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![Current
interpretation
of
progesterone
value
High progesterone levels will
advance the window of
implantation.
The question of whether PE on the
day of hCG administration affects
the outcomes of IVF is still being
debated [2–12].
large-sample meta-analysis
confirmed the adverse effect of PE
on IVF pregnancy outcomes](https://image.slidesharecdn.com/progesteronemeasurementtalkatisarbengal-170615092110/85/Progesterone-measurement-5-320.jpg)
Uploaded byG A RAMA Raju
Progesterone measurement .
1. The document discusses measuring progesterone levels during IVF treatment and the role of progesterone in implantation. 2. There is debate around what progesterone levels indicate successful implantation, with some studies finding levels above 1.0 or 1.5 ng/ml can negatively impact outcomes, while others find higher thresholds. 3. Accurately measuring progesterone is challenging due to issues with assays, sample handling, and lack of standards between clinics. Establishing a standardized reference level could help improve IVF success rates.
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Progesterone measurement .
- 1. DR G ARAMA RAJU Krishna Ivf clinic Visakhapatnam INDIA PROGESTERONE MEASUREMENT
- 2. DR Subhas Mukherjee Architect ofworlds second test tube baby Refhttp://www.drsubhasmukherjee.com/doctor_subhas_mukh erjee_life.html 1931 Born in Bihar PhD Calcutta university PhD Edinburgh university worked on LH SALUTATAIONS
- 3. Russel marker Extracted progesterone from bark Madesynthetic progesterone Empowered women by his discovery pill
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- 5. Current interpretation of progesterone value High progesterone levelswill advance the window of implantation. The question of whether PE on the day of hCG administration affects the outcomes of IVF is still being debated [2–12]. large-sample meta-analysis confirmed the adverse effect of PE on IVF pregnancy outcomes
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- 7. DAY 3 transfer Serumprogesterone 1.0 ng/ml had a detrimental effect on CPRs. effect worsened when the progesterone concentration reached 1.5 ng/ml.
- 8. DAY 5 transfer Serumprogesterone cycles, the detrimental effect did not appear until the progesterone concentration reached 1.75 ng/ml
- 9. WHENWAS FIRSTTHOUGHTTHERE ISROLE FOR PROGESTERONE In 1991, a report from Schoolcraft et al. (1991) drew attention to the fact that in certain patients, progesterone still rose above normal follicular phase levels prior to hCG administration in spite of gonadotropin suppression by GnRH-a.
- 10. Early suggestions Silverberg KM,Burns WN, Olive DL, Riehl RM, Shenken RS. Serum progesterone levels predict success of the IVF/ET in patients stimulated with leuprolide acetate and human menopausal gonadotropins. J Clin Endocrinol Metab. 1991;73:797–803. MioY, OnaharaY, Sekijima A, HaradaT, IwabeT,Terakawa N. Subtle rise in serum progesterone during the follicular phase as predictor of the outcome of in- vitro fertilization. Fertil Steril.1992;58:159–65.
- 11. Do we realise? Premature luteinization. Premature progesterone rise (PPR),
- 12. Premature luteinization (“prematureLH surge”) occurs when prior to the plannedinitiation of the hCG trigger, a progressive rise in LH, irreversibly? Premature luteinization.
- 13. Premature progesterone raise(Ppr) refers to a rise in serum progesterone (P) levels on the day of hCG administration. cut-off level differed from 0.8 to 2 ng/mL. . Premature progesterone rise (PPR),
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- 15. Variables AGE BMI FSH AFC Duration of stimulation Dosage of gonadotrophin Numberof follicles Estradiol on triggering day Number of oocyte Ovarian sensitivity
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- 17. Progesterone and Embryoquality
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- 19. WHY DOWE HAVECONFUSIONABOUTIT (Fleming, 2008), Dr Fleming suggests that measurements of progesterone during the follicular phase using commercial assays are unreliable and this might explain the lack of association between progesterone elevation and probability of pregnancy in the meta-analysis byVenetis et al. (2007)
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- 25. Role of adrenal evaluation. Cyp21polymorphism Specifically, 21-hydroxylase converts progesterone and 17α- hydroxyprogesterone into 11- deoxycorticosterone and 11- deoxycortisol, respectively, by hydroxylating at the C21 position.
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- 27. Role of progesterone inendometrial receptivity
- 28. Female age PROGESTERONE ELEVATION the developmental stageof the transferred embryos Number of transferred top- quality embryos
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- 31. Fundamental researchhas shown that the presence of late follicular phase progesterone is essential for follicular development, ovulation and endometrial receptivity.
