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Premature progesterone elevation: targets and rescue strategies
Barbara Lawrenz1, Elena Labarta2, Human Fatemi1
1IVI-RMA Middle East Fertility Clinic, Abu Dhabi, United Arab Emirates.
Fertility and Sterility
|April 15, 2018
Summary
Elevated progesterone during late follicular phase ovarian stimulation negatively impacts in vitro fertilization outcomes by affecting endometrial receptivity and potentially oocyte/embryo quality. Individualized stimulation protocols are key to prevention.
Area of Science:
- Reproductive Endocrinology
- In Vitro Fertilization
- Assisted Reproductive Technology
Background:
- Progesterone elevation in the late follicular phase of ovarian stimulation is linked to reduced success rates in assisted reproductive technology (ART).
- This elevation is associated with advanced endometrial maturation, potentially impairing uterine receptivity.
- Evidence also suggests a possible negative impact on oocyte and embryo quality.
Purpose of the Study:
- To review the impact of progesterone elevation during ovarian stimulation on IVF outcomes.
- To identify the causes of progesterone elevation, particularly enhanced follicle-stimulating hormone stimulation.
- To discuss strategies for preventing progesterone elevation and improving ART success.
Main Methods:
- Review of recent publications and retrospective analyses on progesterone elevation in IVF cycles.
- Analysis of factors contributing to progesterone elevation, including stimulation protocols.
- Evaluation of potential interventions and preventative measures.
Main Results:
- Enhanced follicle-stimulating hormone stimulation in the late follicular phase is identified as a primary cause of progesterone elevation.
- Progesterone elevation negatively affects endometrial receptivity and may compromise oocyte and embryo quality.
- Individualized ovarian stimulation based on ovarian reserve and response is crucial for prevention.
Conclusions:
- Preventing progesterone elevation through tailored stimulation protocols is essential for optimizing IVF outcomes.
- Strategies include individualizing stimulation based on patient reserve and response, adjusting dosage, and considering measures like corticosteroid administration or freeze-all policies.
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