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Volume 14
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

The Association Between Early Progesterone Rise and Serum Estradiol Levels as Well as Endometrial Thickness in IVF Cycles

by
Katarina Ivanovic
1,
Lidija Tulic
1,2,*,
Ivan Tulic
1,
Stefan Ivanovic
3,
Jelena Stojnic
1,2,
Jovan Bila
1,2,
Tatjana Dosev
1,
Zeljka Vukovic
1 and
Branislav Milosevic
1,2
1
Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
2
Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
3
Obstetrics and Gynecology Clinic “Narodni Front”, 11000 Belgrade, Serbia
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(17), 5965; https://doi.org/10.3390/jcm14175965 (registering DOI)
Submission received: 17 July 2025 / Revised: 6 August 2025 / Accepted: 13 August 2025 / Published: 23 August 2025
(This article belongs to the Special Issue Female Infertility: Clinical Diagnosis and Treatment)
Versions Notes

Abstract

Background/Objectives: The success of artificial reproductive technologies (ARTs) depends on different factors, such as patient-specific reproductive features, ovarian response to stimulation, oocyte and embryo quality, and endometrial receptivity. This study aimed to evaluate their association with oocyte yield, fertilization, endometrial thickness, and pregnancy outcomes. Methods: A prospective clinical study included 128 women undergoing IVF/ICSI. Baseline hormone levels (E2, P4, FSH, LH, AMH) were assessed prior to stimulation. E2 levels were monitored during stimulation, and P4 was measured on the day of oocyte retrieval. Patients were grouped based on P4 levels (<2 ng/mL vs. ≥2 ng/mL). IVF outcomes and endometrial characteristics were statistically analyzed. Results: Lower P4 levels (<2 ng/mL) on the day of oocyte retrieval were significantly associated with higher fertilization rates (p < 0.003), more fertilized oocytes (p < 0.001), and increased pregnancy rates (p < 0.001). Elevated P4 (≥2 ng/mL) correlated with a higher frequency of thin endometrium (<7 mm, p < 0.007). E2 levels on the hCG trigger day correlated positively with the number of retrieved and mature oocytes and fertilization outcomes (p < 0.05). Patients who achieved pregnancy had lower P4 and BMI, and higher E2, AMH, and endometrial thickness. ROC identified a P4 threshold of 1.99 ng/mL with moderate predictive value. Conclusions: Elevated progesterone levels on the day of oocyte retrieval negatively impact fertilization and pregnancy outcomes, likely due to impaired endometrial receptivity. Combined assessment of P4, E2, AMH, and endometrial thickness may enhance embryo transfer planning and improve IVF success rates.
Keywords: endometrial thickness; E2 levels; hCG trigger; P4 endometrial thickness; E2 levels; hCG trigger; P4

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MDPI and ACS Style

Ivanovic, K.; Tulic, L.; Tulic, I.; Ivanovic, S.; Stojnic, J.; Bila, J.; Dosev, T.; Vukovic, Z.; Milosevic, B. The Association Between Early Progesterone Rise and Serum Estradiol Levels as Well as Endometrial Thickness in IVF Cycles. J. Clin. Med. 2025, 14, 5965. https://doi.org/10.3390/jcm14175965

AMA Style

Ivanovic K, Tulic L, Tulic I, Ivanovic S, Stojnic J, Bila J, Dosev T, Vukovic Z, Milosevic B. The Association Between Early Progesterone Rise and Serum Estradiol Levels as Well as Endometrial Thickness in IVF Cycles. Journal of Clinical Medicine. 2025; 14(17):5965. https://doi.org/10.3390/jcm14175965

Chicago/Turabian Style

Ivanovic, Katarina, Lidija Tulic, Ivan Tulic, Stefan Ivanovic, Jelena Stojnic, Jovan Bila, Tatjana Dosev, Zeljka Vukovic, and Branislav Milosevic. 2025. "The Association Between Early Progesterone Rise and Serum Estradiol Levels as Well as Endometrial Thickness in IVF Cycles" Journal of Clinical Medicine 14, no. 17: 5965. https://doi.org/10.3390/jcm14175965

APA Style

Ivanovic, K., Tulic, L., Tulic, I., Ivanovic, S., Stojnic, J., Bila, J., Dosev, T., Vukovic, Z., & Milosevic, B. (2025). The Association Between Early Progesterone Rise and Serum Estradiol Levels as Well as Endometrial Thickness in IVF Cycles. Journal of Clinical Medicine, 14(17), 5965. https://doi.org/10.3390/jcm14175965

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