Progesterone Elevation and Preventive Strategies to Avoid Implantation Failure

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization
• Hormonal Regulation

Background:

• Progesterone elevation (P4E) affects 5-30% of ovarian stimulation (OS) cycles.
• P4E negatively impacts pregnancy rates in fresh IVF cycles.
• Hyper-responder patients may require higher P4 levels for adverse effects.

Purpose of the Study:

• To investigate the impact of progesterone elevation on pregnancy rates in OS cycles.
• To explore the mechanisms behind P4 overproduction during OS.
• To identify preventive strategies and optimal management approaches for P4E.

Main Methods:

• Review of preclinical and clinical data on P4E during OS.
• Analysis of hormonal assays and enzyme activity in granulosa cells.
• Discussion of endometrial gene expression and oocyte/embryo quality effects.

Main Results:

• Aggressive OS may increase P4 production via specific enzyme activity.
• High P4 concentrations can alter endometrial gene expression.
• Lack of 17α-hydroxylase in humans contributes to systemic P4 leakage.

Conclusions:

• Avoiding aggressive OS is the primary strategy to prevent P4 overproduction.
• Deferred embryo transfer in thaw cycles requires further research.
• Center-specific P4E thresholds should be established due to assay variability.