Research Article | DOI: https://doi.org/10.31579/2578-8965/315
1Consultant of Obstetrics and Gynecology (Infertility and Reprodu ctive Medicine), Cairo, Egypt.
2Infertility and Reproductive Medicine Unit, Department of Obstetrics and Gynecology, King Fahd Central Hospital, Jazan, Saudi Arabia.
3Obstetrics & Gynecology Specialist, Saudi Airlines Medical Center, Fakeeh Care Group, Jeddah, Saudi Arabia.
4Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University.
*Corresponding Author: Salah Nagi Abdelhamid Mansour Elmalawy, Consultant of Obstetrics and Gynecology (Infertility and Reproductive Medicine), Cairo, Egypt.
Citation: Mansour Elmalawy SNA, Abo Khalil MA, Dalia R. Ghoneim, Yasser Mohmed ELshehawy, (2025), Influence of Trigger-Day Serum Progesterone Level on Reproductive Outcomes in IVF/ICSI Cycles: A Prospective Cohort Study, J. Obstetrics Gynecology and Reproductive Sciences, 9(2) DOI:10.31579/2578-8965/315
Copyright: © 2025, Salah Nagi Abdelhamid Mansour Elmalawy. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 02 February 2025 | Accepted: 15 February 2025 | Published: 25 February 2025
Keywords: ivf; icsi; progesterone elevation; hcg trigger; clinical pregnancy rate; implantation rate; assisted reproductive technology; controlled ovarian stimulation
Background: Premature progesterone elevation (PE) on the day of human chorionic gonadotropin (hCG) trigger during controlled ovarian stimulation has been reported in IVF/ICSI cycles despite the use of GnRH agonist or antagonist protocols. The impact of elevated progesterone levels on reproductive outcomes remains controversial, particularly regarding implantation and clinical pregnancy rates. Identifying clinically relevant progesterone thresholds may improve treatment strategies and optimize IVF/ICSI outcomes.
Objective: To evaluate the relationship between serum progesterone levels on the day of hCG trigger and reproductive outcomes in IVF/ICSI cycles and to determine the progesterone threshold associated with adverse clinical outcomes.
Methods: This prospective cohort study included 95 infertile women aged 20–35 years undergoing IVF/ICSI treatment at Ain Shams University Hospital between June 2023 and October 2024. Participants were categorized according to trigger-day serum progesterone levels into three groups: <1.3 ng/mL, 1.3–1.5 ng/mL, and >1.5 ng/mL. Demographic characteristics, hormonal profiles, ovarian response parameters, fertilization rate, implantation rate, and clinical pregnancy outcomes were compared. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive value of serum progesterone for pregnancy outcomes.
Results: Among the participants, 83.2% had progesterone levels <1.3 ng/mL, 4.2% had levels between 1.3 and 1.5 ng/mL, and 12.6% had levels >1.5 ng/mL. Clinical pregnancy rates were 43.0%, 50.0%, and 25.0%, respectively. Although differences in implantation and pregnancy rates did not reach statistical significance, outcomes were consistently lower in women with progesterone levels >1.5 ng/mL. No significant differences were observed in oocyte yield, embryo quality, fertilization rate, or baseline hormonal parameters. ROC analysis identified a progesterone cutoff value >0.7 ng/mL for predicting pregnancy outcomes (AUC = 0.622, sensitivity = 66.7%, specificity = 64.3%).
Conclusions: Elevated serum progesterone on the day of hCG trigger, particularly levels >1.5 ng/mL, is associated with reduced implantation and clinical pregnancy outcomes in IVF/ICSI cycles. Careful monitoring of progesterone levels and individualized treatment approaches, including consideration of freeze-all strategies, may improve reproductive success.
Despite routine suppression of endogenous gonadotropins by gonadotropinreleasing hormone (GnRH) agonists, serum progesterone elevation (PE) on the day of human chorionic gonadotropin (hCG) trigger has been reported in controlled ovarian stimulation (COS) cycles in not only short protocols but also long protocols [1]
The occurrence rates of PE have been reported to be 13% to 46% of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles with GnRH agonists [2]. However, the possible effects of these subtle progesterone increases on pregnancy outcomes are controversial. Most studies have advocated that PE on the day of hCG trigger adversely affects pregnancy outcome [3] due to its detrimental effect on the endometrium or the compromised quality of the oocyte [4].
For most studies, the role of PE on the day of hCG trigger on pregnancy rates has been estimated through simple bivariate analyses, which are unable to control for confounders such as the number of oocytes, female age, or body mass index (BMI), and the available studies may actually underestimate the true effect of PE on pregnancy rates [5]
Furthermore, these varying results may also be attributed to the use of different arbitrary cut-off levels. However, the effect of ovarian response on the association of PE with the probability of pregnancy outcomes remains unclear. Recent studies have shown that serum progesterone level is positively associated with ovarian response and oocyte number has been demonstrated to be correlated with PE [6]
It has been demonstrated that PE is associated with a higher number of oocytes; more oocytes might indicate more available embryos, whereas fewer oocytes might indicate embryos that already have diminished implantation potential [7]. Consequently, the aim of the study is to investigate the relationship between serum progesterone level on the day of h-CG trigger and IVF/ICSI outcomes in patients with different ovarian responses using GnRH long agonist or antagonist protocols and identify the thresholds at which PE has a detrimental effect on IVF/ICSI outcomes.
After written consents from the patients, this this prospective cohort study was performed on total 95 infertile women aged 20–35 years with a BMI between 18.5 and 30 kg/m². Participants underwent controlled ovarian stimulation (COS) using GnRH long agonist or antagonist protocols, followed by fresh embryo transfer at tertiary care hospital at Ain Shams University Hospital “infertility clinic and ART unit” starting from June 2023 till October 2024.
Inclusion Criteria
Participants eligible for enrollment in this study were infertile women aged between 20 and 35 years with a body mass index (BMI) ranging from 18.5 to 30 kg/m². All participants underwent controlled ovarian stimulation (COS) using either a GnRH long agonist protocol or a GnRH antagonist protocol and were scheduled for fresh IVF/ICSI embryo transfer cycles. To ensure adequate ovarian reserve and hormonal balance, only women with basal day-3 estradiol (E2) levels below 60 pg/mL and follicle-stimulating hormone (FSH) levels below 15 IU/mL were included. Additionally, participants were required to have both ovaries present and a documented normal uterine cavity confirmed by either transvaginal ultrasonography (U/S) or hysterosalpingography (HSG).
