An analysis of freeze-all cycles to investigate the association between elevated progesterone on day of trigger and oocyte quality.

Purpose: To investigate whether a premature rise in progesterone at the end of the follicular phase is adversely associated with oocyte quality in IVF cycles.

Methods: A retrospective cohort study including patients less than or equal to 40 years of age undergoing their first IVF/ICSI cycle between January 2017 and December 2021 with freeze-all involving D5 or D6 blastocysts. Main Outcome Measure(s) Cumulative live birth rate (cLBR) and cumulative sustained implantation rate (cSIR).

Result: (s) A total of 1,373 IVF/ICSI cycles were included and categorized into progesterone tertiles (T1: 0.10-0.96 ng/ml; T2: 0.97-1.63 ng/ml; T3: 1.64-9.62 ng/ml). The cLBRs for T1, T2, and T3 were 54.0%, 56.6%, and 52.9%, respectively, and the cSIRs were 54.4%, 56.8%, and 53.3%, respectively. After adjustment for age, peak estradiol, and total dose of gonadotropins used, the risk of cLBR was statistically significantly increased for women in T2 (RR 1.19, 95% CI 1.06-1.33) and T3 (RR 1.14, 95% CI 1.01-1.28) compared with T1. Similar results were obtained for cSIR. For cycles with 5-10 oocytes, a statistically significant positive association was observed between T3 progesterone:oocyte ratio for both cLBR (RR 1.78, 95% CI 1.22-2.60) and cSIR (RR 1.80, 95% CI 1.24-2.62) compared with T1 after adjusting for oocyte number, while no such association was observed for cycles with >10 oocytes retrieved (cLBR: RR 0.95, 95% CI 0.84-0.95; cSIR: RR 0.95, 95% CI 0.83-1.08).

Conclusion: Our findings do not support an adverse association between a premature rise in progesterone and oocyte quality. In normal responders, this rise may be beneficial.