The relationship between embryo quality assessed using routine embryology or time–lapse videography and serum progesterone concentration on the day of ovulatory trigger in in vitro fertilization cycles

ObjectiveTo investigate the relationship between elevated serum progesterone levels (EP) on the day of ovulatory trigger, live birth rates, and the growth of resulting embryos.MethodsA total of 836 in vitro fertilization (IVF) cycles with 4 478 embryos in conventional culture were retrospectively analyzed, together with an additional 90 IVF cycles producing 618 embryos from culture and assessment using the Embryoscope™ time-lapse system.ResultsIn cycles using conventional culture, serum progesterone per follicle ≥14 mm (median 0.42 nmol/L/follicle, range 0.05-3.50 nmol/L/follicle) was a significant negative predictor of live-birth (ROC AUC = 0.395, 95% CI 0.345-0.445; P=0.000) as were progesterone/estradiol ratio (0.442, 0.391-0.494; P=0.027) and progesterone per oocyte (0.374, 0.326-0.421; P=0.000) but not progesterone alone (0.470, 0.419-0.521; P>0.05). Women with an EP/follicle (>0.42 nmol/L/follicle) had reduced live birth rates if they were ≥35 yrs (14.4% vs. 24.2%, P<0.05) but not <35 years (35.3% vs. 37.4%, ns). Despite reduced pregnancy rates, cycles with EP/follicle in women ≥35 years produced similar proportions of “good” and “top” quality embryos in conventional culture compared to women with low progesterone/follicle, and no difference in abnormalities of cleavage (direct cleavage or reverse cleavage), multinucleation or timings of division (pronuclear fading to 2-cell, 3-cell, 4-cell and 5-cell; cc2 and S2) observed with time-lapse videography.ConclusionsEP/follicle ≥14 mm (>0.42 nmol/L/follicle) adversely affects embryo implantation in women aged ≥35 years, but not <35 yrs. However, no adverse features were seen in the embryos from these affected cycles in terms of morphological appearance, abnormal patterns of cleavage, or morphokinetic timings.