Minerva Endocrinology 2021 Apr 01

DOI: 10.23736/S2724-6507.21.03328-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Proof of concept use of progesterone/estradiol ratio to investigate late follicular progesterone in women with low number of pre-ovulatory follicles

Johnny S. YOUNIS ^{1, 2} ✉, Shiran YAKOVI ¹, Yuri PERLITZ ^{1, 2}, Ido IZHAKI ³

¹ Reproductive Medicine, Department of Obstetrics & Gynecology, Baruch-Padeh Medical Center-Poriya, Tiberias, Istrael; ² Azrieili Faculty of Medicine, Galilee, Bar-Ilan University, Safed, Israel; ³ Department of Evolutionary and Environmental Biology, University of Haifa, Haifa, Israel

BACKGROUND: To investigate late follicular progesterone (P) serum level in women with low number of pre-ovulatory follicles in the assisted reproductive technologies (ART) setting.
METHODS: Fifty-five consecutive women having four or less pre-ovulatory follicles of >14 mm on the day of human chorionic gonadotropin (hCG) administration were prospectively evaluated. Spearman correlation tests between serum estradiol (E2) level, serum P level, P/E2 ratio, number of pre-ovulatory follicles, oocytes and embryos were performed. Women enrolled were further divided into two groups in accordance with the P/E2 ratio on the day of hCG administration and compared.
RESULTS: Serum E2 level correlated positively with P serum level (rs = 0.36, P < 0.01), number of mature follicles (rs = 0.50, P < 0.01) and number of oocytes retrieved (rs = 0.36, P < 0.05), whereas negatively with P/E2 ratio (rs = - 0.68, P < 0.01). Likewise, number of pre-ovulatory follicles correlated positively with E2 level (rs = 0.50, P < 0.01), P level (rs = 0.27, P < 0.05) and number of oocytes retrieved (rs = 0.33, P < 0.05), while it correlated negatively with P/E2 ratio (rs = - 0.33, P < 0.05). Furthermore, women with P/E2 ratio > 1 on the day of hCG administration received considerably higher total follicular stimulating hormone (FSH) dosage and achieved significantly lower number of oocytes and embryos as compared to controls.
CONCLUSIONS: The reverse relationship between number of pre-ovulatory follicles and P/E2 ratio implies that P rise is not only the result of increased steroidogenic activity but other oocytefollicle disrupted mechanisms seems to be involved. An exaggerated FSH stimulation appears to disrupt further these mechanisms.

KEY WORDS: Assisted reproduction; Gonadotropin-releasing hormone analogues; Late follicular progesterone; Low ovarian reserve; Ovarian ageing; P/E2 ratio