The effect of late-follicular phase progesterone elevation on embryo ploidy and cumulative live birth rates

Published:August 05, 2021DOI:


      • Progesterone elevation on the day of trigger does not have any detrimental effect on embryo euploidy rate.
      • Progesterone elevation does not affect the blastocyst formation rate or pregnancy outcomes following euploid FET.
      • This is the first study to evaluate the influence of progesterone elevation on both embryo ploidy and CLBR.


      Research question

      Does late-follicular phase progesterone elevation have a deleterious effect on embryo euploidy, blastocyst formation rate and cumulative live birth rates (CLBR)?


      A multicentre retrospective cross-sectional study including infertile patients aged 18–40 years who underwent ovarian stimulation in a gonadotrophin-releasing hormone antagonist protocol and preimplantation genetic testing for aneuploidies (PGT-A) followed by a freeze-all strategy and euploid embryo transfer between August 2017 and December 2019. The sample was stratified according to the progesterone concentrations on the day of trigger: normal (≤1.50 ng/ml) and high (>1.50 ng/ml). Moreover, sensitivity analyses were performed to determine whether different conclusions would have been drawn if different cut-offs had been adopted. The primary outcome was the embryo euploidy rate. Secondary outcomes were the blastocyst formation rate, the number of euploid blastocysts and CLBR.


      Overall 1495 intracytoplasmic sperm injection PGT-A cycles were analysed. Late-follicular phase progesterone elevation was associated with significantly higher late-follicular oestradiol concentrations (2847.56 ± 1091.10 versus 2240.94 ± 996.37 pg/ml, P < 0.001) and significantly more oocytes retrieved (17.67 ± 8.86 versus 12.70 ± 7.00, P < 0.001). The number of euploid embryos was significantly higher in the progesterone elevation group (2.32 ± 1.74 versus 1.86 ± 1.42, P = 0.001), whereas the blastocyst formation rate (47.1% [43.7–50.5%] versus 51.0% [49.7–52.4%]), the embryo euploidy rate (48.3% [44.9–51.7%] versus 49.1% [47.7–50.6%], the live birth rate in the first frozen embryo transfer (34.1% versus 31.1%, P = 0.427) and CLBR (38.9% versus 37.0%, P = 0.637) were not significantly different between the two groups.


      Euploidy rate and CLBR do not significantly differ among PGT-A cycles with and without late-follicular progesterone elevation in a freeze-all approach.


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      Professor Nikolaos Polyzos is Head of Department of the Department of Reproductive Medicine of Dexeus University Hospital. With more than 140 publications in peer-reviewed journals, his research interests include reproductive endocrinology, ovarian reserve markers, poor ovarian response and genetics of premature ovarian ageing.
      Key message
      Progesterone elevation on the day of trigger does not have any detrimental effect on the number of euploid embryos or on embryo euploidy rate among patients undergoing an antagonist protocol ICSI/PGT-A cycle. Furthermore, progesterone elevation does not affect the blastocyst formation rate or pregnancy outcomes following euploid embryo transfer in freeze-only cycles. These findings question previous studies claiming a detrimental effect of progesterone elevation on embryo quality.