Progesterone
Before the introduction of GnRH analogs in ART cycles, detection
of premature endogenous LH surge was a constant concern because
LH surges usually occurred when follicular development was still
uncompleted and had some deleterious effects on the oocyte quality
and on the implantation rate. At that time, determination of
plasma concentrations of progesterone (P) was considered as
a complementary tool to detect partial luteinization of granulosa
cells attributed to some small or short LH surges that could
not have been detected even by daily blood sampling.
It is clear that the current use of GnRH agonist and the recent
marketing authorization of GnH antagonists, two agents effective
to prevent LH surges, have led to strictly limit the determination
of plasma P to some periods of the ART cycles.
It is usual to control plasma P values at the time of the hypophyseal
desensitization. It seems worth while to make sure that the
corpus luteum is not still active and has not been inadvertently
rescued by a prolonged GnRH-a flare up or by a spontaneous pregnancy.
Moreover, at that time, if a cyst formation is observed on ultrasound,
an increase in plasma P concentrations would indicate the functional
nature of the cyst and would lead to perform ovarian punction
before FSH administration. It is recommended not to start ovarian
stimulation in a hormonal environment that may be deleterious
for the oocyte or the endometrium. In that respect, an increase
In plasma P, which would overcome follicular phase values at
the time of hypophyseal desensitization, is considered as deleterious
for the subsequent ART cycle and requires to extend the administration
of the GnRH-a alone and to postpone ovarian stimulation. (Source:
Textbook of Assisted Reproductive Techniques. Edited by Gardner,
Howles, Weissman, and Shoham. Martin Dunitz, 2001)
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