A Proof of Concept Study of Serum Progesterone Levels for IVF/ICSI Following HCG Trigger for Oocyte Maturation

Studies have suggested that controlled ovarian hyperstimulation adversely affects endometrial receptivity. In ovarian stimulation cycles with exogenous gonadotrophins there is an ongoing debate regarding the effect of a late follicular phase progesterone level on reproductive outcomes. It is not yet clarified if an elevated serum progesterone level in the late follicular phase is a symptom or cause of an adverse effect on reproductive outcomes. A new hypothesis is evolving and gaining momentum providing a novel explanation for the association between late follicular phase progesterone rise and reproductive outcome. It is proposed that exogenous FSH (Follicle-stimulating hormone) administration results in supraphysiological levels of FSH, which induce an abundance of LH (luteinizing hormone) receptors on granulosa cells causing the follicles to become hypersensitive to LH-like activity (ie hCG trigger). Based on this hypothesis, the focus should be placed on the hCG trigger rather than on the late follicular phase progesterone rise.

Inclusion criteria

• Females aged 18 to 42 years with regular menstrual cycles of 26-34 days
• Undergoing ovarian stimulation for IVF/ICSI & PGS.
• Receiving recombinant FSH for stimulation
• hCG 5000iu IM as trigger injection for oocyte maturation.
• Ovarian stimulation in GnRH-antagonist protocols
• BMI 18- 35 kg/m2
• Having 1 or 2 euploid embryos for transfer in spontaneous natural cycles.

Exclusion criteria

• Poor ovarian reserve as defined by Bologna criteria
• PCOS in accordance with Rotterdam criteria