J.K. Blakemore

Serum progesterone trend after day of transfer predicts live birth in fresh IVF cycles

PurposeOur objective was to determine if a change in serum P4 from day of transfer (defined as day 19) to day 28 could predict live birth outcome in patients undergoing IVF.MethodsThis study was a retrospective analysis of fresh IVF cycles from 2010 to 2013 at a single center. Primary outcomes include raw and percent change in serum P4, live birth rate, missed abortion, and biochemical pregnancies.ResultsOur results showed an association between live birth rate and percent change in P4. Patients with a 10% or greater drop in serum P4 from day 19 to day 28 had a lower live birth rate, at 26 versus 63%. Interestingly, both groups had “normal” serum P4 levels on day 19, but patients with a 10% or greater drop had lower P4 levels than their counterparts. There was no association between percent P4 change and spontaneous abortion or biochemical pregnancy.ConclusionsThis is the first study to show that percent drop in serum P4 from day of transfer to day 28 is associated with decreased rates of live birth and ongoing pregnancy in fresh IVF cycles, even despite “high or normal” P4 levels on day of transfer.

Hormone therapy and ovarian cancer

www.thelancet.com Vol 386 September 12, 2015 1037 be increased with long-term use, and that the UK guidelines are set to be reviewed. Unfortunately the study missed an opportunity to inform these regulatory bodies. After estimating the relative risks in this case-control comparison, a glaring omission is that the attributable risk was not reported. If the attributable risk is greater than zero, its value shows the number of cases of ovarian cancer among hormone therapy users that can be attributed to hormone therapy use itself, or alternatively the number of cases of ovarian cancer among hormone therapy users that could be eliminated if hormone therapy use is eliminated. This missed opportunity means that the public health eff ect of advice to women to consider stopping hormone therapy because of the risk of ovarian cancer will remain undefi ned. Additionally, the attributable risk is the only measure that can be used to sustain the present advice that women should use the lowest dose of hormone therapy for the shortest possible time. This advice still has no basis and the present central analysis missed an opportunity to inform on this advice. Why did the study not report on this simple extension to the relative risk? For the attributable risk to be of value, an assumption of causality has to exist between exposure and disease. Although the study strongly states a support for causality, an interpretation of the results cannot stand up to causality scrutiny. The study is unlikely to be repeated or surpassed by a randomised controlled study. Therefore it missed many opportunities, including the clarifi cation of the diff erence between minimally increased epidemiological risk and causation.

Erratum to: Serum progesterone levels greater than 20 ng/ml on day of embryo transfer are associated with lower live birth and higher pregnancy loss rates

Erratum to: J Assist Reprod Genet (2015) 32:1395–1399 DOI: 10.1007/s10815-015-0546-7 It has come to the authors’ attention that their presentation of the progesterone data in the manuscript is inconsistent and has the potential to generate confusion to readers. Unfortunately, there were two typographical errors in the manuscript that should be corrected. The title lists the progesterone units as ng/dl. In fact, the correct unit is ng/ml. This same error is made on page 1397 (within the materials and methods section). This should also read as ng/ml. Also, to be clear, the units for progesterone levels should be ng/ml in figure 1.