Exclusion Criteria
Women were excluded from the study if they had an early follicular phase (days 2–4) serum FSH level greater than 15 mIU/mL, as elevated FSH is associated with poor ovarian response to fertility treatment. Patients with abnormalities of the uterine cavity, such as endometrial polyps or congenital uterine anomalies detected by sonohysterography or hysterosalpingography, were also excluded because of their potential negative impact on implantation. Additional exclusion criteria included the presence of advanced endometriosis (grade III or IV), estradiol levels on the trigger day exceeding 6000 pg/mL or below 500 pg/mL, and an antral follicle count greater than 15 on baseline ultrasound assessment. Women whose embryo transfer cycles were canceled, those with medical contraindications to pregnancy, or those who had received investigational drugs within three months prior to enrollment were also excluded. Furthermore, patients unable to communicate effectively with the investigators, unwilling to provide written informed consent, or those who had previously participated in the study were not eligible for inclusion.
Sample size Justification:
Using PASS 11 program for sample size calculation, reviewing results from a previous study (8) showed that elevation progesterone level on the hCG trigger day may have a negative effect on the clinical pregnancy in GnRH-ant cycles, assuming a mild negative correlation between serum progesterone level and clinical pregnancy rate (r=-0.3) and after 10?justment for dropout rate a sample size of at least 95 patients achieves 80% power to detect a difference of -0.3 between the null hypothesis zero correlation and the alternative hypothesis correlation of 0.3 using a two- sided hypothesis test with a significance level of 0.05.
Study procedures and interventions:
Eligible participants were enrolled according to the predefined inclusion and exclusion criteria. A comprehensive clinical evaluation was performed for all participants, including detailed medical, surgical, and infertility histories. General and gynecological examinations were conducted, and transvaginal ultrasonography (TVS) was performed to assess uterine and adnexal anatomy as well as antral follicle count (AFC).
Patients were subjected to long agonist or antagonist protocol depending upon patient’s specific characteristics, a history of prior attempts at ART, baseline hormonal profile, and clinician’s preference.
1.Baseline Investigations
Baseline hormonal assessment was carried out on day 3 of the menstrual cycle and included measurement of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-Müllerian hormone (AMH) levels. A baseline transvaginal ultrasound examination was also performed to evaluate ovarian reserve and pelvic anatomy.
2. Controlled Ovarian Stimulation Protocols
Participants underwent either a GnRH agonist long protocol or a GnRH antagonist protocol based on individual patient characteristics, previous assisted reproductive technology (ART) attempts, baseline hormonal profile, and clinician preference.
2.1 GnRH Agonist Long Protocol
In patients assigned to the GnRH agonist long protocol, a GnRH agonist (Decapeptyl® 0.1 mg subcutaneously daily; Ferring) was initiated on day 21 of the preceding menstrual cycle. Ovarian stimulation with recombinant FSH (Gonapure®; Minapharm) commenced on day 3 of the treatment cycle after confirmation of adequate pituitary downregulation, defined as LH<5 mIU/mL, E2 <60 pg/mL, endometrial thickness <5 mm, and follicular diameter <10 mm.
2.2 GnRH Antagonist Protocol
In the antagonist protocol, ovarian stimulation with recombinant FSH or human menopausal gonadotropin (HMG) was started on day 3 of the menstrual cycle, provided that basal LH was <5 mIU/mL and E2 was<60 pg/mL. The GnRH antagonist (Cetrotide® 0.25 mg subcutaneously daily; Merck-Serono) was introduced using a flexible regimen when at least one follicle reached a diameter of ≥14 mm and was continued until the morning of the trigger day.
3. Monitoring of Ovarian Response
The gonadotropin dose was individualized according to each patient's ovarian response. Serial transvaginal ultrasonography was performed throughout stimulation to monitor follicular growth. Serum progesterone levels were measured on the day of ovulation trigger.
4. Group Allocation According to Progesterone Levels
Participants were categorized into three groups based on serum progesterone concentration measured on the day of hCG trigger:
5. Ovulation Trigger and Oocyte Retrieval
Final oocyte maturation was induced when at least three follicles measuring 17–18 mm in diameter were present. Triggering was achieved using either human chorionic gonadotropin (hCG) (Choriomon® 5,000–10,000 IU intramuscularly; IBSA) or a GnRH agonist trigger (Decapeptyl® 0.2 mg). Oocyte retrieval was performed 35–36 hours after triggering under standard clinical protocols.
6. Fertilization and Embryo Culture
Retrieved oocytes underwent intracytoplasmic sperm injection (ICSI) as indicated. Fertilization assessment was performed on the second day after insemination or ICSI. Embryos were subsequently cultured in a fixed culture medium until transfer.
7. Embryo Transfer and Luteal Phase Support
Embryo transfer was performed on either day 3 or day 5 after fertilization, depending on the number and quality of available embryos. Luteal phase support consisted of vaginal progesterone suppositories (Prontogest® 400 mg once daily) and oral dydrogesterone (Duphaston® 10 mg three times daily).
8. Pregnancy Assessment and Outcome Evaluation
Serum β-hCG levels were measured 15 days after embryo transfer. A positive pregnancy test was defined as a β-hCG level ≥50 mIU/mL and was used to calculate the conception rate. Clinical pregnancy was confirmed by transvaginal ultrasonography two weeks after a positive β-hCG result. The implantation rate was calculated as the number of gestational sacs divided by the number of embryos transferred. Clinical pregnancy rate was defined as the presence of an intrauterine gestational sac with fetal cardiac activity detected by ultrasonography at 6 weeks of gestation.
Outcomes:
Primary outcome:
Secondary outcome:
Statistical analysis: Data were fed to the computer and analyzed using IBM SPSS software package version 20.0 (Armonk, NY: IBM Corp, released in 2011). Qualitative data were described using number and percent. The Kolmogorov-Smirnov test & Shapiro-Wilk test was used to verify the normality of distribution. Quantitative data were described using range (minimum and maximum), mean, standard deviation, median and interquartile range (IQR). Significance of the obtained results was judged at the 5% level.
