Correlation between Elevated Serum Progesterone in the Day of Hcg Injection, Metaphase II Oocytes and Their Impact on The Success of ICSI

Abstract

Objective: In this study we tried to understand the effect of progesterone level at the time of ovulation
trigger on intracytoplasmic sperm injection (ICSI) outcome. We expected identifying cut off values for
serum progesterone level the day of hCG injection (P-hCG) & P-hCG per mature oocyte ratio (P-hCG /
MII), as predictive tests of ICSI success. Methods: 200 women 18-40 years old and attending IVF unit
of Kasr el Aini hospital for management of infertility were included in the study. They were scheduled for
ICSI after controlled ovarian induction with GnRH- agonist protocol. Inclusion criteria were tubal factor
of infertility, unexplained infertility, polycystic ovarian syndrome and BMI ? 30 kg/m2. Exclusion criteria
were severe male factor infertility, hyperprolactinemic patients, high basal FSH > 11 IU/L, frozen embryo
transfer cycles, uterine anomalies or synechia. Primary outcome parameter included correlation of serum
progesterone on day HCG administration, number of MII oocytes and calculated progesterone/ MII oocyte
ratio with success of ICSI.
Results: 193cases underwent embryo transfer, 7cases cancelled. Clinical pregnancy was reported in 52
(27.9%) cases. Higher P-hCG was observed in cases who didn’t get pregnant compared to those who got
pregnant (p= 0.01) with cut off value of 1 ng/ml correlated well with the clinical pregnancy rate after ICSI
with 61% sensitivity and 59% specificity (p=0.004). A significantly lower P-hCG/MII ratio was found in
the pregnant women group compared to that found in the non-pregnant group (p=0.001) and cut off value
of 0.18 correlated best with clinical pregnancy after ICSI with sensitivity 70.5% and specificity 61.2%
(p<0.001). Conclusion : We demonstrated negative correlation between P-hCG and P-hCG/MII and
clinical pregnancy rate after ICSI.