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- 33. Pre analytics andprogesterone advice Blood sample Till it reaches the machine
- 34. Progesterone can be assayed using immunoassay methods whichinvolves detection techniques radioactive intensity, Fluorescence and Chemiluminescence
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- 36. Whether automated or manual,all immunoassay systems are vulnerable Effects of assay calibration Temperature Reagent variability Specimen preparation processing
- 37. Things to lookfor : Ask for uncertainty of the lab and as per NABL guidelines you have a right to ask
- 38. WHY DO WE HAVE CONFUSION ABOUTIT (Fleming, 2008), Dr Fleming suggests that measurements of progesterone during the follicular phase using commercial assays are unreliable and this might explain the lack of association between progesterone elevation and probability of pregnancy in the meta-analysis byVenetis et al. (2007)
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- 41. Be prepared and improveto have Good embryologist Good blastocyst formation Good freezing program Good cryopreservation program Fool proof pt identification
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- 43. AT KRISHNA IVF Highresponder Use 1.8ng/ml Exclude cyp 21 dysfunction Endometrium ,at ultrasound Quality of three line sign Clear cut protocols
- 44. At Krishna ivfclinic cryopreservation Number of embryo
- 46. Laboratory Instruments andAutomatedAnalyzers basedon chemiluminescence technology; P range 0.2–40 ng/mL. IMMULITE 1000 (Siemens Healthcare Diagnostics): dioxetane-based chemiluminescence. P range 0.08–40 ng/mL. Access II Immunoassay System (Beckman-Coulter): based on chemiluminescence technology. P range 0.1–40 ng/mL. Tosoh AIA 600II (Tosoh Biosciences): based on chemiluminescence technology; P range 0.03–60 ng/mL. Roche Cobas e411 (Roche Diagnostics):
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- 49. In the settingof IVF, these diagnostic errors could result in alternative treatments that are unnecessary, expensive, and potentially compromising of outcome. Depending on P threshold level the day of the assay the type of automated platform ,there is a potential for diagnostic errors
- 50. Professional Society responsibility A concerted effort fromthe IVF community is needed 1 The calculation of the true level of P to enable IVF decision 2 For an universally recognized reference standard. 3
- 51. ProfessionalSociety responsibility This development andvalidation of a P standard for use by all IVF clinics has the potential to unify and improve the accuracy of clinical decisions when used in the setting of IVF.
- 52. "Freezing - Transfer", the netincreasein the outcome is 2% only ? and if not properly executedthen it will impact the outcome by 10 % ? "Freezing -Transfer", the net increase in the outcome is 2% only ? and if not properly executed then it will impact the outcome by 10 % ?
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Editor's Notes
- #2 @
- #5 High progesterone levels will advance the window of implantation. Moreover, the question of whether PE on the day of chg. administration affects the outcomes of IVF is still being debated [2–12]. b) large-sample meta-analysis confirmed the adverse effect of PE on IVF pregnancy outcomes
- #8 In the day 3 ET cycles, a serum progesterone concentration of This detrimental
- #9 In the day 3 ET cycles, a serum progesterone concentration of This detrimental
- #11 Schoolcraft et al [8] started the debate in 1991 Shortly after this report Silverberg and colleagues Mio et al
- #12 Significant raised lh Subtle pe Some thing about ,
- #13 Significant raised lh Subtle pe Some thing about ,
- #14 Significant raised lh Subtle pe Some thing about ,
- #18 Urrego R, Herrera-Puerta E, Chavarria NA, Camargo O, Wrenzycki C, Rodriguez-Osorio N. Follicular progesterone concentrations and messenger RNA expression of MATER and OCT-4 in immature bovine oocytes as predictors of developmental competence. Theriogenology. 2015; 83(7):1179–87. Epub 2015/02/11. doi: 10.1016/j.theriogenology.2014.12.024 S0093-691X(14)00700-6 [pii]. PMID: 25662108. 27. O'Shea LC, Mehta J, Lonergan
- #21 The duration of premature serum progesterone (P) elevation before administration of hCG affect the outcomes of IVF/ICSI embryo transfer (-ET) cycles? Recent studies have demonstrated that prematurely elevated serum P may cause an advanced endometrial secretory transformation resulting in the early closure of the implantation window
- #22 The serum P concentration is above a critical value during COS, it might mimic the condition of the LH surge in natural ovulation cycles and induce a change in implantation window
- #37 Lab @ levels (0.9–2.5 ng/mL) reported in the literature (13–16). Our results indicate that P thresholds based on a specific immunoassay platform can not be generalized to IVF centers using a different platform. Furthermore, our findings argue
- #44 Use it for main presentataion
- #46 Immunoassays Liquid chromatography tandem mass spectrometry Precision of progesterone measurements with the use of automated immunoassay analyzers and the impact on clinical decisions for in vitro fertilization
- #47 lab
- #48 lab
- #49 lab
- #50 lab
- #51 conclusion
- #52 conclusion Harada T, Katagiri C, Takao N, Toda T, Mio Y, Terakawa N. Altering the timing of human chorionic gonadotropin injection according to serum progesterone (P) concentrations improves embryo quality in cycles with subtle P rise. Fertil Steril 1996;65:594–7.