Premature progesterone elevation: targets and rescue strategies

Progesterone elevation during the late follicular phase of ovarian stimulation for in vitro fertilization negatively impacts the assisted reproductive technology-outcome. The evidence available supports an advanced endometrial maturation and a direct negative effect on its receptivity. On the other hand, some retrospective analysis suggests an impairment of oocyte and embryo quality. Recent publications confirm that enhanced follicle-stimulating hormone-stimulation towards the end of the follicular phase of ovarian stimulation is the main course of progesterone elevation. A key element in preventing this event is the individualization of ovarian stimulation according to the patient's ovarian reserve and the adaption of the stimulation dosage during late follicular phase according to the patient's response. Additional measures as corticosteroid administration, avoidance of prolonged stimulation and cycle segmentation with freeze-all-policy can be discussed.