Midluteal progesterone

A marker of treatment outcomes in couples with unexplained infertility

Karl R. Hansen, Esther Eisenberg, Valerie Baker, Micah J. Hill, Sixia Chen, Sara Talken, Michael Peter Diamond, Richard S. Legro, Christos Coutifaris, Ruben Alvero, Randal D. Robinson, Peter Casson, Gregory M. Christman, Nanette Santoro, Heping Zhang, Robert A. Wild

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Context Adequate luteal phase progesterone exposure is necessary to induce endometrial changes required for a successful pregnancy outcome. The relationship between low midluteal progesterone concentration and the outcome of live birth in ovarian stimulation with intrauterine insemination (OS-IUI) treatments is not defined. Objective To determine the level of midluteal progesterone portending a low chance of live birth after OS-IUI in couples with unexplained infertility. Design and Setting Secondary analyses of data from a prospective, randomized, multicenter clinical trial that determined pregnancy outcomes following OS-IUI with clomiphene citrate, letrozole, or gonadotropins for couples with unexplained infertility. Participants Couples (n = 900) underwent 2376 OS-IUI cycles during the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation clinical trial. Main Outcome Measures Live birth as it relates to midluteal progesterone level and thresholds below which no live births occur by treatment group. Results Thresholds for non-live birth cycles were similar for clomiphene (14.4 ng/mL) and letrozole (13.1 ng/mL) yet were lower for gonadotropin (4.3 ng/mL) treatments. A midluteal progesterone level >10th percentile specific for each treatment group independently was associated with greater odds for a live birth in all OS-IUI cycles (adjusted OR: 2.17; 95% CI: 1.05, 4.48). Conclusions During OS-IUI, a low midluteal progesterone level was associated with a low probability of live birth. Thresholds differed by medication, with the lowest threshold for gonadotropin. Several pathophysiologic mechanisms may account for low progesterone levels. Refinement of the predictive range associated with particular ovarian stimulation medications during treatment of unexplained infertility may improve accuracy.

Original languageEnglish (US)
Pages (from-to)2743-2751
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume103
Issue number7
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

Fingerprint

Ovulation Induction
Infertility
Progesterone
Insemination
Live Birth
letrozole
Gonadotropins
Clomiphene
Pregnancy Outcome
Therapeutics
Luteal Phase
Multicenter Studies
Randomized Controlled Trials
Outcome Assessment (Health Care)
Clinical Trials
Parturition
Pregnancy

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Hansen, K. R., Eisenberg, E., Baker, V., Hill, M. J., Chen, S., Talken, S., ... Wild, R. A. (2018). Midluteal progesterone: A marker of treatment outcomes in couples with unexplained infertility. Journal of Clinical Endocrinology and Metabolism, 103(7), 2743-2751. https://doi.org/10.1210/jc.2018-00642

Midluteal progesterone : A marker of treatment outcomes in couples with unexplained infertility. / Hansen, Karl R.; Eisenberg, Esther; Baker, Valerie; Hill, Micah J.; Chen, Sixia; Talken, Sara; Diamond, Michael Peter; Legro, Richard S.; Coutifaris, Christos; Alvero, Ruben; Robinson, Randal D.; Casson, Peter; Christman, Gregory M.; Santoro, Nanette; Zhang, Heping; Wild, Robert A.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 103, No. 7, 01.07.2018, p. 2743-2751.

