Pregnancy of early folicular serum progesterone levels in ovulation induction cycles preview power

Primar infertility can be defined as the inability to achieve pregnancy after at least 12 months of regular and unprotected sexual intercourse for couples who have had no pregnancy. Secondary infertility can be identified as the failure to conceive after at least of 6 months of regular and protected sexual intercourse for couples who have had at least one pregnancy. Anovulation, tuboperitoneal factor, spermiogram abnormalities, uterus anomalies, cervical factor and endometriosis can be the underlying causes of infertility. In case luteolysis occurs inffectively and incompletely at the end of the preceding menstrual cycle, serum progesteron concentrations would remain to be elevated during the early follicular phase of the following cycle. This alteration would lead to the impairment of the optimal micro-environment within endometirum and oocyte/ embryo quality. This thesis study aims to determine the prognostic power of serum progesterone levels at early follicular phase for predicting clinical pregnancy rates in ovulation induction cycles. This is a prospective review of 125 couples who were admitted to the Department of Obstetrics and Gynecology at Afyonkarahisar Health Sciences University Hospital due to infertility between January 2018 and June 2020. The couples who are aged younger than 40 years and the couples who had indications for ovulation induction and intrauterine insemination (IUI) were enrolled into the study. The indications for ovulation induction were enlisted as anovulation, uterine factor, unilateral tubal blockade and hypogonadotropic hypogonadism. The indications for IUI were addressed as unexplained infertility, cervical factor and mild male factor. The couples who were aged older than 40 years and the couples who had indications for in vitro fertilization (IVF) were excluded from the study. In this thesis study, 48 out of 125 infertile couples (38.6%) received clomiphene citrate while 33 couples (26.4%) had letrozole and 44 couples (35.2%) had recombinant gonadotropin for ovulation induction. IUI was performed in 44 couples out of 125 couples (35.2%). Ovulation induction resulted in clinical pregnancy in 41 couples out of 125 couples (32.8%). Clinical pregnancy ended up with ongoing pregnancy in 33 couples (26.4%) and spontaneous miscarriage during first trimester in 8 couples (6.4%). The mean serum progesterone concentration at early follicular phase was calculated to be 1.01±0.43 ng/ml for female participants. When compared to the women who failed to conceive by ovulation induction, the women who were able to achieve pregnancy by ovulation induction had significantly lower body mass index (26.06±4.34 kg/m2 vs 24.29±3.30 kg/m2, p=0.037), significantly lower parity (0.6±0.2 vs 0.2±0.1, p=0.026), significantly higher number of miscarriages (0.13±0.03 vs 0.31±0.02, p=0.034) and significantly lower concentrations of serum progesterone at early follicular phase (1.29±0.27 ng/ml vs 0.69±0.33 ng/ml, p=0.001). Early follicular phase serum progesterone level was specified as an independent prognostic factor for predicting clinical pregnancy in ovulation induction cycles (p=0.001). When these findings were taken into account with those of literature, it would be prudent to assume that serum progesterone concentrations at early follicular phase could be used to predict clinical pregnancy rates in ovulation induction cycles. Since this thesis study has a relatively small cohort, receiver operating characteristic (ROC) curve analysis could not be performed and, thus, a cut-off value could not be determined. Therefore, the mean serum progesterone concentration measured at early follicular phase for the participants of this study could be accepted as the cut-off value (1.29 ng/ml) for predicting clinical pregnancy rate. Any measurement of serum progesterone concentration above 1.29 ng/ml at early follicular phase could be regarded as a poor prognostic factor for conception. Such a finding might allow the counselling of infertile couples who can decide to continue with the ovulation induction cycle or withdraw from this cycle. Further research is warranted to determine the early follicular phase serum progesterone concentration which can be used optimally for predicting the treatment success in women who are to undergo ovulation induction and IUI procedures.