Impact of progesterone (on hCG day)/oocyte ratio on pregnancy outcome in long agonist non donor fresh IVF/ICSI cycles

OBJECTIVE: To assess the role of progesterone (P) on [human chorionic gonadotropin (hCG) day]/oocyte ratio rather than a single cut-off value of serum P on hCG day to predict in vitro fertilization (IVF) outcomes. MATERIALS AND METHODS: A Retrospective, single center, cohort study in 687 infertile women undergoing fresh IVF/intracytoplasmic sperm injection (ICSI) treatment with long agonist protocol. The data was categorized into three groups according to serum P levels (Group A < 1.0, Group B: 1.0-1.5, Group C ≥ 1.5) and two groups on the basis of P/oocyte ratio (Group A ≤ 0.15; Group B > 0.15) determined using receiver operating characteristic (ROC). For comparing categorical data, χ(2)/Fishers exact test was carried out as appropriate. ROC analysis was performed to determine cut-off value for P and P/oocyte, which may discriminate between pregnancy and nonpregnancy. RESULTS: The mean age of participants was 31.6 ± 3.7 years and overall pregnancy rate was 26.1%. Elevation of both serum P levels and P/oocyte ratio was found to significantly reduce the pregnancy potential in IVF without affecting fertilization and cleavage rates. The detrimental cut-off value for P and P/oocyte was found to be >1.0 ng/mL (sensitivity 56%; specificity 52%) and >0.15 (sensitivity 62%; specificity 61%) respectively. Pregnancy rate (35.3%) among the patients having ≤0.15 P/oocyte ratio was significantly higher (p < 0.001) compared with 18.8% observed among the patients having value >0.15. CONCLUSION: P/oocyte ratio may be considered as a valuable tool to predict IVF outcomes when compared with serum P levels alone, but more evidence from randomized studies is required.