The impact of an increased progesterone‐to‐follicle number ratio on live delivery rates in women with normal ovarian reserve

Objective To explore the relationship between progesterone–follicle number (P/F) ratio and live delivery rate in patients with normal ovarian reserve undergoing cleavage‐stage embryo transfer with a long gonadotropin‐releasing hormone agonist cycle. Methods The present retrospective study included data from patients younger than 38 years with normal ovarian reserve who were undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer at Zhongnan Hospital, Wuhan University, China, between January 1, 2009 and December 31, 2015. Patients underwent cleavage‐stage fresh embryo transfer with a long gonadotropin‐releasing hormone agonist cycle, and associations between P/F ratios and fertility/pregnancy outcomes were analyzed. Results Patients with a P/F ratio of 0.11 or above had higher serum progesterone levels ( P <0.001) and lower serum estradiol levels ( P <0.001) on the day of human chorionic gonadotropin administration in comparison with patients with lower P/F ratios; elevated P/F ratios were also associated with fewer follicles at least 14 mm in size ( P <0.001) and lower live delivery rates ( P <0.001). Multiple logistic regression confirmed that P/F ratio was an independent predictor of live delivery rate ( P =0.001). Conclusion A P/F ratio of at least 0.11 was associated with lower live delivery rates in women with normal ovarian reserve undergoing cleavage‐stage embryo transfer with a long gonadotropin‐releasing hormone agonist cycle.