Taiwanese Journal of Obstetrics and Gynecology
Volume 47, Issue 2 , Pages 168-174, June 2008

Increased Progesterone/Estradiol Ratio on the Day of hCG Administration Adversely Affects Success of In Vitro Fertilization–Embryo Transfer in Patients Stimulated with Gonadotropin-releasing Hormone Agonist and Recombinant Follicle-stimulating Hormone

  • Yu-Che Ou

      Affiliations

    • Chang Gung Memorial Hospital—Kaohsiung Medical Center, Chang Cung University College of Medicine, Kaohsiung, Taiwan
    • ,
  • Kuo-Chung Lan

      Affiliations

    • Chang Gung Memorial Hospital—Kaohsiung Medical Center, Chang Cung University College of Medicine, Kaohsiung, Taiwan
    • Department of Obstetrics and Gynecology, ChangGung University School of Medicine, Taoyuan, Taiwan
    • ,
  • Shiuh-Young Chang

      Affiliations

    • Chang Gung Memorial Hospital—Kaohsiung Medical Center, Chang Cung University College of Medicine, Kaohsiung, Taiwan
    • Department of Obstetrics and Gynecology, ChangGung University School of Medicine, Taoyuan, Taiwan
    • ,
  • Fu-Tsai Kung

      Affiliations

    • Chang Gung Memorial Hospital—Kaohsiung Medical Center, Chang Cung University College of Medicine, Kaohsiung, Taiwan
    • Department of Obstetrics and Gynecology, ChangGung University School of Medicine, Taoyuan, Taiwan
    • ,
  • Fu-Jen Huang

      Affiliations

    • Chang Gung Memorial Hospital—Kaohsiung Medical Center, Chang Cung University College of Medicine, Kaohsiung, Taiwan
    • Department of Obstetrics and Gynecology, ChangGung University School of Medicine, Taoyuan, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Fu-Jen Huang, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan

Accepted 20 September 2007.

Article Outline

Summary 

Objective

We investigated the influence of premature luteinization in in vitro fertilization using a long protocol of gonadotropin-releasing hormone agonist (GnRHa) and recombinant follicle-stimulating hormone (rFSH), taking ovarian response into account in the definition of premature luteinization.

Materials and Methods

A total of 339 cycles of controlled ovarian hyperstimulation with rFSH and GnRHa were performed in 311 infertile couples. Premature luteinization was defined as a progesterone (P) to estradiol (E2) ratio of > 1 on the day of human chorionic gonadotropin (hCG) administration. The P/E2 ratio is calculated as: P (ng/mL) × 1,000/E2 (pg/mL). Clinical outcomes were compared for the prematurely luteinized and non-prematurely luteinized groups.

Results

The mean number of retrieved oocytes, recovered mature oocytes, embryos and top quality embryos were significantly higher in the non-prematurely luteinized group than in the prematurely luteinized group. Although fertilization rates and implantation rates were similar between the two groups, the clinical pregnancy rate was higher in the non-prematurely luteinized group than in the prematurely luteinized group.

Conclusion

Premature luteinization, defined as late follicular P/E2 ratio of > 1 in long GnRHa cycles with rFSH stimulation, adversely affected ovarian responses and clinical outcomes. It seems unrelated to preovulatory luteinizing hormone (LH) elevation and LH/hCG content of gonadotropins and could be associated with poor ovarian response and the presence of dysmature follicles. [Taiwan J Obstet Cynecol 2008;47(2):1 68-1 74]

Key Words:  GnRH agonist , premature luteinization , progesterone to estradiol ratio , recombinant FSH

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PII: S1028-4559(08)60075-3

doi:10.1016/S1028-4559(08)60075-3

Taiwanese Journal of Obstetrics and Gynecology
Volume 47, Issue 2 , Pages 168-174, June 2008

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