Progesterone level and progesterone/estradiol ratio on the day of hCG administration: detrimental cutoff levels and new treatment strategy?

7 04 2011

To the Editor:

I read the paper by Elgindy (1) on the detrimental role of progesterone levels on the day of hCG administration in pregnancy rates.

The detrimental effect of the high steroid levels on endometrial receptivity is a matter of debate. The advances in the study of endometrial receptivity are providing us with deeper knowledge of the possible mechanisms (2). The advances in cryopreservation are helping to propose new strategies to make up for the endometrium-embryo desynchronization (3).

However, Elgindy’s article raises two points:

Firstly, the authors find through ROC analysis that the levels of P > 1.5 ng/mL and the rate of P/E > 0.55 on the day of hCG administration had a detrimental effect on the pregnancy rates in the cleave-stage embryo transfer compared with blastocyst-stage embryo transfer. However, in an earlier study (4), using the same kind of analysis and with a population of similar characteristics (normal response and long protocol) we did not identify a cut-off level that had prognostic value, for which reason we disagree with their conclusions. Read the rest of this entry »

Comment on the article by Madani et al. ‘Improvement of pregnancy rate by modification of embryo transfer technique: a randomized clinical trial’

28 06 2010

To the Editor:

I read with great interest the paper by Madani et al. (1). The authors report a randomized controlled study of 110 women in which pushing 0.2 mL of air into the uterus after embryo transfer (ET) was associated with a significant improvement of the clinical pregnancy rate from 9/55 (16.4%) in the control group to 22/55 (40%) in the study group. Read the rest of this entry »

Is perifollicular vascularity assessment always feasible and clinically effective?

29 01 2009

To the Editor:

We read with great interest the recent paper by Robson et al. (1). The authors described their experience on power Doppler assessment of perifollicular vascularity (PV) at the time of ultrasound-guided transvaginal oocyte retrieval in infertile patients who underwent in vitro fertilization (IVF) showing that this procedure is practical and reproducible, and concluding that it should be tested in larger studies in order to define its clinical value. Read the rest of this entry »