Progesterone levels on the hCG trigger day affect the pregna
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Two meta-analyses have shown that pregnancy and birth rates are significantly higher after blastocyst transfer than after cleaved embryo transfer. Other studies have revealed that a serum progesterone level>1.5 ng/ml on the trigger day is responsible for premature luteinization and is associated with a low pregnancy rate.

The objectives of this retrospective study were to determine whether blastocyst transfer gave higher pregnancy rates than cleaved embryo transfer at day 3 in both the general and selected IVF/ICSI populations and whether the serum progesterone level influenced the pregnancy rate.

Researchers studied IVF/ICSI cycles with GnRH antagonist - FSH/hMG protocols in a general population and a selected “top cycle” population, after blastocyst transfer on day 5 or cleaved embryo transfer on day 3. The selected couples had to meet the following criteria: female age<35, first or second cycle, and one or two embryos transferred.

Results are:
--In the general population, the clinical pregnancy rate was significantly higher after blastocyst transfer than after cleaved embryo transfer; the same was true for the birth rate.

--The differences between blastocyst and embryo transfer groups were not significant in the selected population.

--The serum progesterone levels on the eve of the trigger day and on the day itself were significantly lower in the pregnant women.

--They found a serum progesterone threshold of 0.9ng/ml, as also reported by other researchers. The progesterone to oocyte index (POI) and the progesterone to follicle index (PFI) appear to have predictive value for cleaved embryo transfers.

Overall, blastocyst transfers were associated with higher clinical pregnancy and birth rates than cleaved embryo transfers in a general population but not in a selected population. The serum progesterone levels on the eve of the trigger day and on the day itself predicted the likelihood of pregnancy.

Source: https://doi.org/10.1186/s12884-021-03832-3
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