Elevated serum progesterone-to-estradiol ratio during gonadotropin stimulation for intrauterine insemination or in vitro fertilization is not associated with diminished ovarian reserve.

OBJECTIVE

To determine whether an elevated serum P:E2 ratio on the day of hCG administration during gonadotropin stimulation for intrauterine insemination (IUI) or IVF is associated with diminished ovarian reserve.

DESIGN

Retrospective chart review.

SETTING

Tertiary fertility center.

PATIENT(S): Two hundred eighty-six women undergoing a fertility evaluation.

INTERVENTION(S): Clomiphene citrate challenge test (CCCT).

MAIN OUTCOME MEASURE(S): E2 and P concentrations on the day of hCG administration.

RESULT(S): For the IUI group (n = 98), 74 women had a normal CCCT, while 24 had an abnormal CCCT. For women undergoing IVF (n = 188), 171 had a normal CCCT and 17 had an abnormal CCCT. For women undergoing IUI with a normal CCCT, 33 (44%) had a [(P/E2) x 1000] ratio <1 on the day of hCG, while 12 (50%) (abnormal CCCT) had a [(P/E2) x 1000] ratio <1. Similarly, for women doing IVF with a normal CCCT, 96 (56%) had a [(P/E2) x 1000] ratio <1 on the day of hCG, and 9 (44%) (abnormal CCCT) had a [(P/E2) x 1000] ratio <1 on the day of hCG. The frequencies were similar for all comparable groups. For both groups, there was no association between serum (P/E2) x 1000 on the day of hCG administration and day 3 or 10 FSH during the CCCT. For women with a normal CCCT, there were no differences in delivery rates based on the (P/E2) x 1000 ratio.

CONCLUSION(S): In women stimulated with hMG for IUI or IVF, the serum P:E2 ratio on the day of hCG administration is not associated with diminished ovarian reserve, as demonstrated by the CCCT, or pregnancy outcome.