THE EFFECT OF PREMATURE ELEVATED PROGESTERONE LEVEL IN LATE FOLLICULAR PHASE ON OOCYTE QUALITY.

To determine whether premature elevated progesterone on day of trigger adversely affect the oocyte quality. A retrospective cohort study was performed using database of Uludag University School of Medicine ART Center from 2011 to 2018. The etiology of infertility, age, BMI, stimulation protocol and trigger agent , which may affect oocyte quality, was standardized. Study inclusion criteria were; isolated male infertilty etiology, women age 24-35 years, female BMI 19-30 kg/m2, 6-15 oocytes obtained GnRH-antagonist protocol cycles with 150-300 IU dose of rFSH and 250 mcg/0.5ml of rhCG. 421 oocytes obtained from 49 ICSI cycle were evaluated. The metaphase II oocytes were grouped according to progesterone level on the trigger day: ≤0.5ng/ml [Grup-1 (n=103)], 0.5-1ng/ml [Grup-2 (n=204)] and ≥1ng/ml [Grup-3 (n=76)]. Individual oocytes were evaluated based on 6 parameters: oocyte shape, oocyte size, ooplasm characteristics, structure of perivitelline space(PVS), zona pellucida(ZP) and polar body(PB) morphology. For each oocyte, each parameter was scored as +1, 0 and -1 to determine the oocyte quality score. There was no significant difference between the groups in terms of patient age (p=0.11), BMI (p=0.12), duration of infertility (p=0.48), basal FSH (p=0.28), LH (p=0.91), E2 (p=0.91), AMH (p=0.20) and AFC (p=0.60). There was a positive correlation between dose of gonadotropin and progesterone concentration on trigger day (p=0.001). There was a negative correlation between oocyte quality score and progesterone level on hCG day (p=0.001). In terms of oocyte quality score, a statistically significant difference was found between 3 groups (5.48, 4.97, 4.14, p=0.001, respectively). The quality score of the Group-3 oocytes was found to be significantly lower than both Group-1 and Group-2 oocytes (p=0.001). Also Group-2 oocyte quality score was significantly lower than Group-1 oocytes (p=0.001). There was a positive correlation between progesterone level and abnormal oocyte percentage (p=0.001). The the highest abnormal oocyte ratio was found in Group-3 (%78.9) and lowest in Group-1 (%28.2). Ooplasm (p=0.007), PVS (p=0.001) and ZP (p=0.004) abnormalities were statistically increased with higher progesterone concentration. Degenerated (p=0.55) and immature oocyte percentage (p=0.82) had no significant correlation between groups. Estradiol concentration on trigger day (p=0.001), total oocyte count (p=0.001) and mature oocyte count (p=0.001) had a positive correlation with progesterone concentration on trigger day. This study comprehensively assessed the relationship between oocyte quality and progesterone.These data demonstrate that elevated progesterone levels (≥1ng/ml) before oocyte maturation were consistently detrimental to the oocyte. Individualization of stimulation protocols and consideration of gonadotropin dose in late follicular phase will lead to positive results in terms of oocyte quality.