Progesterone/Estradiol ratio as a predictor in the ART cycles with premature progesterone elevation on the day of hCG trigger

Background: The purpose of the study was to evaluate the role of Progesterone/ Estradiol ([P.sub.4]/[E.sub.2]) ratio as a predictive tool for clinical pregnancy in ART cycles with a premature progesterone rise of >1.5 ng/ml on the day of human chorionic gonadotropin (hCG) trigger. Methods: Retrospective analysis was done on 569 fresh embryo transfer cycles from January 2011 to December 2012 at the infertility unit of a tertiary care hospital. Age, BMI, number of cycles and number of clinical pregnancies have been considered. Results: The overall clinical pregnancy rate per embryo transfer was 42.8% (244/ 569). The clinical pregnancy rate in the 36 cycles with progesterone ([P.sub.4]) level >1.5 ng/ml was significantly lower than the 533 cycles with normal [p.sub.4] [less than or equal to] 1.5 ng/ml (22.2% vs. 44.2%; p=0.0092). The 36 cycles with progesterone level >1.5 ng/ml were divided into subgroups of [P.sub.4]/[E.sub.2] >1 (n=20) and [P.sub.4]/[E.sub.2] [less than or equal to] 1 (n=16). The 20 cycles with [P.sub.4]/[E.sub.2] >1 and [P.sub.4] >1.5 ng/ml had a significantly lower pregnancy rate than the cycles with [P.sub.4] [less than or equal to] 1.5 ng/ml (15% vs. 42.8%; p=0.0103). The 15 cycles with [P.sub.4]/[E.sub.2] [less than or equal to] 1 and P4 >1.5 ng/ml had a similar pregnancy rate as the cycles with [P.sub.4] 1. Keywords: ART, Pregnancy, Premature progesterone elevation, Progesterone estradiol ratio.