Can Progesterone Levels Predict IVF Success New Study Uncovers Critical Insights

Introduction

A groundbreaking study from Saudi Arabia explores whether progesterone levels on the day of hCG administration can accurately predict IVF/ICSI outcomes. Despite the advancements in reproductive technologies, pregnancy success rates remain variable. This study critically assesses the predictive validity of progesterone elevation (PE) on cycle outcomes, challenging previous assumptions and shedding light on a controversial fertility biomarker.

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Evaluating Progesterone’s Predictive Power

Researchers examined 256 IVF/ICSI cycles in a retrospective cohort at a major reproductive center in Riyadh, Saudi Arabia. Patients were evaluated based on:

• Progesterone levels (P4) on hCG day
• Pregnancy outcome (positive vs. negative)
• Cycle parameters including BMI, estrogen levels, and oocyte retrieval

Key findings revealed:

• A 36.7% pregnancy rate
• Patients with negative outcomes had significantly higher mean P4 levels (2.26 nmol/L) compared to those with positive results (1.84 nmol/L)
• A cut-off of 1.5 nmol/L was identified but had limited diagnostic validity

Read the full study at: https://doi.org/10.29328/journal.cjog.1001028

Broader Implications in Fertility Practice

The American Society for Reproductive Medicine (ASRM) notes that premature progesterone rise can affect endometrial receptivity, though its clinical impact remains debated. This study supports the hypothesis that higher P4 levels may compromise pregnancy outcomes, particularly in fresh embryo transfers.

Cycles with P4 ≥1.5 nmol/L were also associated with:

• Lower BMI
• Higher estrogen (E2) levels
• Higher abortion and ovarian hyperstimulation rates
• Lower live birth outcomes

The data encourages clinics to individualize stimulation protocols and consider additional hormonal profiling before embryo transfer.

Despite identifying 1.5 nmol/L as a threshold, the ROC analysis showed low sensitivity (59%) and specificity (51%), making it unreliable for clinical prediction.

A detailed analysis can be found in our main journal articledoi.org/10.29328/journal.cjog.1001028, hosted by Clinical Journal of Obstetrics and Gynecology.

Clinical Takeaways

• Progesterone elevation on hCG day may signal reduced IVF success, but alone is not a reliable predictive marker.
• A multi-hormonal assessment approach is likely more accurate.
• Progesterone levels should be interpreted alongside BMI, estrogen, and cycle history.

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