{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:18:20Z","timestamp":1793215100955,"version":"4.5.0"},"reference-count":70,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      This study aimed to analyze the effect of progesterone (P) levels on the human chorionic gonadotropin (hCG) trigger day and the progesterone on hCG day-to-basal progesterone (P\n                      <jats:sub>hCG<\/jats:sub>\n                      \/P\n                      <jats:sub>basal<\/jats:sub>\n                      ) ratio on pregnancy outcomes in patients with a normal ovarian response undergoing fresh embryo transfer in a gonadotropin-releasing hormone antagonist (GnRH-ant) cycle.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      This was a single-center retrospective study including 1,981 GnRH-ant protocol cycles with fresh embryo transfer from January 2017 to December 2023. All enrolled patients with a normal ovarian response were divided into four groups according to P levels on the hCG trigger day and P\n                      <jats:sub>hCG<\/jats:sub>\n                      \/P\n                      <jats:sub>basal<\/jats:sub>\n                      ratio based on cutoffs determined by receiver operating characteristic (ROC) analysis: Group A (P level&amp;lt;1.06 ng\/mL and P\n                      <jats:sub>hCG<\/jats:sub>\n                      \/P\n                      <jats:sub>basal<\/jats:sub>\n                      ratio&amp;lt;1.2), Group B (P level &amp;lt;1.06 ng\/mL and P\n                      <jats:sub>hCG<\/jats:sub>\n                      \/P\n                      <jats:sub>basal<\/jats:sub>\n                      ratio\u22651.2), Group C (P level\u22651.06 ng\/mL and P\n                      <jats:sub>hCG<\/jats:sub>\n                      \/P\n                      <jats:sub>basal<\/jats:sub>\n                      ratio&amp;lt;1.2) and Group D (P level\u22651.06 ng\/mL and P\n                      <jats:sub>hCG<\/jats:sub>\n                      \/P\n                      <jats:sub>basal<\/jats:sub>\n                      ratio\u22651.2). Subsequently, the associations between clinical variables and pregnancy outcomes were analyzed and compared across the groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The positive pregnancy rate (53.5%), clinical pregnancy rate (50.0%), live birth rate (LBR) (43.6%) and singleton rate (36.7%) were significantly higher in Group A than in the other three groups (all\n                      <jats:italic>P&amp;lt;0.001<\/jats:italic>\n                      ). Furthermore, the LBR (30.2% vs. 22.4%) and singleton rate (23.8% vs. 17.1%) were significantly higher in Group C than in Group D (both\n                      <jats:italic>P&amp;lt;0.05<\/jats:italic>\n                      ). The early miscarriage rate in Group A was comparable to Group B, but lower than in Group C and D (10.6% vs. 14.6% vs. 17.4% vs. 20.4%,\n                      <jats:italic>P = 0.016<\/jats:italic>\n                      ). After multivariable logistic regression analysis, the LBR was highest in Group A (Group B vs.A: AOR = 0.437, 95% CI = 0.316-0.603,\n                      <jats:italic>P&amp;lt;0.001<\/jats:italic>\n                      ; Group C vs.A: AOR = 0.512, 95% CI = 0.391-0.670,\n                      <jats:italic>P&amp;lt;0.001<\/jats:italic>\n                      ; Group D vs.A: AOR = 0.325, 95% CI = 0.240-0.441,\n                      <jats:italic>P&amp;lt;0.001<\/jats:italic>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      For patients with a normal ovarian response undergoing the GnRH-ant protocol, even a slight elevation in P levels on the hCG trigger day affected LBR. Moreover, the impact of the P\n                      <jats:sub>hCG<\/jats:sub>\n                      \/P\n                      <jats:sub>basal<\/jats:sub>\n                      ratio on pregnancy outcomes also warrants attention. A serum P level &amp;lt; 1.06 ng\/mL on the hCG trigger day and P\n                      <jats:sub>hCG<\/jats:sub>\n                      \/P\n                      <jats:sub>basal<\/jats:sub>\n                      ratio &amp;lt; 1.2 were associated with a significantly higher LBR. When the P\n                      <jats:sub>hCG<\/jats:sub>\n                      \/P\n                      <jats:sub>basal<\/jats:sub>\n                      ratio \u2265 1.2, the LBR declined regardless of P levels on hCG trigger day. These findings highlight the potential for incorporating P\n                      <jats:sub>hCG<\/jats:sub>\n                      \/P\n                      <jats:sub>basal<\/jats:sub>\n                      ratio considerations into individualized clinical management strategies to optimize pregnancy outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1653555","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T06:45:56Z","timestamp":1765953956000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Effect of progesterone levels on the hCG trigger day and the progesterone-to-basal progesterone ratio on pregnancy outcomes in fresh IVF\/ICSI cycles with GnRH antagonist protocol: a retrospective cohort 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