Hyperprolactinemia has long been considered detrimental to fertility due to irregularity of ovulation. Whether mild hyperprolactinemia should be corrected before initiating an in-vitro fertilization/intracytoplasmic sperm injection cycle (IVF/ICSI) has not been determined; this study aimed to examine how different levels of prolactin affect IVF outcomes. A total of 3,009 patients with basal prolactin level <50 ng/mL undergoing IVF/ICSI cycles for tubal or male factors were recruited in this study. Patients diagnosed with anovulation owing to polycystic ovarian syndrome or hyperandrogenism were ruled out. Pregnancy outcomes were compared between patients with basal prolactin levels higher or lower than the median level of prolactin (16.05 ng/mL). Multifactor analyses were carried out among four subgroups depending on different prolactin levels. Repeated-measures analysis of variance was used to explore the relationship between the ascending trend of prolactin levels over ovarian stimulation and the corresponding cumulative pregnancy outcomes. There were significantly higher numbers of oocytes (9 vs. 8, P = 0.013) and embryos (6 vs. 5, P = 0.015) in patients with basal prolactin higher than 16.05 ng/mL. Basal prolactin higher than 30 ng/mL was positively related to cumulative clinical pregnancy, and a level higher than 40 ng/mL was a good indicator for the cumulative live birth rate. Throughout ovarian stimulation, the prognosis of pregnancy improved with increasing prolactin levels. Patients with better cumulated pregnancy outcomes had significantly higher prolactin levels as well as a profoundly increasing trend during the stimulating process than those who did not conceive. For patients who underwent the gonadotropin-releasing hormone agonist long protocol IVF/ICSI treatment, a slightly higher prolactin level during the controlled ovarian hyperstimulation protocol was a positive indicator for cumulated pregnancy/live birth rates.

OBJECTIVE: Are high-responder IVF patients protected from the deleterious effect of prematurely elevated serum progesterone level on the probability of pregnancy?
METHODS: In this retrospective cohort study, 2971 autologous fresh embryo transfer IVF cycles with gonadotrophin-releasing hormone agonist long protocol were analysed to investigate whether the detrimental effect of prematurely rising progesterone levels on clinical pregnancy rate (CPR) varies depending on the magnitude of ovarian response. Nine different evenly spaced intervals were constructed for serum progesterone level on the human chorionic gonadotrophin day (<0.5/0.5-0.9/1-1.4/1.5-1.9/2-2.4/2.5-2.9/3-3.4/3.5-3.9/>4 ng/ml). Then, IVF cycles in each of these intervals were further divided into low (≤3 oocytes), normal (4-15 oocytes) and high responders (≥16 oocytes).
RESULTS: The progressive rise of serum progesterone from the <0.5 to the >4 ng/ml interval caused a gradual and continuous decline in the CPR of all three types of ovarian response. The absolute difference in the CPR between the lowest and the highest progesterone groups was not related to the magnitude of ovarian response (-26.6%, -37.7% and -40.7% for the low, normal and high responders, respectively). On multivariate logistic regression analysis, the detrimental effect of progesterone started at 1.5-1.9 ng/ml, 3.0-3.4 ng/ml and 4.0-4.4 ng/ml intervals for the low, normal and high responders, respectively.
CONCLUSIONS: High responders are not exempt from the detrimental effects of prematurely rising serum progesterone levels but the threshold interval where the detrimental effect begins is higher in the high responders compared with the low and normal responders.

This study aims to investigate whether oral contraceptive pills (OCP) pretreatment impairs pregnancy outcomes in polycystic ovary syndrome (PCOS) women undergoing GnRH agonist protocol. A total of 1025 couples underwent their first cycle of in vitro fertilization. Patients were divided into GnRH agonist protocol group (LP group) and OCP dual suppression GnRH agonist protocol group (OC-LP group). Logistic regressions were performed to estimate the risk factors affecting live birth following fresh embryo transfer between groups. Frozen-thawed embryos from the first oocyte retrieval cycle were replaced into uterus for women did not get live birth. Cumulative live birth rates between groups were compared by Kaplan-Meier survival analysis. Serum luteinizing hormone level, endometrial thickness, and live birth rate were significantly reduced in the OC-LP group in fresh cycle. Thinner endometrium, higher progesterone, and poorer embryo quality were independent risk factors for failure in getting live birth following fresh embryo transfer. However, cumulative live birth rate, medium embryo transfer attempts required to achieve live birth were comparable between groups. OCP pretreatment in GnRH agonist protocol does not seem to impair the pregnancy outcome when calculated by cumulative live birth rate in PCOS women.

To compare the effect of the different protocols in patients receiving in vitro fertilization treatment due to poor ovarian response. Seventy-seven of the patients included in the study were treated with gonadotropin (450 IU) + GnRH antagonist (group 1), 84 of the patients were treated with gonadotropin (450 IU) + microdose GnRH analog (group 2), and 53 of the patients were treated with clomiphene citrate (100 mg/day) + gonadotropin (300 IU) + GnRH antagonist (Group 3). In assessing total gonadotropin dosage, patients in Group 3 detected significantly less gonadotropin as compared to the other two groups (p < .001). Group 1 were superior to the other two groups with respect to retrieved oocytes, meiosis II oocytes and number of embryos obtained at the end of the treatment. As for the evaluation of clinical pregnancy, although the highest pregnancy rate was in Group 3, this finding was not of statistical significance. Although increasing the dosage of gonadotropins for ovarian hyper stimulation treatment in patients with poor ovarian response is beneficial with respect to retrieved oocytes, meiosis II oocytes and number of embryos, the increased dosage does not provide a statistically significant increase in clinical pregnancy rates.