ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Reproduction
This article is part of the Research TopicAdvancing Reproductive Outcomes: Integrating Molecular, Metabolic, and Endocrine Insights into Oocyte MaturationView all 6 articles
Effect of Progesterone Levels on the hCG Trigger Day and the Progesterone-to-Basal Progesterone Ratio on Pregnancy Outcomes in Fresh IVF/ICSI Cycles with GnRH Antagonist Protocol: A Retrospective Cohort Study
Provisionally accepted
- 1Shandong University of Traditional Chinese Medicine, Jinan, China
- 2Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
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Objective: This study analyzed the effects of progesterone (P) levels on the hCG trigger day and the progesterone-to-basal progesterone ratio (PhCG/Pbasal) on pregnancy outcomes in normal ovarian responders undergoing fresh embryo transfer in GnRH-antagonist (GnRH-ant) cycles. Materials and Methods: We retrospectively included 1,981 GnRH-ant cycles with fresh embryo transfer from January 2017 to December 2023. Patients were divided into four groups based on P levels on the hCG day and PhCG/Pbasal ratio using ROC-derived cutoffs: Group A (P<1.06 ng/mL, PhCG/Pbasal<1.2), Group B (P<1.06 ng/mL, PhCG/Pbasal≥1.2), Group C (P≥1.06 ng/mL, PhCG/Pbasal<1.2), and Group D (P≥1.06 ng/mL, PhCG/Pbasal≥1.2). Associations between clinical variables and pregnancy outcomes were compared across groups. Results: Group A showed the highest positive pregnancy rate (53.5%), clinical pregnancy rate (50.0%), live birth rate (LBR, 43.6%), and singleton rate (36.7%) compared to the other groups (all P<0.001). LBR (30.2% vs. 22.4%) and singleton rate (23.8% vs. 17.1%) were higher in Group C than D (both P<0.05). Early miscarriage rate was lowest in Group A (10.6%) and highest in Group D (20.4%, P=0.016). Multivariable logistic regression confirmed the highest LBR in Group A (adjusted OR vs. B: 0.437; vs. C: 0.512; vs. D: 0.325; all P<0.001). Conclusions: Even slight elevation of P on hCG day reduces LBR in normal responders. A P<1.06 ng/mL with PhCG/Pbasal<1.2 predicts higher LBR, whereas PhCG/Pbasal≥1.2 decreases LBR regardless of P levels. These findings suggest that incorporating PhCG/Pbasal ratio into individualized management may optimize pregnancy outcomes.
Keywords: Progesterone, Gonadotropin-releasing hormone antagonist protocol, Fresh embryo transfer, NormalOvarian Response, Live Birth
Received: 25 Jun 2025; Accepted: 01 Dec 2025.
Copyright: © 2025 Guan, Wu, Li, Liang, Zhen, Xiang and Lian. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Shan Xiang
Fang Lian
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