Luteal phase serum progesterone level as a predictor of vaginal bleeding or adverse pregnancy outcome in patients undergoing assisted reproductive techniques

Ashish Kale, Ashwini Kale


Background: With advances in assisted reproductive techniques its becoming increasingly important to identify pregnancies having a potential of adverse outcome in the form of per vaginal bleeding or early pregnancy loss. The objective of this study was to find out whether the value of luteal phase progesterone can be used as a marker to predict the possibility of per vaginal bleeding and early pregnancy loss in cases conceived by in vitro fertilization (IVF) and embryo transfer (ET).

Methods: A total of 40 women of age less than or equal to 40 years undergoing IVF and ET were included in this study depending upon inclusion criteria. Patients were excluded if they had any factor defined as exclusion criteria. on D14 after embryo transfer B-hCG was done in all the patients. If B-hCG levels were found to be ≥ 100 mIU/ml then serum progesterone levels were also done. B-hCG levels were repeated after 48 hours. Pregnancies were followed up and correlation between suboptimal rise in serum progesterone levels and adverse pregnancy outcome was studied.

Results: Mean Beta-hCG and Serum progesterone levels on D14 of embryo transfer were found to be 388.86±34 mIU/ml and 54.24±4.32 ng/ml respectively. A repeat B-hCG and serum progesterone level 48 hours after initial estimation showed mean B-hCG and serum progesterone level to be 598.80±52.12 mIU/ml and 72. 24±5.24 ng/ml respectively. Out of 40 patients 26 patients showed >30% rise in serum progesterone level while 14 patients showed less than 30% rise in serum progesterone level.

Conclusions: Suboptimal rise in serum progesterone level (<30%) was associated with increased incidence of adverse pregnancy outcome in women conceived after in vitro fertilization and embryo transfer.


Adverse pregnancy outcome, B-hCG, Embryonal transfer, In vitro Fertilization, Luteal phase progesterone levels

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Bhattacharya S, Johnson N, Tijani HA, Hart R, Pandey S, Gibreel AF. Female infertility. BMJ Clinical Evidence. 2010;2010:819.

Kumar N, Singh AK. Trends of male factor infertility, an important cause of infertility: a review of literature. J Human Reprod Sci. 2015;8(4):191-6.

Sauer MV. Assisted reproductive technology. Western J Med. 1994;161(2):164-5.

Huang JY, Rosenwaks Z. Assisted reproductive techniques. Methods Mol Biol. 2014;1154:171-231.

Klemetti R, Sevón T, Gissler M, Hemminki E. Complications of IVF and ovulation induction. Hum Reprod. 2005;20(12):3293-300.

Zhu L, Zhang Y, Liu Y. Maternal and live-birth outcomes of pregnancies following assisted reproductive technology: a retrospective cohort study. Sci Rep. 2016;6:35141.

Ashmita J, Vikas S, Swati G. The impact of progesterone level on day of hCG injection in ivf cycles on clinical pregnancy rate. J Hum Reprod Sci. 2017;10(4):265-70.

Ragusa A, de Carolis C, dal Lago A, Miriello D, Ruggiero G, Brucato A, et al. Progesterone supplement in pregnancy: an immunologic therapy? Lupus. 2004;13(9):639-42.

Druckmann R, Druckmann MA. Progesterone and the immunology of pregnancy. J Steroid Biochem Mol Biol. 2005;97(5):389-96.

Di Renzo GC, Mattei A, Gojnic M, Gerli S. Progesterone and pregnancy. Curr Opin Obstet Gynecol. 2005;17(6):598-600.

Qu F, Wu Y, Zhu YH. The association between psychological stress and miscarriage: a systematic review and meta-analysis. Sci Rep. 2017;7:1731.

Mesen TB, Young SL. Progesterone and the luteal phase: a requisite to reproduction. Obstet Gynecol Clin North Am. 2015;42(1):135-51.

Yanushpolsky EH. Luteal phase support in in vitro fertilization. Semin Reprod Med. 2015;33(2):118-27.

Guth B, Hudelson J, Higbie J, Solomon B, Polley S, Thomas S, et al. Predictive value of hCG level 14 days after embryo transfer. J Assist Reprod Genet. 1995;12(1):13-4.

Slattengren AH, Prasad S, Oyola S. Is this pregnancy viable? J Fam Pract. 2013;62(6):305-16.

Jie Z, Yiling D, Ling Y. Association of assisted reproductive technology with adverse pregnancy outcomes. Iranian J Reprod Med. 2015;13(3):169-80.

Singh N, Begum AA, Malhotra N, Bahadur A, Vanamail P. Role of early serum beta human chorionic gonadotropin measurement in predicting multiple pregnancy and pregnancy wastage in an in vitro ET fertilization cycle. J Hum Reprod Sci. 2013;6(3):213-8.

Kaur J, Naidu P, Kumkum R, Mahajan N. Impact of mid-luteal serum progesterone levels on pregnancy outcome in fresh and frozen embryo transfer cycles in women of Indian ethnicity. Onco Fertil J. 2018;1:30-5.

Kim YJ, Shin JH, Hur JY, Kim H, Ku SY, Suh CS. Predictive value of serum progesterone level on β-hCG check day in women with previous repeated miscarriages after in vitro fertilization. Plos One. 2017;12(7).

Abdelazim IA, Belal MM, Makhlouf HH. Relation between single serum progesterone assay and viability of the first trimester pregnancy. J Turkish German Gynecol Assoc. 2013;14(2):68-71.