpose was to determine whether elevated progesterone (P) during ovulation induction in IVF-ET cycles is a poor prognostic factor for achieving pregnancy. Design: We retrospectively reviewed 672 consecutive IVF-ET cycles in which ovulation was performed using luteal LA downregulation and hMG. Setting: The ART program at the Brigham & Women's Hospital, a tertiary care institution, was the study setting. Main Outcome Measures: Patients were divided into groups by serum P levels at baseline, on stimulation day 5, on the day of hCG injection, and, on the day after hCG injection and the following parameters were compared: duration of luteal LA treatment, number of ampoules of hMG used, estradiol (E₂) levels, number of follicles 12 mm, number of follicles 15 mm, number of oocytes, number of normal embryos, number of polyspermic embryos, fertilization rate, implantation rate, and clinical and ongoing/live birth pregnancy rates. Results: Based on serum P level, patients were divided into three groups: Group I, 0.31 ng/ml (conversion factor to SIU, 3.180); Group II, and >0.3 and <1.0 ng/ml and Group III, 1.0 ng/ml. Measureable P at baseline was associated with a higher cancellation rate, but no difference in other cycle outcome parameters. Progesterone >0.31 ng/ml on stimulation day 5 was associated with a higher fertilization rate in Groups II and III, but there was no difference in the clinical pregnancy or ongoing/live birth rates among the three groups. Based on P on the day of hCG administration, Groups II and III had significantly more oocytes and higher fertilization rates than did Group I, however, clinical pregnancy and ongoing/live birth rates were not significantly different. On the day after hCG, there was a trend toward a higher clinical pregnancy rate in Group III, which had younger patients, better follicular recruitment, and more embryos than Groups I or II, but these differences did not reach statistical significance. Conclusions: Serum P >0.31 ng/ml during ovulation induction reflects good follicular recruitment, and is not a predictor of IVF outcome.Presented in part at the Conjoint American Fertility Society and Canadian Fertility and Andrology Society Meeting, Montreal, Canada, October 11–14, 1993.     

Serum progesterone concentrations on the day of HCG administration cannot predict pregnancy in assisted reproduction cycles

The effect of subtle rises of progesterone in the late follicular phase of cycles of ovarian stimulation with gonadotrophin-releasing hormone (GnRH) agonists on pregnancy outcome is controversial. This study used receiver-operating characteristic (ROC) analysis to gain further insight into the predictive value of serum progesterone concentrations on the day of human chorionic gonadotrophin (HCG) injection in normally responding patients receiving the long protocol of GnRH agonist (group L; n = 218) and in low responders receiving the short ('flare-up') protocol (group S; n = 159). ROC analysis showed that serum progesterone concentration on the HCG day was not indicative of conception and non-conception cycles in the whole population studied, in group L or in group S. To further assess the potential impact of 'high' concentrations of circulating progesterone on the day of HCG administration on pregnancy rates and outcome, the threshold value (<0.9 ng/ml) to discriminate between women with 'high' (group H; n = 197) and 'normal' (group N; n = 180) progesterone was applied. No significant differences were found with respect to pregnancy and miscarriage rates between these two groups. Serum progesterone concentrations on the day of HCG administration therefore cannot predict pregnancy in assisted reproduction cycles using GnRH agonists and gonadotrophins.     

Subtle progesterone rise in the single-dose gonadotropin-releasing hormone antagonist (cetrorelix) stimulation protocol in patients undergoing in vitro fertilization or intracytoplasmic sperm injection cycles.

A subtle rise in serum progesterone during the late follicular phase in patients undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles is a frequent event that can decrease implantation and pregnancy rates in controlled ovarian hyperstimulation (COH) protocols that use a gonadotropin-releasing hormone (GnRH) antagonist. The aim of the present study was to evaluate the prevalence and effect of the subtle progesterone rise during COH with single-dose GnRH antagonist in combination with clomiphene citrate (CC) and human menopausal gonadotropins (hMG) in IVF or ICSI cycles. Ninety-five women undergoing COH with CC, hMG and a single 2.5 mg dose of the GnRH antagonist, cetrorelix, were enrolled in the study. Patients were grouped according to serum progesterone level on the day of human chorionic gonadotropin (hCG) administration (P < 1.2 ng/ml or P >/= 1.2 ng/ml). The incidence of a subtle progesterone rise was 54.7% (52/95). The group with P >/= 1.2 ng/ml had significantly higher serum levels of luteinizing hormone (p = 0.002) and estradiol (p < 0.001) on the day of hCG injection than the group with P < 1.2 ng/ml, and more oocytes were retrieved (p = 0.001). However, there was no significant difference in fertilization, clinical pregnancy or implantation rate between the two groups. In conclusion, a subtle progesterone rise during the late follicular phase is common but not associated with pregnancy outcome.     