The used tests were
1 - Chi-square test; For categorical variables, to compare between different groups
2 - Fisher’s exact test; Correction for chi-square when more than 20% of the cells have expected count less than 5
3 - F-test (ANOVA); For normally distributed quantitative variables, to compare between more than two groups
4 – Kruskal Wallis test; For abnormally distributed quantitative variables, to compare between more than two studied groups.
| No. | % | |
| S progesteron | ||
| <1.3 | 79 | 83.2 |
| 1.3 – 1.5 | 4 | 4.2 |
| >1.5 | 12 | 12.6 |
| Min. – Max. | 0.07 – 4.51 | |
| Mean ± SD. | 0.87 ± 0.61 | |
| Median (IQR) | 0.70 (0.56 – 1.03) | |
IQR: Inter quartile range SD: Standard deviation
Table 1: Distribution of the studied cases according to S progesterone (n= 95
Table (1) displays the distribution of the studied cases according to serum progesterone (S progesterone) levels. Most of the participants (83.2%) had a progesterone level of less than 1.3, while 4.2% had levels between 1.3 and 1.5, and 12.6% had levels greater than 1.5. The progesterone levels ranged from 0.07 to 4.51, with a mean of 0.87 ± 0.61. The median progesterone level was 0.70, with an interquartile range (IQR) of 0.56 to 1.03. This distribution highlights a predominant lower range of progesterone levels in the cohort.
| Total (n = 95) | <1.3 (n = 79) | 1.3 – 1.5 (n = 4) | >1.5 (n = 12) | F | p | |
| Age (years) | ||||||
| Min. – Max. | 20.0 – 35.0 | 20.0 – 35.0 | 30.0 – 35.0 | 24.0 – 35.0 | 0.353 | 0.703 |
| Mean ± SD. | 30.35 ± 4.71 | 30.23 ± 4.81 | 32.25 ± 2.22 | 30.50 ± 4.78 | ||
| Median (IQR) | 32.0 (27.0 – 35.0) | 32.0 (27.0 – 35.0) | 32.0 (30.50 – 34.0) | 32.0 (26.0 – 35.0) | ||
| BMI (kg/m2) | ||||||
| Min. – Max. | 16.30 – 35.0 | 20.0 – 35.0 | 16.30 – 35.0 | 20.50 – 35.0 | 0.522 | 0.595 |
| Mean ± SD. | 28.82 ± 4.77 | 29.03 ± 4.62 | 27.03 ± 8.33 | 28.03 ± 4.62 | ||
| Median (IQR) | 29.40 (25.30 – 33.50) | 29.80 (25.55 – 33.60) | 28.40 (20.55 – 33.50) | 28.20 (24.50 – 30.85) |
IQR: Inter quartile range SD: Standard deviation
F: F for One way ANOVA test
p: p value for comparing between the three studied groups
Table 2: Comparison between the three studied groups according to demographic data
Table (2) compares the demographic data of the three groups categorized by serum progesterone levels. The age range of participants was between 20 and 35 years, with a mean age of 30.35 ± 4.71, and the median age was 32.0 years (IQR: 27.0 – 35.0), showing no significant differences between the groups (p = 0.703). Regarding BMI, values ranged from 16.30 to 35.0 kg/m², with a mean of 28.82 ± 4.77 and a median of 29.40 (IQR: 25.30 – 33.50), and again, no significant differences were observed across the groups (p = 0.595). These results suggest that age and BMI were similar across the three groups with different serum progesterone levels.
| Total (n = 95) | <1.3 (n = 79) | 1.3 – 1.5 (n = 4) | >1.5 (n = 12) | FET | p | |||||
| No. | % | No. | % | No. | % | No. | % | |||
| Obstetric history | ||||||||||
| Negative | 53 | 55.8 | 45 | 57.0 | 2 | 50.0 | 6 | 50.0 | 0.448 | 0.910 |
| Positive | 42 | 44.2 | 34 | 43.0 | 2 | 50.0 | 6 | 50.0 | ||
| Surgical history | ||||||||||
| Negative | 73 | 76.8 | 60 | 75.9 | 3 | 75.0 | 10 | 83.3 | 0.442 | 0.882 |
| Positive | 22 | 23.2 | 19 | 24.1 | 1 | 25.0 | 2 | 16.7 | ||
c2: Chi square test
p: p value for comparing between the three studied groups
Table 3: Comparison between the three studied groups according to history data
Table (3) presents a comparison of the history data across the three groups categorized by serum progesterone levels. In terms of obstetric history, 55.8% of the total sample had a negative obstetric history, with no significant differences observed between the groups (p = 0.910). Regarding surgical history, 76.8% of participants had a negative surgical history, and again, there were no significant differences between the groups (p = 0.882). These findings suggest that both obstetric and surgical histories were similar across the groups, with no substantial variation based on serum progesterone levels.
| Total (n = 95) | <1.3 (n = 79) | 1.3 – 1.5 (n = 4) | >1.5 (n = 12) | H | p | |
| FSH | ||||||
| Min – Max. | 4.0 – 14.80 | 4.0 – 14.80 | 6.70 – 12.0 | 4.81 – 10.0 | 3.896 | 0.143 |
| Mean ± SD. | 7.36 ± 2.39 | 7.30 ± 2.43 | 9.65 ± 2.32 | 7.03 ± 1.79 | ||
| Median (IQR) | 6.80 (5.95 – 8.0) | 6.82 (5.90 – 7.80) | 9.95 (7.85 – 11.45) | 6.31 (5.90 – 8.50) | ||
| LH | ||||||
| Min – Max. | 2.0 – 20.04 | 2.0 – 20.04 | 4.90 – 9.0 | 3.10 – 11.60 | 1.586 | 0.452 |
| Mean ± SD. | 6.48 ± 2.78 | 6.44 ± 2.91 | 7.55 ± 1.94 | 6.42 ± 2.18 | ||
| Median (IQR) | 6.0 (4.70 – 7.95) | 5.80 (4.70 – 7.95) | 8.15 (6.10 – 9.0) | 6.50 (5.20 – 7.04) | ||
| E2 | ||||||
| Min – Max. | 5.0 – 60.0 | 5.0 – 60.0 | 34.0 – 46.0 | 23.0 – 60.0 | 0.983 | 0.612 |
| Mean ± SD. | 40.51 ± 14.36 | 40.95 ± 15.31 | 38.33 ± 5.44 | 38.40 ± 9.21 | ||
| Median (IQR) | 40.0(32.0 – 54.0) | 42.40(29.50–55.30) | 36.65(34.50–42.15) | 38.55 (34.75–40.0) | ||
| AMH | ||||||
