Dados do Trabalho

Title

Endometriosis is associated to an increased serum progesterone level during late follicular phase in controlled ovarian stimulation for in vitro fertilization

Objective

To investigate the serum progesterone, LH and estradiol levels during late follicular phase in infertile patients with endometriosis submitted to controlled ovarian stimulation for IVF.

Methods

We prospectively studied 102 infertile patients undergoing the first IVF cycle using the same controlled ovarian stimulation protocol (hMG + GnRH antagonist), during 2021-22.

All of the studied patients met the following inclusion criteria: (i) both ovaries present, with no morphological abnormalities (such as cysts, endometriomas, etc.), no history of past surgery and adequately visualised in transvaginal ultrasound scans; (ii) regular menstrual cycle lengths ranging between 25 and 35 days; (iii) no current or past diseases affecting ovaries or gonadotrophin or sex steroid secretion, clearance or excretion; (iv) no clinical signs of hyperandrogenism; (v) BMI ranging from 16 to 30 kg/m2 . Patients were divided into two groups. Study group: peritoneal endometriosis diagnosticated using laparoscopy, n=27 and control group: tubal or masculine infertility etiology, n=72.

Progesterone, estradiol and LH were collected on hcg-day and analyzed using chemiluminescence immunoassay. We also compared some important reproductive outcomes. Our data were analyzed using parametric and non-parametric correlation tests and multivariable analysis (Linear regression). P was considered significant when < 5%.

Results

Mean age (35.4±4 x 35.7±4), Antral Follicle Count (10±5 x 8.5±5), AMH (2.33±1.9 x 2.33±2.3), number of MII oocytes (6±4 x 6±5) and number of embryos (5±1 x 5±1) were not different between control and endometriosis groups, respectively (P>0.05). Furthermore, serum estradiol (2743±222 x 3046±278) and LH (2.54±3 x 2.53±4) levels did not differ also. However, serum progesterone levels on the HCG-day were increased in endometriosis patients compared to controls (1.12±0.6 x 0.87±0.5, P=0.026). Using the cutoff of serum progesterone above 1.5 ng/ml to freeze embryos and transfer in another cycle, 50% of endometriosis patients reached that criterion versus 33% of the control group (P=0.09).

Conclusion

Patients with endometriosis demonstrated a granulosa cell secretion of progesterone after controlled ovarian stimulation for IVF different if compared to tubal or male fector. Those endometriotic patients are at risk of premature progesterone increase during the late follicular phase and need to be closely monitored.

Keywords

progesterone, IVF, follicular phase, controlled ovarian stimulation