In recent years, multiple studies have proposed the potential use of P levels on the day of HCG administration as a predictor of pregnancy outcomes [11]. Some studies have shown that high P levels during daily HCG administration may adversely impact pregnancy outcomes. It has been reported that too high or too low P levels can adversely affect live birth rates. A 2013 meta-analysis based on 60,000 IVF cycles revealed that elevated daily P levels following HCG administration significantly lower pregnancy rate upon GnRH agonist and antagonist treatment in the fresh cycle [12]. It is speculated that raised follicular-phase P concentration produced by ovarian stimulation-induced multiple follicle growth may contribute to changes in the endometrium, leading to embryo–endometrial asynchrony.[13]. A study by Yding and colleagues, analyzing 475 patients undergoing IVF assisted pregnancy, found that the daily P levels on HCG administration did not affect pregnancy rate, and that elevated P levels correlated with the number of eggs obtained. To further investigate the effect of HCG P levels on pregnancy outcomes, we selected IVF cases for infertility caused by fallopian tube factors and performed embryo transfer on the third day after egg retrieval. Our study revealed that when P levels are below the range of 1.0-1.25 ng/ml, the rate of live births increases with rising P levels,indicating that a certain level of P is required for successful pregnancy. When P levels exceed this range, the LBR first drops. A follow up of the three groups revealed that the age, duration of infertility, Gn dosage, Gn days, daily HCG levels, daily LH level, 2PN fertilization rate, CPR,LBR, full-term yield and preterm birth rate were not significantly different between the groups. While the BMI (P = 0.001), basal LH levels (P = 0.034), estrogen peak level (P = 0.000) and number of eggs obtained (P = 0.000) were found to differ significantly between the groups. The numbers of oocytes obtained were highest in the high P group relative to the other two groups, suggesting that higher P levels may indicate the number of resulting oocytes. These observations are in agreement with previous reports showing that elevated P levels are significantly correlated with the number of oocytes retrieved, which is in turn associated with successful IVF outcomes [14]. The rates of 2PN fertilization and quality embryos were also observed to be higher in the group with elevated P levels, although the differences were not statistically significant. It has previously been reported that that post-HCG P levels are positively associated with the number of oocytes retrieved and this does not affect oocyte or embryo quality [16]. Other studies have focused on the effect of the P depending on the embryonic stage. It has been demonstrated that when P levels exceed 1.5 ng/ml, clinically defined pregnancy rates decrease. However, similar results were not seen following transfer at the blastocyst stage [15]. These observations suggest that controlling P levels in patients with low late follicular P levels may improve IVF outcomes [16]. To that end, limiting the total dose of FSH administered might be beneficial [17]. For example, previous randomized trials have reported that late follicular replacement of daily FSH with low-dose HCG achieves effects comparable to those of P receptor(PR) [18] [19] without the detrimental effects of late follicular P elevation [18]. In the current study, we observed that P levels ranging between 1.0-1.25 ng/ml exhibit better clinical pregnancy and live birth rates. Additionally, we observed that HCG P levels negatively correlate with BMI and positively correlated with E2 and the number of eggs. Together, these observations suggest that the BMI, in such clinical contexts may predict HCG P levels. Many published studies have relied on different P level thresholds. Typically, when these thresholds are surpassed, the embryos are collected for freezing. Indeed, no study has demonstrated any deleterious effects of P on frozen embryo transfer [20] .Overall, HCG daily P levels have limitations as predictors of IVF outcomes. There are reports suggesting that progesterone/oocyte ratio should be considered as a tool for the prediction of IVF outcomes in reference to serum P levels alone. However, more evidence from randomized studies is required to support this [21].
In this retrospective study, we analyzed the value of HCG daily P levels to predict the success of IVF in patients fallopian tube complications. P levels that fall within1.0 ng/ml to 1.25 ng/ml are associated with rates of clinical pregnancy and live births. While the observed differences between study groups are not statistically significant, we contend that the can be used as a clinical references.