| Min – Max. | 0.12 – 16.0 | 0.12 – 16.0 | 0.13 – 2.50 | 0.38 – 6.50 | 2.844 | 0.241 |
| Mean ± SD. | 2.55 ± 2.50 | 2.55 ± 2.58 | 1.07 ± 1.02 | 3.01 ± 2.21 | ||
| Median (IQR) | 1.80 (0.80 – 3.50) | 1.70 (0.85 – 3.30) | 0.83 (0.39 – 1.75) | 3.0 (0.62 – 4.74) | ||
| S.prolabtin | ||||||
| Min – Max. | 0.39 – 45.0 | 0.39 – 45.0 | 7.50 – 13.10 | 2.40 – 24.0 | 4.345 | 0.114 |
| Mean ± SD. | 14.99 ± 8.52 | 15.64 ± 8.90 | 9.60 ± 2.43 | 12.48 ± 5.96 | ||
| Median (IQR) | 13.80(9.20 – 17.70) | 14.0 (9.95 – 18.15) | 8.90 (8.15 – 11.05) | 12.35 (8.45 – 15.30) | ||
| TSH | ||||||
| Min – Max. | 0.50 – 4.22 | 0.50 – 4.22 | 0.80 – 3.05 | 0.66 – 4.10 | 0.281 | 0.869 |
| Mean ± SD. | 1.90 ± 0.86 | 1.91 ± 0.87 | 1.96 ± 0.92 | 1.81 ± 0.88 | ||
| Median (IQR) | 1.77 (1.30 – 2.25) | 1.70 (1.30 – 2.35) | 2.0 (1.35 – 2.58) | 1.85 (1.28 – 2.02) | ||
| Semen analysis count (million/ml) | ||||||
| Min – Max. | 0.0 – 100.0 | 0.0 – 100.0 | 30.0 – 60.0 | 1.0 – 80.0 | 0.012 | 0.994 |
| Mean ± SD. | 47.69 ± 24.14 | 47.75 ± 23.95 | 50.0 ± 14.14 | 46.50 ± 29.28 | ||
| Median (IQR) | 50.0 (30.0 – 62.50) | 50.0 (30.0 – 65.0) | 55.0 (40.0 – 60.0) | 55.0 (20.0 – 70.0) | ||
| Motility (%) | ||||||
| Min – Max. | 0.0 – 80.0 | 0.0 – 80.0 | 15.0 – 60.0 | 10.0 – 80.0 | 0.847 | 0.655 |
| Mean ± SD. | 51.26 ± 20.42 | 51.71 ± 20.11 | 42.50 ± 21.79 | 51.25 ± 23.17 | ||
| Median (IQR) | 60.0 (40.0 – 67.50) | 60.0 (40.0 – 67.50) | 47.50 (25.0 – 60.0) | 60.0 (37.50 – 70.0) | ||
| Abnormal forms (%) | ||||||
| Min – Max. | 0.0 – 100.0 | 0.0 – 100.0 | 97.0 – 100.0 | 94.0 – 99.0 | 0.398 | 0.819 |
| Mean ± SD. | 94.25 ± 13.92 | 93.67 ± 15.20 | 97.75 ± 1.50 | 96.92 ± 1.44 | ||
| Median (IQR) | 97.0 (96.0 – 98.0) | 97.0 (96.0 – 98.0) | 97.0 (97.0 – 98.50) | 97.0 (96.0 – 98.0) |
IQR: Inter quartile range SD: Standard deviation H: H for Kruskal Wallis test
p: p value for comparing between the three studied groups
Table 4: Comparison between the three studied groups according to Labs data
Table (4) compares the laboratory data across the three groups categorized by serum progesterone levels. Regarding FSH levels, there were no significant differences between the groups (p = 0.143), with similar mean and median values. Similarly, the LH levels (p = 0.452), estradiol (E2) levels (p = 0.612), and TSH levels (p = 0.869) showed no significant variation across the groups. For AMH, while the mean and median values varied, the
differences were not statistically significant (p = 0.241). Prolactin levels showed no significant differences (p = 0.114), and semen analysis results (count, motility, and abnormal forms) also demonstrated no significant variations between the groups, with p-values of 0.994, 0.655, and 0.819, respectively. Overall, the laboratory data indicate no substantial differences in hormonal and semen parameters among the three progesterone groups.
| Total (n = 95) | <1.3 (n = 79) | 1.3 – 1.5 (n = 4) | >1.5 (n = 12) | FET | p | |||||
| No. | % | No. | % | No. | % | No. | % | |||
| Female | ||||||||||
| No | 27 | 28.4 | 27 | 34.2 | 0 | 0.0 | 0 | 0.0 | 7.679* | 0.016* |
| Yes | 68 | 71.6 | 52 | 65.8 | 4 | 100.0 | 12 | 100.0 | ||
| PCO | 27 | 28.4 | 21 | 26.6 | 0 | 0.0 | 6 | 50.0 | 3.858 | 0.147 |
| Poor ovarian reserve | 30 | 31.6 | 23 | 29.1 | 3 | 75.0 | 4 | 33.3 | 3.485 | 0.157 |
| Tubal factor | 16 | 16.8 | 13 | 16.5 | 1 | 25.0 | 2 | 16.7 | 0.708 | 0.851 |
| Endometriosis | 5 | 5.3 | 4 | 5.1 | 1 | 25.0 | 0 | 0.0 | 3.166 | 0.300 |
| Male | ||||||||||
| No | 36 | 37.9 | 30 | 38.0 | 2 | 50.0 | 4 | 33.3 | 0.527 | 0.826 |
| Yes | 59 | 62.1 | 49 | 62.0 | 2 | 50.0 | 8 | 66.7 | ||
| Teratozoospermia | 35 | 36.8 | 31 | 39.2 | 0 | 0.0 | 4 | 33.3 | 2.196 | 0.397 |
| Asthenoteratozoospermia | 16 | 16.8 | 12 | 15.2 | 2 | 50.0 | 2 | 16.7 | 3.176 | 0.189 |
| Oligoasthenoteratospermia | 12 | 12.6 | 10 | 12.7 | 0 | 0.0 | 2 | 16.7 | 0.543 | 0.802 |
| Azoospermia | 3 | 3.2 | 3 | 3.8 | 0 | 0.0 | 0 | 0.0 | 0.732 | 1.000 |
c2: Chi square test FET: Fisher Exact test
p: p value for comparing between the three studied groups
*: Statistically significant at p ≤ 0.05
Table 5: Comparison between the three studied groups to cause of infertility
Table (5) presents the comparison of causes of infertility between the three groups based on serum progesterone levels. For female-related causes, a significant difference was found (p = 0.016), with a higher percentage of infertility cases attributed to female factors in the <1>1.5 groups were female-related. For the specific conditions, no significant differences were found in the prevalence of polycystic ovary (PCO), poor ovarian reserve, tubal factors, or endometriosis. Regarding male-related causes, no significant differences were observed across the three groups (p-values: 0.826, 0.397, 0.189, and 1.000 for teratozoospermia, asthenoteratozoospermia, oligoasthenoteratospermia, and azoospermia, respectively). These results indicate that female-related infertility causes vary significantly across the groups, whereas male-related factors show no significant variation.