The relationship between a novel evaluation parameter of premature luteinization and IVF outcomes

Research questionCan premature luteinization of granulosa cells (PLGC) act as a novel parameter of premature luteinization and affect IVF outcomes?Study designIn this retrospective cohort study, infertile patients undergoing fresh IVF cycles between January 2006 and December 2016 at the Reproductive Medicine Center in Tongji Hospital were included. A total of 42,468 cycles were conducted. Propensity score matching was carried out to match the baseline characteristics, and participants were assigned to the PLGC group and control group. The main outcomes were pregnancy rate and live birth rate.ResultsPatient characteristics and clinical outcomes were compared before and after matching. In general, the fate of oocytes in the PLGC group was much worse than those in the control group after matching, including metaphase II rate, two-pronuclei rate, available embryo rate, blastocyst formation rate, high-quality blastocyst rate, pregnancy rate, implantation rate and live birth rate. Among those potential risk factors, gonadotrophin duration, oestradiol and progesterone on HCG day were positively associated with the occurrence of PLGC in the multivariate logistic regression model, with gonadotrophin dosage negatively related. Moreover, cumulus–oocyte complexes with PLGC showed a high correlation with elevated progesterone levels over 1.5 ng/ml.ConclusionsOur findings demonstrated the adverse effect of PLGC on oocyte competency. In evaluating cumulus–oocyte complexes, PLGC provide an available novel parameter for premature luteinization judgement in clinical and individualized precise treatment. Close monitoring of progesterone level as well as critical analysis of progesterone elevation can reduce the occurrence of premature luteinization.     

Subtle progesterone rise in the single-dose gonadotropin-releasing hormone antagonist (cetrorelix) stimulation protocol in patients undergoing in vitro fertilization or intracytoplasmic sperm injection cycles

A subtle rise in serum progesterone during the late follicular phase in patients undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles is a frequent event that can decrease implantation and pregnancy rates in controlled ovarian hyperstimulation (COH) protocols that use a gonadotropin-releasing hormone (GnRH) antagonist. The aim of the present study was to evaluate the prevalence and effect of the subtle progesterone rise during COH with single-dose GnRH antagonist in combination with clomiphene citrate (CC) and human menopausal gonadotropins (hMG) in IVF or ICSI cycles. Ninety-five women undergoing COH with CC, hMG and a single 2.5 mg dose of the GnRH antagonist, cetrorelix, were enrolled in the study. Patients were grouped according to serum progesterone level on the day of human chorionic gonadotropin (hCG) administration (P < 1.2 ng/ml or P ≥ 1.2 ng/ml). The incidence of a subtle progesterone rise was 54.7% (52/95). The group with P ≥ 1.2 ng/ml had significantly higher serum levels of luteinizing hormone (p = 0.002) and estradiol (p < 0.001) on the day of hCG injection than the group with P < 1.2 ng/ml, and more oocytes were retrieved (p = 0.001). However, there was no significant difference in fertilization, clinical pregnancy or implantation rate between the two groups. In conclusion, a subtle progesterone rise during the late follicular phase is common but not associated with pregnancy outcome.     

Adding phytoestrogens to clomiphene induction in unexplained infertility patients--a randomized trial

This study investigated the role of oral phytoestrogens in improving pregnancy rate and cycle outcomes with clomiphene citrate. Patients with unexplained infertility and recurrent clomiphene citrate induction failure, were randomly divided into two groups: group I (n = 60) and group II (n = 59). Both groups received clomiphene citrate 150 mg per day (days 3 to 7). Group I received additional oral phytoestrogen (Cimicifuga racemosa) 120 mg/day from days 1 to 12. Human chorionic gonadotrophin (HCG) injection (10,000 IU i.m.) was given and timed intercourse was recommended when a leading follicle reached >17 mm and serum oestradiol exceeded 200 (pg/ml). There was a non-significant shortening of induction cycles in group I. Oestradiol and LH concentrations were higher in group I compared with group II. Endometrial thickness, serum progesterone and clinical pregnancy rate were significantly higher in group I (8.9 +/- 1.4 mm versus 7.5 +/- 1.3 mm, P < 0.001; 13.3 +/- 3.1 ng/ml versus 9.3 +/- 2.0 ng/ml, P < 0.01; 36.7% versus 13.6%, P < 0.01, respectively). It is concluded that adding C. racemosa rhizome dry extract to clomiphene citrate induction can improve the pregnancy rate and cycle outcomes in these couples.     

Endometriosis patients benefit from high serum progesterone in hormone replacement therapy–frozen embryo transfer cycles: a cohort study

Research questionWhat is the optimal serum progesterone cut-off level in patients with endometriosis undergoing hormone replacement therapy frozen embryo transfer (HRT-FET) with intensive progesterone luteal phase support?DesignA cohort study, including 262 HRT-FET cycles in 179 patients all diagnosed with endometriosis either by laparoscopy or by ultrasound in patients with visible endometriomas. Pre-treatment consisted of 42 days of oral contraceptive pills and 5 days’ wash-out, followed by 6 mg oral oestrogen daily. Exogenous progesterone supplementation with vaginal progesterone gel 90 mg/12h commenced when the endometrium was 7 mm or thicker. From the fourth day of vaginal progesterone supplementation, patients also received intramuscular progesterone 50 mg daily. Blastocyst transfer was scheduled for the sixth day of progesterone supplementation.ResultsThe overall positive HCG, live birth (LBR) and total pregnancy loss rates were 60%, 39% and 34%, respectively. The optimal progesterone cut-off level was 118 nmol/l (37.1 ng/ml) defined as the maximum of the Youden index. The unadjusted LBR was significantly higher in patients with progesterone measuring 118 nmol/l or above compared with patients with progesterone measuring less than 118 nmol/l (51% [44/86] versus 34% [59/176], P = 0.01), whereas the adjusted odds ratio for a live birth was 2.1 (95% CI 1.2 to 3.7) after adjusting for age, body mass index, blastocyst score, blastocyst age, quality and number of blastocysts transferred.ConclusionsSerum progesterone levels above 118 nmol/l (37.1ng/ml) resulted in significantly higher LBR compared with lower serum progesterone levels, suggesting that a threshold for optimal serum progesterone exists.