Activities per year
Abstract
Introduction: The stimulation protocols in IVF treatment cycles induce supraphysiological
serum concentrations of oestradiol (E2) during the follicular phase. Despite the use of GnRH analogues, there is a risk of premature progesterone
(P) rise jeopardizing the pregnancy outcome. To the best of our knowledge,
this is the first study to investigate the relationship between premature
P rise and serum E2 levels and the number of follicles in GnRH antagonist/
rec-FSH stimulated cylces.
Material and Methods: Two hundreds and seven patients treated by IVF/ICSI at
the Centre for Reproductive Medicine of Dutch-Speaking Brussels Free University
were included in this observational study. Recombinant FSH (Puregon; NV
Organon, OSS, The Netherlands) was started on Day 2 of the menstrual cycle at
a dose of 200 IU/day in all patients. GnRH antagonist (Orgalutran; NV Organon)
was started day 6 of rFSH stimulation. Triggering of final oocyte maturation was
performed using 10000 IU hCG (Pregnyl; Organon, Oss, The Netherlands) as
soon as at least three follicles ? 17 mm were present on ultrasound scan.
Hormonal assessment was performed at the initiation of stimulation, on
Day 6 of rec-FSH stimulation, on Day 8 and on the day of hCG administration.
Ultrasound scan was performed on Day 6 and thereafter as necessary in order
to ensure that hCG would be injected as soon as the patient had ? 3 follicles
of ? 17 mm.
Results: A logestic regression model was performed to assess the relationship
between E2 and number of follicles of ? 11 mm of the trigger day with progesterone
rise (over 1.5 ng/ml). A significant effect on progesterone rise was
observed for both E2 (p <0.001) and the number of follicles (p = 0.041).
The maximum accuracy calculated via the ROC curve was employed in
order to estimate a cut-off for E2 and number of follicles on day of trigger when
progesterone is > 1.5 ng/ml. A serum E2 on day of hCG > 2428 pg/ml and more
than 12 follicles of ? 11 mm in diameter were found to have a 0.1793 and 0.3655
specificity, 0.4355 and 0.5484 sensitivity, a positive predictive value 27% and
34% and negative predictive value 92% and 117% respectively for progesterone
rise over 1.5 ng/mi. The AUC was 0.62547 and 0.60845 respectively.
Conclusions: These data demonstrate a significant effect on progesterone rise
by E2 (P <0.001) and number of follicles (P = 0.041) in GnRH antagonist/rec-
FSH stimulated cycles.
Premature progesterone rise during GnRH antagonist IVF cycles is a frequent
phenomenon which is associated with lower pregnancy and implantation
rates. With this knowledge, an upcoming progesterone rise during follicular
phase can be anticipated and prevented.
serum concentrations of oestradiol (E2) during the follicular phase. Despite the use of GnRH analogues, there is a risk of premature progesterone
(P) rise jeopardizing the pregnancy outcome. To the best of our knowledge,
this is the first study to investigate the relationship between premature
P rise and serum E2 levels and the number of follicles in GnRH antagonist/
rec-FSH stimulated cylces.
Material and Methods: Two hundreds and seven patients treated by IVF/ICSI at
the Centre for Reproductive Medicine of Dutch-Speaking Brussels Free University
were included in this observational study. Recombinant FSH (Puregon; NV
Organon, OSS, The Netherlands) was started on Day 2 of the menstrual cycle at
a dose of 200 IU/day in all patients. GnRH antagonist (Orgalutran; NV Organon)
was started day 6 of rFSH stimulation. Triggering of final oocyte maturation was
performed using 10000 IU hCG (Pregnyl; Organon, Oss, The Netherlands) as
soon as at least three follicles ? 17 mm were present on ultrasound scan.
Hormonal assessment was performed at the initiation of stimulation, on
Day 6 of rec-FSH stimulation, on Day 8 and on the day of hCG administration.
Ultrasound scan was performed on Day 6 and thereafter as necessary in order
to ensure that hCG would be injected as soon as the patient had ? 3 follicles
of ? 17 mm.
Results: A logestic regression model was performed to assess the relationship
between E2 and number of follicles of ? 11 mm of the trigger day with progesterone
rise (over 1.5 ng/ml). A significant effect on progesterone rise was
observed for both E2 (p <0.001) and the number of follicles (p = 0.041).
The maximum accuracy calculated via the ROC curve was employed in
order to estimate a cut-off for E2 and number of follicles on day of trigger when
progesterone is > 1.5 ng/ml. A serum E2 on day of hCG > 2428 pg/ml and more
than 12 follicles of ? 11 mm in diameter were found to have a 0.1793 and 0.3655
specificity, 0.4355 and 0.5484 sensitivity, a positive predictive value 27% and
34% and negative predictive value 92% and 117% respectively for progesterone
rise over 1.5 ng/mi. The AUC was 0.62547 and 0.60845 respectively.
Conclusions: These data demonstrate a significant effect on progesterone rise
by E2 (P <0.001) and number of follicles (P = 0.041) in GnRH antagonist/rec-
FSH stimulated cycles.
Premature progesterone rise during GnRH antagonist IVF cycles is a frequent
phenomenon which is associated with lower pregnancy and implantation
rates. With this knowledge, an upcoming progesterone rise during follicular
phase can be anticipated and prevented.
Original language | English |
---|---|
Pages (from-to) | 324, 526 |
Number of pages | 2 |
Journal | Human Reproduction |
Volume | 26 |
Publication status | Published - Jul 2011 |
Event | Unknown - Duration: 1 Jul 2011 → … |
Keywords
- Progesterone
- Estradiol
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- 1 Participation in workshop, seminar
-
27th Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE)
Paul Devroey (Participant)
3 Jul 2011 → 6 Jul 2011Activity: Participating in or organising an event › Participation in workshop, seminar