Effect of Trigger-day serum progesterone level on clinical pregnancy in Fresh n Vitro Fertilization (IVF) Cycles: A retrospective chart review.
The Impact of Late Follicular Phase Progesterone Level on Pregnancy Outcomes in Fresh IVF Cycles
DOI:
https://doi.org/10.69614/ejrh.v18i04.1226Abstract
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.
References
Organization WH. Guideline for the prevention, diagnosis and treatment of infertility: summary of recommendations. Geneva: World Health Organization. 2025.
Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. The International Glossary on Infertility and Fertility Care, 2017. Human Reproduction. 2017;32(9):1786-801.
Guan L, Wu H, Li Y, Liang Q, Zhen X, Xiang S, et al. Effect of progesterone levels on the hCG trigger day and the progesterone-to-basal progesterone ratio on pregnancy outcomes in fresh IVF/ICSI cycles with GnRH antagonist protocol: a retrospective cohort study. Frontiers in endocrinology. 2025 2025-December-17;Volume 16 - 2025. English.
Han X, Song N, Zhang Y, Wang J, Zhao F, Zhang Y, et al. Clinical impact of progesterone levels on HCG trigger day in a follicular long-term IVF protocol. Frontiers in endocrinology. 2025;16:1593079.
Hokmabadi E, Salahi E, Ghasemi M. The relationship between serum progesterone level on the day of HCG trigger in IVF/ICSI cycles and oocyte maturation and embryo quality: a retrospective observational study. BMC women's health. 2024 Dec 30;24(1):673. PubMed PMID: 39736583.
Huang L, Huang S, Wen Y, Zhang X, Hu X, Wu R, et al. The Impact of Late Follicular Phase Progesterone Elevation on Cumulative Live Birth Rate and Embryo Quality in 4072 Freeze-All Cycles. Journal of Clinical Medicine. 2022;11(24):7300.
Merviel P, Bouée S, Jacamon AS, Chabaud JJ, Le Martelot MT, Roche S, et al. Progesterone levels on the human chorionic gonadotropin trigger day affect the pregnancy rates for embryos transferred at different stages of development in both general and selected IVF/ICSI populations. BMC Pregnancy and Childbirth. 2021 2021/05/06;21(1):363.
Organization WH. Infertility prevalence estimates, 1990–2021. Geneva: World Health Organization, 2023 Contract No.: Licence: CC BY-NC-SA 3.0 IGO.
Mohamed Salih EL, Farah A, Saeed Mohammed HM, Badre Adam HS, Altayeb Abdullah RB. Clinical Predictors of Successful Pregnancy After In Vitro Fertilization (IVF): A Comprehensive Systematic Review of Evidence. Cureus. 2026 Jan;18(1):e100734.
van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F. Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis. Hum Reprod Update. 2010 Nov-Dec;16(6):577-89.
Ashmita J, Vikas S, Swati G. The Impact of Progesterone Level on Day Of hCG Injection in IVF Cycles on Clinical Pregnancy Rate. Journal of human reproductive sciences. 2017 Oct-Dec;10(4):265-70.
Venetis CA, Kolibianakis EM, Bosdou JK, Tarlatzis BC. Progesterone elevation and probability of pregnancy after IVF: a systematic review and meta-analysis of over 60 000 cycles. Hum Reprod Update. 2013 Sep-Oct;19(5):433-57.
Abdullah Z. ASSOCIATION BETWEEN PRE-TRIGGER SERUM PROGESTERONE LEVEL AND CONCEPTION RATE AFTER A FRESH EMBRYO TRANSFER IN IVF-ICSI CYCLES. Journal of Sulaimani Medical College. 2020 09/21;10:187-91.
Lawrenz B, Labarta E, Fatemi H, Bosch E. Premature progesterone elevation: targets and rescue strategies. Fertility and Sterility. 2018 04/01;109:577-82.
Li F, Cai H, Tian L, Bai H, Shi J. Effect modification by developmental stage of embryos on the association between late follicular phase progesterone elevation and live birth in fresh transfers. BMC Pregnancy Childbirth. 2023 Jan 13;23(1):24.