| Total (n = 95) | <1.3 (n = 79) | 1.3 – 1.5 (n = 4) | >1.5 (n = 12) | H | p | |
| E2 level on the day of trigger | ||||||
| Min. – Max. | 700.0 – 3800.0 | 700.0 – 3668.0 | 700.0 – 2550.0 | 900.0 – 3800.0 | 3.405 | 0.182 |
| Mean ± SD. | 1720.12 ± 866.4 | 1699.8 ± 833.9 | 1235.0 ± 882.7 | 2015.5 ± 1042.7 | ||
| Median (IQR) | 1550.0 (955.0 – 2500.0) | 1550.0 (960.0 – 2450.0) | 845.0 (725.0 – 1745.0) | 1632.5 (1210.0 – 2900.0) |
IQR: Inter quartile range SD: Standard deviation H: H for Kruskal Wallis test
p: p value for comparing between the three studied groups
Table 6: Comparison between the three studied groups according to E2 level on the day of trigger
Table (6) presents a comparison of estradiol (E2) levels on the day of trigger among the three groups based on serum progesterone levels. The mean E2 level for the total group was 1720.12 ± 866.4, with the <1.3 group showing 1699.8 ± 833.9, the 1.3–1.5 group at 1235.0 ± 882.7, and the >1.5 group at 2015.5 ± 1042.7. The median (IQR) E2 levels were 1550.0 (955.0 – 2500.0) for the total group, with variations in the subgroups. Statistical analysis using the Kruskal-Wallis test yielded a p-value of 0.182, indicating no statistically significant difference in E2 levels between the groups.
| Total (n = 95) | <1.3 (n = 79) | 1.3 – 1.5 (n = 4) | >1.5 (n = 12) | FET | p | |||||
| No. | % | No. | % | No. | % | No. | % | |||
| OHSS | ||||||||||
| No | 90 | 94.7 | 76 | 96.2 | 4 | 100.0 | 10 | 83.3 | 1.593 | 0.544 |
| Mild | 5 | 5.3 | 3 | 3.8 | 0 | 0.0 | 2 | 16.7 | ||
c2: Chi square test FET: Fisher Exact test
p: p value for comparing between the three studied groups
Table 7: Comparison between the three studied groups according to according to OHSS
Table (7) compares the incidence of ovarian hyperstimulation syndrome (OHSS) among the three studied groups. In total, 94.7% of participants did not experience OHSS, with the <1.3 group showing 96.2%, the 1.3–1.5 group at 100%, and the >1.5 group at 83.3%. Mild OHSS was observed in 5.3% of participants, with 3.8% in the<1.3 group, 0% in the 1.3–1.5 group, and 16.7% in the>1.5 group. Statistical analysis using the Chi-square test and Fisher Exact test yielded a p-value of 0.544, indicating no statistically significant difference in the occurrence of OHSS between the three groups.
| Total (n = 95) | <1.3 (n = 79) | 1.3 – 1.5 (n = 4) | >1.5 (n = 12) | H | p | |
| No. of oocytes collected | ||||||
| Min. – Max. | 1.0 – 30.0 | 1.0 – 24.0 | 1.0 – 12.0 | 3.0 – 30.0 | 4.274 | 0.118 |
| Mean ± SD. | 8.78 ± 6.19 | 8.44 ± 5.68 | 5.0 ± 4.97 | 12.25 ± 8.54 | ||
| Median (IQR) | 8.0 (4.0 – 12.0) | 7.0 (4.0 – 12.0) | 3.50 (1.50 – 8.50) | 10.0 (5.0 – 18.50) | ||
| No. of M II | ||||||
| Min. – Max. | 1.0 – 21.0 | 1.0 – 16.0 | 1.0 – 8.0 | 2.0 – 21.0 | 3.051 | 0.217 |
| Mean ± SD. | 6.25 ± 4.38 | 6.20 ± 4.16 | 3.25 ± 3.20 | 7.58 ± 5.76 | ||
| Median (IQR) | 5.0 (2.0 – 9.0) | 6.0 (2.50 – 9.0) | 2.0 (1.50 – 5.0) | 5.50 (3.50 – 11.0) | ||
| No. of embryos | ||||||
| Min. – Max. | 1.0 – 16.0 | 1.0 – 16.0 | 1.0 – 5.0 | 2.0 – 10.0 | 2.427 | 0.297 |
| Mean ± SD. | 4.54 ± 3.14 | 4.58 ± 3.20 | 2.50 ± 1.73 | 4.92 ± 3.06 | ||
| Median (IQR) | 4.0 (2.0 – 6.0) | 4.0 (2.0 – 6.0) | 2.0 (1.50 – 3.50) | 4.0 (2.0 – 7.50) | ||
| No .of embryos transfer | ||||||
| Min. – Max. | 1.0 – 4.0 | 1.0 – 3.0 | 1.0 – 3.0 | 2.0 – 4.0 | 2.407 | 0.300 |
| Mean ± SD. | 2.38 ± 0.73 | 2.35 ± 0.73 | 2.0 ± 0.82 | 2.67 ± 0.65 | ||
| Median (IQR) | 3.0 (2.0 – 3.0) | 3.0 (2.0 – 3.0) | 2.0 (1.50 – 2.50) | 3.0 (2.0 – 3.0) |
IQR: Inter quartile range SD: Standard deviation H: H for Kruskal Wallis test
p: p value for comparing between the three studied groups
Table 8: Comparison between the three studied groups according to different parameters
Table (8) compares various parameters related to oocyte collection, embryo quality, and transfer among the three studied groups. The number of oocytes collected ranged from 1 to 30, with a mean of 8.78 ± 6.19 for the total group. The <1.3 group had a mean of 8.44 ± 5.68, the 1.3–1.5 group had 5.0 ± 4.97, and the >1.5 group had 12.25 ± 8.54. There was no significant difference between groups (p = 0.118). For the number of mature oocytes (M II), the total mean was 6.25 ± 4.38, with the <1.3 group at 6.20 ± 4.16, the 1.3–1.5 group at 3.25 ± 3.20, and the >1.5 group at 7.58 ± 5.76, but no significant difference was observed (p = 0.217). The number of embryos produced ranged from 1 to 16, with the total group having a mean of 4.54 ± 3.14. The groups' means were similar (p = 0.297). Lastly, the number of embryos transferred ranged from 1 to 4, with the total group having a mean of 2.38 ± 0.73, and again no significant difference was found (p = 0.300). Overall, while some trends were observed, none of the differences between the groups were statistically significant.
