Metformin in Intracytoplasmic Sperm Injection Cycles
Status:
Completed
Trial end date:
2019-04-01
Target enrollment:
Participant gender:
Summary
The relationship between serum progesterone level on the day of human chorionic gonadotropin
administration and outcome of in vitro fertilization /intracytoplasmic sperm injection and
embryo transfer has been controversial for several decades. some studies presented data
against the negative effect of premature luteinization and reported that elevated serum
progesterone had no adverse effect on pregnancy rates in fresh embryo-transfer cycles within
different ovarian responses. However, most studies have evaluated the association between
serum progesterone level and clinical outcome in fresh in vitro fertilization
/intracytoplasmic sperm injection cycles and advocated that serum progesterone elevation on
the day of human chorionic gonadotropin administration may adversely affect the clinical
outcome by jeopardizing endometrial receptivity.
In addition, the underlying mechanism through which premature luteinization influences
clinical outcomes is elusive. some proposed that premature luteinization cause impairment of
the endometrial receptivity, which may indicate a change in the implantation window, is more
likely to be affected than the oocyte.whereas some documented that the compromised quality of
oocytes might also be a cause.
The cut-off point of premature luteinization is not well established until now. Premature
luteinization has been variously defined based on serum P levels, with thresholds of 0.9-1.5
ng/mL being used.
Previous studies have shown that metformin inhibits the first steps of steroidogenesis
dose-dependently reducing granulosa cells progesterone output. Moreover, other authors have
recently reported that low dose metformin could improve in vitro fertilization outcome in non
poly-cystic ovarian syndrome repeaters. So, considering the safety of this drug before
pregnancy, metformin can be given to consenting patients from first ultrasound monitoring
until ovulation triggering.