Effect of Serum Progesterone (P4) Level at the Day of Human Chorionic Gonadotropin (HCG) Administration on the Outcome of Intracytoplasmic Sperm Injection and Fresh Embryo Transfer

Our aim was to investigate the effect of different progesterone (P4) at day of triggering HCG on the outcomes of ICSI with fresh embryo transfer in cases who underwent controlled ovarian stimulation (COS). Pituitary desensitization done either with long agonist or antagonist pituitary desensitization protocols, then analyzing the effect of serum P4-hCG level on ICSI-fresh embryos transfer outcome including; number and quality of retrieved oocytes (OR), embryo number (ER) & quality and ongoing pregnancy outcomes. The cases are which continued their pregnancy till 12 weeks, aborted cases, ectopic pregnancy & cancelled cases (for different reasons).

Materials and Methods: This prospective cohort study was carried on 120 cases who underwent ICSI cycles for different causes and types of infertility. Controlled ovarian stimulation (COS) protocol and pituitary down-regulation either by; GnRH long agonist /antagonist protocols then, fertilization, embryo grading, embryo transfer and hormonal luteal support was done. Blood samples were taken on the day of hCG administration to measure P4 in all cases. All patients who got pregnant and continue till 12 weeks, they were categorized into 3 subgroups as regard serum P4 level: Group A: (P4< 0.5 ng/ml), Group B: (P4=O.5-I.5 ng/ml) & Group C: (P4 >I.5 ng/ml) and correlated with their ICSI outcome. The outcomes of ICSI-ET cycles in those cases were compared with 3 groups of P4 levels in the controlled ovarian stimulation with two protocols.

Results: P4 level had insignificant relation with number and quality of retrieved oocytes, fertilized embryo number and quality and endometrial thickness regardless the protocol of COS. The low and high levels of P4 both, had a detrimental effect on CPR, meanwhile, with no harmful impact on the ongoing pregnancy rate was noticed, regardless the protocol of ovarian stimulation. P4-hCG isn’t considered to be the only predictive measure of ICSI outcome. Highest CRP was noticed in cases with P4 level (0.5-I.5 ng/ mI) regardless the type of protocol used.