Effect of Trigger-day serum progesterone level on clinical pregnancy in Fresh n Vitro Fertilization (IVF) Cycles: A retrospective chart review.

Introduction: Clinical pregnancy rates remain suboptimal in many fresh In Vitro Fertilization (IVF) cycles. Progesterone elevation prior to oocyte retrieval remains a controversial factor that may negatively affect pregnancy rates. There is no single globally accepted serum progesterone threshold level so far. In addition, there are only limited studies done on the issue in low resource countries. Objective: To assess the late follicular phase serum progesterone level that adversely affects clinical pregnancy rate in fresh IVF cycles in low-resource setting. Methods: A three years retrospective cross sectional study. It was conducted at Alhikmah Fertility Center, Addis Ababa, Ethiopia, 2023 – 2025 GC. Women undergoing fresh IVF/ICSI cycles who fulfill the eligibility criteria were included. The data was entered and analyzed using SPSS version 25. Result: A total of 214 fresh IVF/ICSI cycles were included. Mean age at ovum pick up was 34.7 ± 6.0 years. The overall clinical pregnancy rate was 23.8%. Progesterone was categorized into three clinically relevant groups based on prior study reports as Group A (<0.7 ng/mL), Group B (0.70–1.00 ng/mL) and Group C (>1.00 ng/mL). Clinical pregnancy rate fell as progesterone level rose, from 34.2% in Group A to 16.3% in Group C. The difference across the three groups was significant (?²=7.80, 2 df, p=0.020). Women with a pre-trigger progesterone level ?1.00 ng/mL had approximately 2.5 times higher odds of clinical pregnancy compared to those with progesterone >1.00 ng/mL (AOR 2.74, 95% CI 1.34–5.59, P=0.006). Conclusions: The findings support an inverse association between trigger-day progesterone concentration and clinical pregnancy in fresh IVF cycles. The pre trigger progesterone level above 1.00 ng/mL was associated with significantly reduced clinical pregnancy.