New Study Shows Improved Pregnancy Rates with Treatment Protocol Changes in Cases of High Progesterone Levels
A retrospective study conducted by physicians at Shady Grove Fertility revealed that a recent change in treatment protocol resulted in higher pregnancy rates. This study of more than 4,000 Assisted Reproductive Technology (ART) cycles showed that frozen embryo transfers (FET) of embryos derived from IVF cycles where progesterone levels were elevated were as successful as FET of embryos derived from IVF cycles with normal progesterone levels. This stands in contrast to previous work done at Shady Grove fertility that showed that progesterone elevation had a significant negative effect on pregnancy rates when embryo(s) were transferred in the same cycle that the progesterone elevation occurred.
What’s the take home message? — The negative impact of high progesterone elevation on IVF outcomes derives from its impact on the endometrium, not on the embryo. By delaying transfer of high quality embryos until a time where the uterus is not impacted by high progesterone levels, outcomes are improved.
Why Progesterone Levels Increase
Throughout the stimulation phase of IVF treatment, medications are given to patients to encourage several follicles in the ovaries to develop in the hopes of retrieving multiple eggs for fertilization. Progesterone levels can rise in response to medications given during this stimulation phase treatment – sometimes to a level that’s higher than ideal.
At Shady Grove Fertility, our teams of fertility specialists monitor progesterone levels closely throughout the stimulation phase of IVF treatment. This study found that among patients whose progesterone levels were elevated during their IVF cycle, those who waited to have a frozen embryo transfer after their progesterone level had returned to normal had better success than patients who continued with a fresh transfer while progesterone levels were still elevated.
Timing is Key to Success
To achieve the best chances of pregnancy during an IVF cycle with a fresh transfer, there are several elements that have to be timed exactly right.
In cases where progesterone hormone levels are too high, the delicate synchronization of the embryo and the uterine lining (a.k.a. endometrium) is disturbed. This study suggests that increased levels of progesterone can result in ‘advancement’ of the uterine lining, such that the uterus is no longer optimally receptive when the embryo is ready to implant.
However, in an FET cycle, some of these crucial timing factors are eliminated. The patient and medical team can focus on preparing the uterine lining and will thaw the embryos when the patient’s lining is most likely to allow for implantation.
Improving the Standard of Care for Patients
Armed with data from this study, patients and physicians can feel confident that when progesterone is elevated, chances of having a baby will be improved by forgoing fresh transfer of high quality embryos in favor of transferring them in a later FET cycle. Taking a 1 to 2 month break between cycles allows the progesterone levels to return to a normal level and can increase pregnancy rates as much as 50 percent. While the delay in treatment can be viewed as a setback, this option gives patients and their embryos the best chance of success.
About the American Society for Reproductive Medicine (ASRM) Annual Meeting
ASRM 2015 is the premier National education and research meeting for the field of Reproductive Endocrinology and Infertility. Plenary lectures will address state-of-the-art issues in reproductive medicine and science.
The outlook for patients with infertility continues to brighten year after year, thanks to the thousands of professionals who dedicate their lives to improving outcomes for fertility treatment. The range of ASRM’s expertise and influence draws from doctors, nurses, and researchers to business experts, pharmaceutical companies, advocacy organizations, and, of course, patients themselves. Shady Grove Fertility continues to play a leading role in clinical research and practice policy at the national level.
If you would like to schedule an appointment with a fertility specialist, please speak with one of our New Patient Liaisons at 877-971-7755.