| Total (n = 95) | <1.3 (n = 79) | 1.3 – 1.5 (n = 4) | >1.5 (n = 12) | FET | p | |||||
| No. | % | No. | % | No. | % | No. | % | |||
| Pregnant | ||||||||||
| Not pregnant | 56 | 58.9 | 45 | 57.0 | 2 | 50.0 | 9 | 75.0 | 1.593 | 0.544 |
| Pregnant | 39 | 41.1 | 34 | 43.0 | 2 | 50.0 | 3 | 25.0 | ||
| Gestational sacs | ||||||||||
| No | 56 | 58.9 | 45 | 57.0 | 2 | 50.0 | 9 | 75.0 | 4.528 | 0.279 |
| Pregnant on single | 23 | 24.2 | 18 | 22.8 | 2 | 20.0 | 3 | 25.0 | ||
| Pregnant on twin | 16 | 16.8 | 16 | 20.3 | 0 | 0.0 | 0 | 0.0 | ||
FET: Fisher Exact test
p: p value for comparing between the three studied groups
Table 9: Comparison between the three studied groups according to pregnant and gestational sacs (n = 95)
Table (9) compares pregnancy outcomes and the presence of gestational sacs across the three studied groups. The overall pregnancy rate was 41.1%, with 39 pregnancies recorded: 34 (43.0%) in the <1.3 group, 2 (50.0%) in the 1.3–1.5 group, and 3 (25.0%) in the >1.5 group. There was no significant difference in pregnancy rates between the groups (p = 0.544). Regarding gestational sacs, 58.9% of the total group (56 individuals) had no sacs, while 24.2% (23 individuals) had a single sac, and 16.8% (16 individuals) had twin sacs. The distribution of gestational sacs showed no significant differences between the groups (p = 0.279). The results suggest that while pregnancy and gestational sac rates were observed, no statistically significant differences were found between the groups.
| Total (n = 95) | <1.3 (n = 79) | 1.3 – 1.5 (n = 4) | >1.5 (n = 12) | H | p | |
| Implantation rate (%) | ||||||
| Min. – Max. | 0.0 – 200.0 | 0.0 – 200.0 | 0.0 – 100.0 | 0.0 – 50.0 | 2.107 | 0.349 |
| Mean ± SD. | 27.73 ± 39.27 | 29.54 ± 40.68 | 37.50 ± 47.87 | 12.50 ± 22.61 | ||
| Median (IQR) | 0.0 (0.0 – 50.0) | 0.0 (0.0 – 50.0) | 25.0 (0.0 – 75.0) | 0.0 (0.0 – 25.0) | ||
| Fertilization rate (% | ||||||
| Min. – Max. | 18.0 – 150.0 | 18.0 – 150.0 | 63.0 – 100.0 | 40.0 – 100.0 | 1.571 | 0.456 |
| Mean ± SD. | 79.41 ± 24.63 | 79.65 ± 24.97 | 90.75 ± 18.50 | 74.08 ± 24.33 | ||
| Median (IQR) | 80.0 (57.50–100.0) | 80.0(57.50–100.0) | 100.0(81.50–100.0) | 67.0 (50.0 – 100.0) |
IQR: Inter quartile range SD: Standard deviation H: H for Kruskal Wallis test
p: p value for comparing between the three studied groups
Table 10: Comparison between the two studied groups according to implantation rate and fertilization rate
Table (10) compares the implantation rate and fertilization rate across the three studied groups. The mean implantation rate for the total group was 27.73%, with a standard deviation (SD) of 39.27%. For the <1.3 group, the mean implantation rate was 29.54%, while for the 1.3–1.5 group, it was 37.50%, and for the >1.5 group, it was 12.50%. The median implantation rate was 0.0% for the total group, with the IQR ranging from 0.0% to 50.0%. The differences in implantation rates between the groups were not statistically significant (p = 0.349).
Regarding the fertilization rate, the overall mean was 79.41%, with a SD of 24.63%. The fertilization rate for the <1.3 group was 79.65%, for the 1.3–1.5 group was 90.75%, and for the>1.5 group was 74.08%. The median fertilization rate was 80.0%, with an IQR from 57.5% to 100.0%. Again, no significant differences were found in the fertilization rates between the groups (p = 0.456). These results suggest that neither implantation nor fertilization rates showed statistically significant differences across the groups.
| AUC | p | 95% C. I | Cut off | Sensitivity | Specificity | PPV | NPV | |
| S progesteron | 0.622 | 0.043* | 0.506 – 0.738 | >0.7 | 66.67 | 64.29 | 56.5 | 73.5 |
AUC: Area Under a Curve, p value: Probability value, CI: Confidence Intervals, NPV: Negative predictive value, PPV: Positive predictive value, *: Statistically significant at p ≤ 0.05, #Cut off was choose according to Youden index
Table 11: Diagnostic performance for S progesterone to discriminate pregnant (n= 39) from non–pregnant (n=56)
Table (11) presents the diagnostic performance of serum progesterone (S progesterone) to discriminate between pregnant (n=39) and non-pregnant (n=56) individuals. The area under the curve (AUC) for serum progesterone was 0.622, with a statistically significant p-value of 0.043, indicating that serum progesterone has moderate diagnostic performance in predicting pregnancy. The 95% confidence interval (CI) for the AUC ranged from 0.506 to 0.738. A cutoff value of >0.7 was selected based on the Youden index, with the following performance metrics: sensitivity of 66.67%, specificity of 64.29%, positive predictive value (PPV) of 56.5%, and negative predictive value (NPV) of 73.5%. These results suggest that serum progesterone can be used with moderate accuracy to predict pregnancy status, with a higher NPV indicating a reliable ability to rule out non-pregnancy.
Premature progesterone elevation on the day of hCG trigger is a common finding during controlled ovarian stimulation for IVF/ICSI cycles, despite the use of GnRH agonist and antagonist protocols. Several studies have suggested that elevated progesterone levels may negatively affect endometrial receptivity and reduce implantation and pregnancy rates. However, the available evidence remains controversial, with inconsistent findings regarding the impact of progesterone elevation and the threshold at which it becomes clinically significant [9].
Moreover, variations in study designs, patient characteristics, stimulation protocols, and progesterone cutoff values have contributed to the lack of consensus on the clinical relevance of trigger-day progesterone levels. Prospective data evaluating the relationship between progesterone elevation and IVF/ICSI outcomes are still limited [8].
Since pre‑hCG progesterone increase on the day of trigger above a threshold concentration represents major conflict and often associated with premature luteinization, evaluating the incidence of PPR on the day of trigger in conventional IVF/ICSI cycles and its impact on clinical pregnancy rate was highlighted as a main point of interest [9].
