Prolonged luteal phase support with progesterone may increase papules and plaques of pregnancy frequency in pregnancies through in vitro fertilization

Abstract

Background Pruritic urticarial papules and plaques of pregnancy development may have a strong relationship with hormone treatments during in vitro fertilization and hormonal changes during pregnancy. Objectives The aim of this study was to evaluate and compare the frequency of papules and plaques of pregnancy and related factors in in vitro fertilization pregnancies and spontaneous pregnancies. Methods In this study, 517 in vitro fertilization pregnancies and 1253 spontaneous pregnancies were retrospectively reviewed for papules and plaques of pregnancy frequency. The diagnosis of papules and plaques of pregnancy was performed by referral to the dermatology department and according to the typical clinical manifestations of the disease. Results The papules and plaques of pregnancy was more common in all in vitro fertilization pregnancies (including single pregnancies) than in spontaneous pregnancies. Age, Rh positivity, mother weight gain, onset of disease during gestation, duration of disease, birth weight and the frequency of male fetus were similar between the two groups (p > 0.05). The rate of multiple pregnancies was higher in in vitro fertilization pregnancies with papules and plaques of pregnancy than in vitro fertilization pregnancies without papules and plaques of pregnancy (p < 0.001). Duration of progesterone treatment was also significantly longer in in vitro fertilization pregnancies with papules and plaques of pregnancy compared to in vitro fertilization pregnancies without papules and plaques of pregnancy (p < 0.001). Study limitations The limitations of the study were the retrospective and single-centered design. Conclusion The results of this study indicate that increased progesterone dosage or prolonged treatment may play a role in the pathogenesis papules and plaques of pregnancy.

Progesterone Hypersensitivity in Assisted Reproductive Technologies: Implications for Safety and Efficacy

“…The intramuscular injections of synthetic progesterone for three weeks during her initial cycle of in vitro fertilization-embryo transfer were notably associated with photosensitivity localized in a vitiliginous facial lesion in a specific case [79]. Moreover, in a comprehensive case-control study, after a comparative analysis of single pregnancies, it was established that the incidence of pruritic urticarial papules and plaques of pregnancy (PUPPP) was significantly higher in individuals undergoing in vitro fertilization [80]. Notably, among IVF patients with PUPPP, there was a notable increase in both the duration of luteal-phase support with progesterone and the frequency of multiple pregnancies compared with IVF patients without PUPPP (p < 0.001 for both factors) [80].…”

“…Moreover, in a comprehensive case-control study, after a comparative analysis of single pregnancies, it was established that the incidence of pruritic urticarial papules and plaques of pregnancy (PUPPP) was significantly higher in individuals undergoing in vitro fertilization [80]. Notably, among IVF patients with PUPPP, there was a notable increase in both the duration of luteal-phase support with progesterone and the frequency of multiple pregnancies compared with IVF patients without PUPPP (p < 0.001 for both factors) [80]. Furthermore, PUPPP has been previously linked with increased progesterone receptor immunoreactivity and multiple pregnancy-induced high progesterone levels [81,82].…”

Update on specific dermatoses of pregnancy

“…A study of 517 in vitro fertilization (IVF) pregnancies and 1,253 spontaneous pregnancies concluded that PEP was statistically more frequent in pregnancies resulting from IVF than in spontaneous pregnancies. Also, it was suggested that prolonged treatment with progesterone might be related to a higher frequency of PEP 19 .…”

Comparative Analysis of Classical Primary Continuous and Novel Technique Uterine Suturing Methods on Uterine Scar Formation after Caesarian Section: A Prospective Comparative Study

“…Correctly applied suture contributes to accelerating the healing process, thereby reducing scarring in the affected areas and reducing the recovery period and postoperative complications (6). Although new studies have reported possible risks (12), especially related to scar defect of cesarean section, there is no suture method comparison for isthmocele, which is one of the cesarean scar defects (13,14). The surgical method used during the closure of the incision to be made to the uterus increases and decreases the probability of occurrence of complications such as isthmocele, rupture, location, and invasion anomalies (15,16).…”