Open Access Journal of Reproductive System How to Determine the Ideal Increased Progesterone Levels Cutoff During Fresh In Vitro Fertilization Cycles: Is it Time to Move Forward-A Short Commentary

LupinePublishers_How to Determine the Ideal Increased ProgesteroneLevels Cutoff During Fresh In Vitro Fertilization Cycles:Is it Time to Move Forward-A Short Commentary by Kulvinder Kochar Kaur in Open Access Journal of Reproductive System and sexual disorders in Lupine_Publishers.

That increased progesterone(P) that is present on the day of human chorionic gonadotropin (HCG)trigger has an effect on the probable chances of a pregnancy resulting following a fresh embryo transfer has been a point that can be debated over the last 25 years [1-3]. A meta-analysis conducted by Venetis et al in 2013, confirmed the negative effect of progesterone on pregnancy following an ET [3]. They Further confirmed that by using proper analytical approaches one can find this correlation [4]. How this effect is brought about is by changing endometrial receptivity, an approach tested both by basic along with clinical research. Most importantly this support comes from cycles in which increased P do not affect if the embryos are frozen and transferred in subsequent cycle of frozen-thawed embryos [3]. Hence a proposal of freeze all/ freeze only policy was suggested as an answer to manage increased P found by the end of follicular phase.
However, the biggest problem that arises is what is the threshold of increased P that has to be considered as abnormal and thus needing any intervening procedure. With multiple thresholds getting in the literature more confusion has got created. Hence clinicians are still not sure that on measuring P on the day of HCG what is the exact threshold which they will employ to decide that they have to cancel a fresh ET and get into freeze-only policy ? This question has been taken up by Hill et al in 2018 [5] by an intense analysis of 7608 ART transfer cycles for getting different P thresholds and found it varied from 0.4 -3.0 ng/ml .Using different methods which kept in mind the sensitivity as well as specificity of every threshold they proposed ,in addition to the cost factor that would result if they used a freeze only(they preferred the term freeze only over freeze all a term adopted by the journal club Global [6]) policy what would the result be. They analyzed that if they used a threshold in between 1.5-2.0ng/ml, it would prove to be the most cost effective to use the freeze only approach [5]. Although they did find a statistically significant negative effect of P on pregnancy rates getting found if a threshold of 0.7ng/ml although they found if they used this low cut off the number required to treat markedly increased which decreased to 13 with the 1.5-2.0ng/ml cutoff.


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