Pitner I, Mikuš M, Šprem Goldštajn M, Laganà AS, Chiantera V, Ferrari F, et al. Effects of different progesterone levels on reproductive outcomes in assisted reproductive technologies: from molecular basis to treatment strategies. Gynecological endocrinology. 2023 Dec;39(1):2190806.
Racca A, Santos-Ribeiro S, De Munck N, Mackens S, Drakopoulos P, Camus M, et al. Impact of late-follicular phase elevated serum progesterone on cumulative live birth rates: is there a deleterious effect on embryo quality? Human Reproduction. 2018;33(5):860-8.
Sonigo C, Dray G, Roche C, Cédrin-Durnerin I, Hugues J-N. Impact of high serum progesterone during the late follicular phase on IVF outcome. Reproductive BioMedicine Online. 2014 2014/08/01/;29(2):177-86.
Lawrenz B, Fatemi HM. Effect of progesterone elevation in follicular phase of IVF-cycles on the endometrial receptivity. Reproductive BioMedicine Online. 2017 2017/04/01/;34(4):422-8.
Lawrenz B, Sibal J, Garrido N, Abu E, Jean A, Melado L, et al. Inter-assay variation and reproducibility of progesterone measurements during ovarian stimulation for IVF. PLoS One. 2018;13(11):e0206098.
Lim YC, Hamdan M, Maheshwari A, Cheong Y. Progesterone level in assisted reproductive technology: a systematic review and meta-analysis. Scientific Reports. 2024 2024/12/28;14(1):30826.
Novia D, Putri Lubis H, Halim B, Pustimbara A, Lestari R, Abinawanto A, et al. The impact of late follicular progesterone level on in vitro fertilization-intracytoplasmic sperm injection outcome: Case-control study. International journal of reproductive biomedicine. 2020 May;18(5):367-74.
de Ziegler D, Andersen CY, Stanczyk FZ, Ayoubi JM. Endocrine mechanisms and assay issues in premature progesterone elevation in assisted reproductive technology. Fertility and Sterility. 2018;109(4):571-6.
Drakopoulos P, Racca A, Errazuriz J, De Vos M, Tournaye H, Blockeel C, et al. The role of progesterone elevation in IVF. Reproductive Biology. 2019 02/01;19.
Abiodun O, Omobuwa, A., Fakunle, A., Oluwagbaye, V., Komolafe, M., Adewale, O., Akindele, A., Fasanu, A., & Komolafe, J. . Premature progesterone rise incidence & its effects on in vitro fertilization cycles . Research Journal of Health Sciences. 2023;11(1):1-11.
De Cesare R, Morenghi E, Cirillo F, Ronchetti C, Canevisio V, Persico P, et al. The Role of hCG Triggering Progesterone Levels: A Real-World Retrospective Cohort Study of More Than 8000 IVF/ICSI Cycles. Frontiers in endocrinology. 2020;11:547684.
George JS, Keefe KW, Lanes A, Yanushpolsky E. PREMATURE PROGESTERONE ELEVATION DURING EARLY AND MID FOLLICULAR PHASES IN FRESH IN VITRO FERTILIZATION (IVF) CYCLES IS ASSOCIATED WITH LOWER IMPLANTATION AND CLINICAL PREGNANCY RATES. Fertility and Sterility. 2021;116(3):e243.
George JS, Keefe KW, Lanes A, Yanushpolsky E. Premature progesterone elevation during the early and mid-follicular phases in fresh in vitro fertilization (IVF) cycles is associated with lower live birth, clinical pregnancy, and implantation rates. Journal of assisted reproduction and genetics. 2023 May;40(5):1029-35.
Huang B, Ren X, Wu L, Zhu L, Xu B, Li Y, et al. Elevated Progesterone Levels on the Day of Oocyte Maturation May Affect Top Quality Embryo IVF Cycles. PLOS ONE. 2016;11(1):e0145895.
Woo J, Kwon H, Choi D, Park C, Kim J, Shin J, et al. Effects of Elevated Progesterone Levels on the Day of hCG on the Quality of Oocyte and Embryo. J Clin Med. 2022 Jul 25;11(15).
Zegers-Hochschild F, Dyer S, Adamson GD, Baker V, Barnhart K, Bhattacharya S, et al. The International Glossary on Infertility and Fertility Care, 2025. Human Reproduction. 2026. DOI:10.1093/humrep/deag029
