Oral Presentation

Does high progesterone levels on ovarian stimulation cycles damage the quality oocytes collected?

Livia Munhoz (BR), Tatiana Bonetti (BR), Eduardo Motta (BR), Thais Domingues (BR)

[Munhoz] Huntington Reproductive Medicine / Universidade de São Paulo, [Bonetti] Huntington Reproductive Medicine / Universidade Federal de São Paulo, [Motta] Huntington Reproductive Medicine / Universidade Federal de São Paulo, [Domingues] Huntington Reproductive Medicine / Universidade Federal de São Paulo

Context: It is know that high progesterone (P4) levels due to ovarian stimulation in in vitro fertilization (IVF) cycles have impact on endometrium, impairing embryo implantation. However, the P4 effect on oocyte quality and consequently on the embryo development is not clear. Objective: The aim of this study was to evaluate the association of P4 levels during ovarian stimulation cycles with oocyte quality of donors and blastocyst formation rate (BFR) of recipients. Methods: This is a retrospective study evaluating IVF cycles using donated oocytes performed from 2014 to 2017. Patients: Egg donors were women under 30 years old, with regular menstrual cycles, no gynecological or other health diseases, and body mass index inferior to 25 Kg/m2. They received standard ovarian stimulation protocol and P4 measurements were performed on trigger day. Oocytes were picked up and donated to fresh or vitrified oocytes recipients’ cycles. Interventions: A total of 1031 egg donor cycles were evaluated, in which fresh or frozen donated oocytes were fertilized by intracytoplasmic sperm injection (ICSI). Embryos were cultured until blastocyst stage and then transferred to recipients after endometrium preparation. Main Outcomes Measures: We compared the P4 levels in patients with oocyte alterations or not. The multivariate linear regression analysis model was performed to evaluate the association donor’s P4 and BFR of recipients adjusted for confounders as donor antral follicle count (AFC), semen quality, number of oocytes injected and fresh or frozen oocyte. Results: Donors were 24.5±3.8 years old and have ACF of 21.6±9.7. P4 levels at the trigger day was 3.2±2.2 ng/mL and number of MII oocyte retrieved was 23.9±12.1. Recipients had 8.4±1.7 oocytes injected and BFR was 51.9%. A mean of 2.0±0.5 blastocysts were transferred per recipient. The mean of P4 was higher (3.6±2.4) for women presenting oocyte alteration compared to those with all good quality oocytes (3.3±2.1; p=0.051). The regression analysis showed the inverse association of P4 and BFR (Coef. -0.653; p=0.044), adjusted for confounders. Conclusions: Our findings demonstrated higher levels of P4 when oocytes alterations were present and an inverse association of P4 levels and BFR. BFR is intimately related with oocyte quality, and then, besides the damage on endometrium, the high levels of P4 may also damage the oocyte and consequently contribute to worst prognosis of embryo implantation.