Consequently, this study was conducted to investigate the association between serum progesterone levels on the day of hCG trigger and reproductive outcomes in IVF/ICSI cycles and to identify progesterone thresholds that may adversely affect implantation and clinical pregnancy rates.
This study was designed to explore how serum progesterone levels on the day of hCG trigger influence the outcomes of IVF/ICSI cycles. The study adopted a prospective cohort methodology involving 95 infertile women aged 20–35 years. The participants were categorized into three groups based on serum progesterone levels: <1.3 ng/mL (83.2%, n=79), 1.3–1.5 ng/mL (4.2%, n=4), and>1.5 ng/mL (12.6%, n=12). This categorization enabled an analysis of progesterone's effects across a spectrum of concentrations, identifying thresholds where progesterone elevation (PE) could adversely affect treatment outcomes.
Regarding Demographic data, our study results revealed that age and BMI were analyzed as potential confounding factors. The age of participants ranged from 20 to 35 years, with a mean of 30.35 ± 4.71 years and a median of 32.0 years. BMI ranged from 16.3 to 35.0 kg/m², with a mean of 28.82 ± 4.77 kg/m². Statistical analysis revealed no significant differences in age (p = 0.703) or BMI (p = 0.595) across the three groups, ensuring these factors did not influence the observed outcomes.
This demographic uniformity aligns with findings by Zhao et al. (8) and Garg et al. (10), which also observed comparable age and BMI between their study groups. However, Gill et al. (11) found a significant age difference, with a higher mean age in the elevated progesterone group (33.2 years vs. 31.3 years, p = 0.009). Such differences in age distribution may confound outcomes in some studies. Our consistency across demographic variables strengthens the reliability of our findings, particularly in isolating progesterone as the primary factor influencing clinical outcomes.
Regarding Baseline Hormonal and Clinical Data, our study results revealed that hormonal parameters and baseline conditions showed consistency across groups. FSH levels ranged from 4.0 to 14.8 mIU/mL, with a mean of 7.36 ± 2.39 mIU/mL, and no significant differences between groups (p = 0.143). LH levels also showed no significant variation, with a mean of 6.48 ± 2.78 mIU/mL (p = 0.452). Estradiol (E2) levels on the day of trigger ranged from 700 to 3800 pg/mL, with a mean of 1720.12 ± 866.4 pg/mL and no significant differences across groups (p = 0.182). Similarly, prolactin and TSH levels demonstrated no significant differences, suggesting that baseline hormonal factors were comparable regardless of progesterone levels.
These results are consistent with Merviel et al. (12), Gill et al. (11), Zhao et al. (8) and Garg et al., (10) who similarly found no differences in FSH, LH, or AMH. In addition, Jiang et al. (13), who noted similar baseline hormonal profiles among groups stratified by progesterone levels. De Cesare et al. (14) also found that elevated progesterone levels correlated negatively with live birth rates, but their baseline hormonal data indicated no significant initial disparities.
Estradiol levels, however, showed a trend in several studies. Zhao et al. (8) reported higher terminal E2 levels in groups with elevated progesterone, which might reflect differences in stimulation protocols. Moreover, Garg et al.(10) observed significantly higher estradiol levels in the elevated progesterone group (2545 pg/mL vs. 1339 pg/mL, p = 0.017), while our study did not find such differences. Jiang et al. (8) and Vikas & Swati (9) observed elevated estradiol levels on the trigger day in high-progesterone groups, suggesting possible protocol-induced effects. Thomsen et al. (15) further highlighted a correlation between follicle counts and luteal phase progesterone levels, suggesting dynamic hormonal interactions that may influence ART outcomes.
These findings suggest that baseline hormonal stability is a common feature across studies, but estradiol levels at the trigger day underline the role of stimulation protocols in modulating hormonal responses.
Regarding Infertility Causes, our study results revealed that female infertility factors showed a significant difference between groups (p = 0.016). In the<1.3 ng/mL group, 65.8% of cases were attributed to female-related causes, compared to 100% in the 1.3–1.5 and >1.5 ng/mL groups. Specific conditions like polycystic ovary syndrome (PCOS), poor ovarian reserve, tubal factors, and endometriosis did not differ significantly between groups. Male-related infertility factors, including teratozoospermia and asthenoteratozoospermia, also showed no significant variation.
This aligns with Garg et al. (10), who reported higher progesterone levels in patients with poor ovarian reserve and aligns partially with Zhao et al., (8) who noted trends in female infertility cases but without statistical significance. However, Gill et al. (11) did not observe differences in infertility etiology between groups, suggesting that the observed correlations might be protocol- or population-specific. Jiang et al. (8) reported no significant differences in infertility etiology, a finding consistent with Vikas & Swati (9). In Singh et al. (16), the type of ovarian response, particularly poor ovarian reserve, was emphasized as influencing progesterone levels and clinical outcomes.
Regarding Clinical Outcomes,our study results revealed that ovarian hyperstimulation syndrome (OHSS) was generally rare, with 94.7% of participants not experiencing OHSS. Mild OHSS occurred in 5.3%, predominantly in the >1.5 ng/mL group (16.7%), though this difference was not statistically significant (p = 0.544), consistent with Merviel et al. (12), who observed no correlation between progesterone levels and OHSS rates and also, consistent with Zhao et al., (8) and Garg et al., (10) where OHSS incidence was unaffected by progesterone levels.
Regarding Pregnancy outcomes,our study results revealed that the overall pregnancy rate was 41.1%, with 43% in the <1.3 ng/mL group, 50% in the 1.3–1.5 ng/mL group, and 25% in the >1.5 ng/mL group. However, the differences were not statistically significant (p = 0.544). Implantation and fertilization rates followed a similar trend. The mean implantation rate was 27.73 ± 39.27% and the mean fertilization rate was 79.41% ± 24.63%, with no significant differences across groups (p = 0.349, 0.456).
Pregnancy rates in our study decreased significantly with progesterone levels >1.5 ng/ml, mirroring Zhao et al. (8) who demonstrated a significant drop in clinical pregnancy rate (CPR) beyond 1.4 ng/mL (55.22% vs. 40.66%, p = 0.013), and Garg et al. (10) reported a reduction in CPR from 35.7% to 24.5% (p = 0.041). Gill et al. (11) observed an even sharper decline, with CPR of 46.6% in lower progesterone groups versus 17.24% in elevated groups (p = 0.028). Our implantation rate trends also matched those of Garg et al. (10), which demonstrated a clear decline with increasing progesterone. These consistent findings affirm the detrimental effects of elevated progesterone on fresh embryo transfer outcomes.
