Progesterone level significance in agonist versus antagonist protocols

Objective: to evaluate the impact of serum progesterone level on the clinical outcome across agonist & antagonist protocols. Design: retrospective cohort study. Setting: IVF unit at Prince Sultan Military Medical City, Riyadh, KSA. Material & Methods: A total of 943 cycles were included in the analysis, 605 long agonist protocol cycles, 227 antagonist protocol cycles & 101 short agonist protocol cycles reaching the stage of embryo transfer between November 2012 and March 2015. Main outcome: clinical pregnancy and miscarriage rates. Results: Number of retrieved, mature and fertilized oocytes, plus transferred embryos were lowest in the short protocol. Clinical pregnancy rate was the lowest in the short protocol and miscarriage rate was similar in all protocols. Setting progesterone cut off level of >1.5 nmol/L in the agonist cycles, high progesterone groups did not show difference in clinical pregnancy or miscarriage rates. In the short protocol, the group with high progesterone level had higher number of frozen embryos. In long protocol, high progesterone level group showed higher number of fertilized oocytes. A level of >2 nmol/L was set in the antagonist protocol. High progesterone group had lower clinical pregnancy rate and similar miscarriage rate, despite having higher number of fertilized oocytes and better quality of embryos. Conclusion: high progesterone level did not affect clinical pregnancy or miscarriage rates in all protocols except in the antagonist protocol where it affected the clinical pregnancy rate adversely. Keywords: Intra cytoplasmic sperm injection (ICSI), In vitro fertilization (IVF), Protocols, Progesterone, Pregnancy rat