Improving Pregnancy outcome by Measures used to Prevent Premature Progesterone Increase-Individualizing Art Treatment

It is well known that if there is increased Progesterone(P) in the latter part of the follicular phase during controlled ovarian stimulation(COS), used for in vitro fertilization(IVF)it has a detrimental effect on the outcome of the same.Proof exists regarding acceleration of endometrial maturation, which directly effects the endometrial receptivity(ER).Also there are some studies although only retrospective, which show premature P rise might affect the oocyte/embryo quality.Increased FSH during the latter part of COS has been identified as the main culprit.Thus important is to individualize the COS protocol, based on the patients ovarian reserve and accordingly taper down if required the dosage of FSH in the end of follicular phase.Additional options are use of corticosteroids, prevention of prolonged stimulation, and use of freeze all strategy, postponing ET in next cycle, although there are questions regarding longterm safety of childrenborn from frozen thwed embryos.