Does the personalized controlled ovarian stimulation by highly purified hMG in ICSI cycles affect serum progesterone at day of trigger

  • OLa Youssef Ahmed Assistant lecturer obstetrics and gynecology
  • Hassan Maghraby Professor of Obstetrics and Gynecology, University Of Alexandria, Egypt
Keywords: Hp-hMG, FSH, progesterone rise, GnRH agonist, GnRH antagonist, ICSI outcomes.

Abstract

Background: Premature progesterone elevation (PE) in late follicular phase is usually defined as progesterone levels of ≥ 1.5 ng/ml at the day of hCG trigger. The cause of PE is debatable. Recent studies suggested that PE maybe related to FSH exposure, number of oocytes retrieved, and estradiol level at the day of trigger as factors affecting the incidence of PE. The objective is to assess the progesterone rise in ICSI cycles using highly purified human menopausal gonadotropin (Hp-hMG) either sequential or combined with FSH.

Methods: Prospective cohort study on consecutive 100 normal responder women undergoing ovarian stimulation for ICSI; 55 patients received combined protocol (FSH+ hp-hMG), 45 patients received the sequential protocol. Outcome: The primary outcome was serum progesterone (P4) at day of trigger of ovulation. Secondary outcomes were the number and percentage of metaphase II oocytes number of top quality embryos, and clinical pregnancy rate.

Results: P4 at day of trigger was not significantly different between two groups. The range for P4 level at day of trigger in concomitant protocol was (min-max 0.05 – 2.58, median 0.63), while in sequential protocol was (min- max 0.09 – 2.43, with median 0.7), P value 0.667. Number of metaphase II oocytes was significantly higher in concomitant protocol; however, percentage of metaphase II was significantly higher in sequential protocol. No difference in top quality embryos or clinical pregnancy rate between two groups.

Conclusions: Controlled ovarian stimulation protocols that contain hp-hMG seem to decrease the incidence of premature progesterone rise, but no evidence that sequential protocol is superior to concomitant one in decreasing progesterone level.

Author Biography

Hassan Maghraby, Professor of Obstetrics and Gynecology, University Of Alexandria, Egypt
  • Director of Dar El-Teb fertility center, Alexadria.
  • One of the main founders and head of Egyptian foundation of reproductive endocrinology (EFRE).
  • Current Sub-specialty: Reproductive medicine and surgery.
  • Head of Board and General Director of Shatby Hospital 2010 -2012)
  • Director of Shatby University Hospital Center of Excellence for ART and Endoscopy (2009 _2012)
  • Chairman of Department of Obstetrics and Gynecology.
  • Research fellowship in reproductive biology, and IVF training, hospital of the University of Pennsylvania, Philadelphia, USA, 1988- 1990
Published
2022-02-13