Association of blood progesterone levels on trigger day and low oocyte retrieval in cases with polycystic ovary syndrome undergoing in-vitro fertilization: A prospective cohort study

Published date: Jul 29 2025

Journal Title: International Journal of Reproductive BioMedicine

Issue title: International Journal of Reproductive BioMedicine (IJRM): Volume 23, Issue No. 5

Pages: 437 – 446

DOI: 10.18502/ijrm.v23i5.19266

Nahid BahramiDepartment of Obstetrics and Gynecology, School of Medicine, Arash Women’s Hospital, Vali-E-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran

Ashraf Moiniashraf_moini@tums.ac.irDepartment of Obstetrics and Gynecology, School of Medicine, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran

Ladan KashaniDepartment of Obstetrics and Gynecology, School of Medicine, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran

Mahshad KhodarahmianDepartment of Obstetrics and Gynecology, School of Medicine, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran

Background: The number of follicles aspirated during intracytoplasmic sperm injection (ICSI)/in vitro fertilization (IVF) treatment does not always match the number of oocytes recovered.

Objective: This study aimed to assess the oocyte retrieval rate (ORR) distribution data and investigate the risk factors for low ORR in polycystic ovary syndrome (PCOS) cases undergoing IVF/ICSI.

Materials and Methods: This prospective cohort study was conducted on 140 women aged between 18 and 40 yr with PCOS who were referred to Arash hospital in Tehran, Iran for ICSI/IVF treatment from March to November 2024. The ratio of obtained oocytes to follicles (≥ 17 mm) on the trigger day was used to determine the OPR. 140 women were split into 2 groups: one with a low ORR and one with a normal ORR, each separated by one standard deviation from the ORR mean.

Results: No significant difference was observed between the low and normal ORR groups for progesterone levels. A statistically significant difference was observed in terms of estradiol/follicle ratio above 17, number of follicles above 17, and number of retrieved eggs between the low and normal ORR groups. Logistic regression analysis showed that serum estradiol/follicle ratio (≥ 17 mm) with (OR = 0.96, 95% CI [0.94–0.98], p = 0.001) was a factor affecting low ORR.

Conclusion: Low ORR, which results in fewer embryos and more cycle cancellations, may be caused by low progesterone levels on the trigger day, low estradiol levels/follicles (≥ 17 mm), and the use of the progestin-primed regimen in PCOS cases.

Keywords: Fertilization in-vitro, Oocyte, Polycystic ovary syndrome, Progesterone, Estradiol

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