BMI, basal P, hCG-day E2/LH, and oocyte count predict elevated progesterone in GnRH-A IVF.

Premature progesterone elevation on the day of human chorionic gonadotropin (hCG) administration is a well-recognized challenge in controlled ovarian stimulation (COS) during in vitro fertilization (IVF) cycles. This phenomenon, particularly observed in gonadotropin-releasing hormone (GnRH) antagonist protocols, can negatively impact endometrial receptivity and pregnancy outcomes, despite its unclear effect on oocyte and embryo quality. Identifying specific patient characteristics and endocrine parameters that predict this elevation is crucial for optimizing treatment strategies and improving success rates in assisted reproductive technologies (ART). Current standard-of-care often involves cycle cancellation or embryo cryopreservation, highlighting the need for proactive risk assessment.

This retrospective cohort study analyzed 1392 IVF-ET or ICSI cycles (2018-2023). Patients undergoing controlled ovarian stimulation with a GnRH-antagonist protocol were stratified: normal progesterone (NP) group (serum P ≤ 1.5 ng/mL, n = 985 cycles) and high progesterone (HP) group (serum P > 1.5 ng/mL, n = 407 cycles) on hCG day. Clinical characteristics and endocrine parameters (basal FSH, basal P, hCG-day E2, hCG-day LH) were compared. Univariate and multivariate logistic regression identified independent factors for elevated hCG-day progesterone.

Significant differences were observed between the NP and HP groups across several parameters (all P < 0.05). The NP group had higher oocyte retrieval age, BMI, basal FSH, and hCG-day serum LH, while the HP group showed higher basal P, antral follicle count, hCG-day serum E2, AMH, and total number of oocytes retrieved. No significant differences were found in basal LH, basal E2, initial Gn dose, total Gn duration, or total Gn dose (all P > 0.05). > Multivariate logistic regression analysis identified BMI (OR = 0.901, p < 0.05), basal P (OR = 2.100, p < 0.05), hCG-day serum E2 (OR = 1.225, p < 0.05), hCG-day serum LH (OR = 1.048, p < 0.05), and total oocytes retrieved (OR = 1.143, p < 0.05) as independent factors influencing elevated progesterone levels on hCG day.