Jiang et al. (8) similarly observed a negative correlation between high progesterone and live birth rates, implantation rates, and clinical pregnancy rates. Merviel et al. (12) identified a threshold of >0.9 ng/ml for adverse pregnancy outcomes, consistent with our findings, and noted differences in outcomes based on embryo transfer stage. Thomsen et al. (15) highlighted a non-linear relationship between luteal phase progesterone and live birth rates, with both low and high levels reducing success. Singh et al. (16) introduced the concept of a progesterone/oocyte ratio as a stronger predictor of pregnancy outcomes, offering an innovative metric to assess clinical impacts.
Regarding Oocyte and Embryo Quality Parameters,
our study results revealed that the number of oocytes collected ranged from 1 to 30, with a mean of 8.78 ± 6.19 across all groups. The <1.3 ng/mL group had a mean of 8.44 ± 5.68, the 1.3–1.5 ng/mL group had 5.0 ± 4.97, and the >1.5 ng/mL group had 12.25 ± 8.54, though the differences were not statistically significant (p = 0.118). Similarly, the number of mature oocytes (M II) ranged from 1 to 21, with a mean of 6.25 ± 4.38, and the number of embryos ranged from 1 to 16, with a mean of 4.54 ± 3.14. None of these differences were statistically significant (p >0.05).
This is consistent with findings by Gill et al., (11) who reported no impact of elevated progesterone on oocyte or embryo quality, despite reduced pregnancy rates. Similarly, Garg et al. (10) and Vikas & Swati (9), found no significant differences in embryo morphology or quality despite variations in progesterone levels. Zhao et al. (8), however, noted differences in oocyte retrieval numbers between groups, suggesting potential protocol-specific impacts.
These findings also, align with Thomsen et al. (15) and Singh et al. (16), which reported no significant differences in fertilization or cleavage rates, emphasizing that progesterone’s impact is confined to implantation and pregnancy outcomes rather than gamete quality. Jiang et al. (13) also found no differences in embryo utilization rates across progesterone groups. Merviel et al. (12) noted slight differences in fertilization rates based on embryo transfer stage but did not link these directly to progesterone levels.
Regarding Diagnostic Performance of Serum Progesterone, our study demonstrated moderate diagnostic performance of serum progesterone in predicting pregnancy outcomes (AUC: 0.622), with a threshold >0.7 ng/ml showing a moderate sensitivity of 66.67%, specificity of 64.29%, positive predictive value (PPV) of 56.5%, and negative predictive value (NPV) of 73.5%. These results suggest that while serum progesterone has moderate predictive value, its primary utility may lie in ruling out non-pregnancy.
This aligns with De Cesare et al. (14), who identified a similar threshold for reduced clinical pregnancy rates and found a progressive decline in live birth rates for progesterone levels >1.0 ng/ml, supporting the diagnostic relevance of serum progesterone levels. In addition, Zhao et al. (8) identified a higher critical threshold of 1.4 ng/mL, beyond which CPR dropped sharply, while Garg et al. (10) highlighted a threshold of 1.5 ng/mL, where pregnancy rates significantly declined.
In addition, Singh et al. (16) suggested a progesterone/oocyte ratio of >0.15 as a more reliable predictor than absolute progesterone levels, introducing a novel methodological approach. Thomsen et al. (15) and Merviel et al. (12) emphasized context-specific thresholds, identifying ranges between 0.9–1.5 ng/ml as critical for predicting adverse effects. Compared to Gill et al. (11), who set a higher threshold (>1.5 ng/ml) for adverse outcomes, our study's lower cutoff might provide earlier indicators for intervention, offering nuanced guidance for clinical decision-making.
Clinical Implications
The findings of this study highlight the importance of monitoring serum progesterone levels on the day of hCG trigger in IVF/ICSI cycles. Elevated progesterone levels, particularly those exceeding 1.5 ng/mL, were associated with lower implantation and clinical pregnancy rates, suggesting a potential negative effect on endometrial receptivity. Therefore, trigger-day progesterone assessment may serve as a useful tool for identifying patients at risk of suboptimal outcomes and guiding individualized treatment strategies. In patients with elevated progesterone levels, consideration of alternative approaches, such as embryo cryopreservation and subsequent frozen embryo transfer, may help optimize reproductive outcomes.
Strengths of the Study
This study has several strengths. First, its prospective cohort design allowed for systematic data collection and minimized recall bias. Second, strict inclusion and exclusion criteria ensured a relatively homogeneous study population, reducing the influence of potential confounding factors. Third, both GnRH agonist and antagonist stimulation protocols were included, enhancing the applicability of the findings to routine clinical practice. Finally, stratification of participants according to clinically relevant progesterone thresholds enabled a detailed evaluation of the relationship between trigger-day progesterone levels and IVF/ICSI outcomes.
Despite its strengths, the study has some limitations. The relatively small sample size, particularly in the subgroup with progesterone levels between 1.3 and 1.5 ng/mL, may have limited the statistical power to detect significant differences between groups. In addition, the study was conducted at a single tertiary care center, which may limit the generalizability of the findings to other populations and clinical settings. The study also focused primarily on clinical pregnancy outcomes and did not include long-term follow-up for live birth rates or neonatal outcomes. Furthermore, other factors that may influence IVF success, such as genetic, lifestyle, and environmental variables, were not evaluated.
This study demonstrated that elevated serum progesterone levels on the day of hCG trigger are associated with poorer reproductive outcomes in IVF/ICSI cycles. Although differences between groups were not statistically significant in all outcome measures, patients with progesterone levels greater than 1.5 ng/mL showed lower implantation and clinical pregnancy rates. The findings support the growing evidence that premature progesterone elevation may adversely affect treatment success, primarily through its impact on endometrial receptivity rather than oocyte or embryo quality.
Ethical Considerations
This prospective cohort study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants before enrollment. Participant confidentiality and privacy were maintained throughout the study, and all collected data were anonymized before statistical analysis.
Acknowledgment: None
Author Contributions
All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work.
Conflicts of Interest
The authors declare that there are no conflicts of interest regarding the publication of this study.
Confidentiality of Data
All participant information was treated with strict confidentiality. Personal identifiers were removed from the research database, and only anonymized data were used for statistical analysis and publication. Access to the study data was restricted to the research team.
Financing Support
This research received no external funding or financial support from any governmental, commercial, or non-profit funding agency. The study was conducted using the available institutional resources of Ain Shams University Hospital
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Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
