Are extremely high progesterone levels still an issue in IVF?

Area of Science:

• Reproductive endocrinology and infertility.
• Assisted reproductive technologies (ART).

Background:

• Premature luteinization affects 1-2% of controlled ovarian stimulation cycles.
• Current management is controversial, often involving cycle cancellation.
• The efficacy of the "freeze-all" policy in this context is under investigation.

Purpose of the Study:

• To evaluate the efficacy of the "freeze-all" strategy in managing premature luteinization during controlled ovarian stimulation.
• To compare outcomes between patients with premature luteinization and controls undergoing a "freeze-all" program.

Main Methods:

• Patients with premature luteinization (progesterone levels ≥3.0 ng/ml and/or P/estradiol ratio ≥1) were included in a "freeze-all" program (n=42).
• Comparison with controls undergoing "freeze-all" with normal progesterone levels (P < 1.5 ng/ml, n=67).
• Outcomes assessed included blastulation and ongoing pregnancy rates after frozen-thawed embryo transfer.

Main Results:

• Blastulation rates were similar between premature luteinization cases (48.1%) and controls (52.3%).
• Ongoing pregnancy rates after the first frozen-thawed embryo transfer were comparable (38.1% vs. 41.0%).
• Cumulative ongoing pregnancy rates after three transfers were also similar (40.5% vs. 47.8%).

Conclusions:

• Marked progesterone elevation during controlled ovarian stimulation does not negatively impact blastocyst development or implantation potential with a "freeze-all" strategy.
• "Freeze-all" is a valuable tool for treating premature luteinization.
• Cycle cancellation for premature luteinization may be considered inappropriate management.