Novel insights on premature progesterone elevation: a mini-review

In vitro fertilization (IVF) success involves ovarian stimulation with conventional or mild stimulation protocols aimed to yield an adequate number of mature oocytes. These oocytes can be further fertilized and generate good quality embryos to be transferred, ideally in the same cycle. Since 2013, following the results of a meta-analysis including more than 60,000 IVF cycles, the negative effects of premature progesterone elevation on reproductive outcomes have been demonstrated. Nowadays, evidence is emerging on the limited regulation on serum progesterone values, demonstrating significantly lower live birth rates in patients with either low (<0.5ng/ml) late follicular phase progesterone or higher levels decreasing sharply. This review discusses and summarizes the different mechanisms of progesterone elevation and its impact on IVF treatments. Different approaches to diminish the impact of progesterone on fertility outcomes are also addressed.