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Updated: Feb 5, 2026
Reproductive Techniques for Ovarian Monitoring and Control in Amphibians
Published on: May 12, 2019
Defining thresholds for abnormal premature progesterone levels during ovarian stimulation for assisted reproduction
Micah J Hill1, Mae Wu Healy1, Kevin S Richter2
1Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Objective:
To evaluate methodologies to establish abnormal progesterone (P) levels on the day of trigger for recommending freeze only cycles.
Design:
Threshold analysis and cost analysis.
Setting:
Private ART practice.
Patient(S):
Fresh autologous ART.
Interventions(S):
None.
Main Outcome Measure(S):
Live birth.
Result(S):
Fourteen established statistical methodologies for generating clinical thresholds were evaluated. These methods were applied to 7,608 fresh ART transfer cycles to generate various P thresholds which ranged widely from 0.4 to 3.0 ng/mL. Lower thresholds ranged from 0.4 to 1 ng/mL and classified the majority of cycles as abnormal as well as required very large number needed to treat (NNT) to increase one live birth. Frozen embryo transfer was cost-effective when P was ≥1.5 ng/mL, with 12% of the population having an abnormal test result and an NNT of 13. Statistical and cost-effective thresholds clustered between 1.5 and 2.0 ng/mL.
Conclusion(S):
Statistically significant thresholds for P were demonstrated as low as 0.4 ng/mL but resulted in a very large NNT to increase one live birth. A clinical benefit to a freeze-only approach was demonstrated above P thresholds ranging from 1.5 to 2.0 ng/dL. At these thresholds, elevated P has a demonstrable and clinically significant negative effect and captures a smaller percentage of the patient population at higher risk for fresh transfer failure, thus making freeze-only a cost-effective option.
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