Research output: Contribution to journalArticle

Hansen, KR, Eisenberg, E, Baker, V, Hill, MJ, Chen, S, Talken, S, Diamond, MP, Legro, RS, Coutifaris, C, Alvero, R, Robinson, RD, Casson, P, Christman, GM, Santoro, N, Zhang, H & Wild, RA 2018, 'Midluteal progesterone: A marker of treatment outcomes in couples with unexplained infertility', Journal of Clinical Endocrinology and Metabolism, vol. 103, no. 7, pp. 2743-2751. https://doi.org/10.1210/jc.2018-00642
Hansen, Karl R. ; Eisenberg, Esther ; Baker, Valerie ; Hill, Micah J. ; Chen, Sixia ; Talken, Sara ; Diamond, Michael Peter ; Legro, Richard S. ; Coutifaris, Christos ; Alvero, Ruben ; Robinson, Randal D. ; Casson, Peter ; Christman, Gregory M. ; Santoro, Nanette ; Zhang, Heping ; Wild, Robert A. / Midluteal progesterone : A marker of treatment outcomes in couples with unexplained infertility. In: Journal of Clinical Endocrinology and Metabolism. 2018 ; Vol. 103, No. 7. pp. 2743-2751.
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abstract = "Context Adequate luteal phase progesterone exposure is necessary to induce endometrial changes required for a successful pregnancy outcome. The relationship between low midluteal progesterone concentration and the outcome of live birth in ovarian stimulation with intrauterine insemination (OS-IUI) treatments is not defined. Objective To determine the level of midluteal progesterone portending a low chance of live birth after OS-IUI in couples with unexplained infertility. Design and Setting Secondary analyses of data from a prospective, randomized, multicenter clinical trial that determined pregnancy outcomes following OS-IUI with clomiphene citrate, letrozole, or gonadotropins for couples with unexplained infertility. Participants Couples (n = 900) underwent 2376 OS-IUI cycles during the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation clinical trial. Main Outcome Measures Live birth as it relates to midluteal progesterone level and thresholds below which no live births occur by treatment group. Results Thresholds for non-live birth cycles were similar for clomiphene (14.4 ng/mL) and letrozole (13.1 ng/mL) yet were lower for gonadotropin (4.3 ng/mL) treatments. A midluteal progesterone level >10th percentile specific for each treatment group independently was associated with greater odds for a live birth in all OS-IUI cycles (adjusted OR: 2.17; 95{\%} CI: 1.05, 4.48). Conclusions During OS-IUI, a low midluteal progesterone level was associated with a low probability of live birth. Thresholds differed by medication, with the lowest threshold for gonadotropin. Several pathophysiologic mechanisms may account for low progesterone levels. Refinement of the predictive range associated with particular ovarian stimulation medications during treatment of unexplained infertility may improve accuracy.",
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AU - Chen, Sixia

AU - Talken, Sara

AU - Diamond, Michael Peter

AU - Legro, Richard S.

AU - Coutifaris, Christos

AU - Alvero, Ruben

AU - Robinson, Randal D.

AU - Casson, Peter

AU - Christman, Gregory M.

AU - Santoro, Nanette

AU - Zhang, Heping

AU - Wild, Robert A.

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N2 - Context Adequate luteal phase progesterone exposure is necessary to induce endometrial changes required for a successful pregnancy outcome. The relationship between low midluteal progesterone concentration and the outcome of live birth in ovarian stimulation with intrauterine insemination (OS-IUI) treatments is not defined. Objective To determine the level of midluteal progesterone portending a low chance of live birth after OS-IUI in couples with unexplained infertility. Design and Setting Secondary analyses of data from a prospective, randomized, multicenter clinical trial that determined pregnancy outcomes following OS-IUI with clomiphene citrate, letrozole, or gonadotropins for couples with unexplained infertility. Participants Couples (n = 900) underwent 2376 OS-IUI cycles during the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation clinical trial. Main Outcome Measures Live birth as it relates to midluteal progesterone level and thresholds below which no live births occur by treatment group. Results Thresholds for non-live birth cycles were similar for clomiphene (14.4 ng/mL) and letrozole (13.1 ng/mL) yet were lower for gonadotropin (4.3 ng/mL) treatments. A midluteal progesterone level >10th percentile specific for each treatment group independently was associated with greater odds for a live birth in all OS-IUI cycles (adjusted OR: 2.17; 95% CI: 1.05, 4.48). Conclusions During OS-IUI, a low midluteal progesterone level was associated with a low probability of live birth. Thresholds differed by medication, with the lowest threshold for gonadotropin. Several pathophysiologic mechanisms may account for low progesterone levels. Refinement of the predictive range associated with particular ovarian stimulation medications during treatment of unexplained infertility may improve accuracy.

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