An analysis of freeze-all cycles to investigate the association between elevated progesterone on day of trigger and oocyte quality.

PurposeTo investigate whether a premature rise in progesterone at the end of the follicular phase is adversely associated with oocyte quality in IVF cycles.MethodsA retrospective cohort study including patients less than or equal to 40 years of age undergoing their first IVF/ICSI cycle between January 2017 and December 2021 with freeze-all involving D5 or D6 blastocysts. Main Outcome Measure(s) Cumulative live birth rate (cLBR) and cumulative sustained implantation rate (cSIR).Result(s) A total of 1,373 IVF/ICSI cycles were included and categorized into progesterone tertiles (T1: 0.10-0.96 ng/ml; T2: 0.97-1.63 ng/ml; T3: 1.64-9.62 ng/ml). The cLBRs for T1, T2, and T3 were 54.0%, 56.6%, and 52.9%, respectively, and the cSIRs were 54.4%, 56.8%, and 53.3%, respectively. After adjustment for age, peak estradiol, and total dose of gonadotropins used, the risk of cLBR was statistically significantly increased for women in T2 (RR 1.19, 95% CI 1.06-1.33) and T3 (RR 1.14, 95% CI 1.01-1.28) compared with T1. Similar results were obtained for cSIR. For cycles with 5-10 oocytes, a statistically significant positive association was observed between T3 progesterone:oocyte ratio for both cLBR (RR 1.78, 95% CI 1.22-2.60) and cSIR (RR 1.80, 95% CI 1.24-2.62) compared with T1 after adjusting for oocyte number, while no such association was observed for cycles with >10 oocytes retrieved (cLBR: RR 0.95, 95% CI 0.84-0.95; cSIR: RR 0.95, 95% CI 0.83-1.08).ConclusionOur findings do not support an adverse association between a premature rise in progesterone and oocyte quality. In normal responders, this rise may be beneficial.