Endogenous progesterone levels could predict reproductive outcome in frozen embryo replacement cycles supplemented with synthetic progestogens: A retrospective cohort study

Abstract

PurposeA retrospective, cohort study was conducted between 2009 and 2017 in a private infertility center to determine the predictive value of endogenous estrogen (E2) and progesterone (P4) levels in hormone‐replacement frozen embryo replacement (FER) treatment cycles.MethodsA total of 120 consecutive, infertile patients who became pregnant after FER cycles were analyzed (age: 37.4 ± 4.4 years). Electively vitrified blastocysts were created during natural cycle IVF or mild ovarian stimulation treatments and subsequently transferred through delayed vitrified‐thawed blastocyst transfer cycles supplemented with estrogens and a combination of synthetic progestogens. Serum E2 and progesterone P4 levels were intensively monitored every five days (from the day after embryo transfer until 9w1d of pregnancy) and compared among patients with a subsequent live birth (n = 76) or first‐trimester pregnancy loss (n = 44).ResultsEndogenous placental activity started as early as 5‐6th pregnancy week differing significantly according to pregnancy outcome. For P4, the exponential rise from 6w2d onwards allowed distinguishing between failing and successful conceptions. For P4, lower quartiles of the live birth group did not intersect with upper quartiles of the miscarriage group.ConclusionsInnovative FER protocols incorporating synthetic progestogens allow the correct measurement of endogenous placental activity and could help to monitor early first‐trimester ART pregnancies.

Serum luteal phase progesterone in women undergoing frozen embryo transfer in assisted conception: a systematic review and meta-analysis

“…We contacted the authors of thirty-two manuscripts to obtain additional study details and data (Supplemental Table 2). To date, we have received responses for ten publications (15,(26)(27)(28)(39)(40)(41)(42)(43)(44).…”

“…Twenty studies have been published as full articles (15, 17, 26-28, 31, 32, 40-45, 47-53) and one as a conference abstract (46). Five of the included studies were conducted in Spain (26-28, 50, 52); three in Japan (32,44,47); two each in Australia (15,51), Denmark (17,45), France (40,41) and Turkey (42,43); and one each in China (53), India (46), Iran (49), Iraq (48) and the USA (31). Eighteen studies focused solely on HRT-FET cycles; two included HRT-FET and fresh donor recipient cycles (26,28); and one study included only NC-FET cycles (52).…”

“…The remaining studies tested progesterone levels later on in the luteal phase: one study two to three days after FET (15); one sixteen days after the onset of progesterone supplementation (51); three studies measured progesterone on the day of pregnancy test (17,45,53); and in one study progesterone was tested on the day of pregnancy test, and then again 46h and 96h later (40). Finally, one study measured serum progesterone every five days from the day after FET until 9w 1d gestation (44).…”

Serum Progesterone Profile Across the Mid and Late Luteal Phase in Artificial Cycles Is Associated With Pregnancy Outcome

“…A preliminary study conducted in oocyte donation recipients under artificial cycles for endometrial preparation suggested that the onset of placental steroidogenesis surrounded the 5th gestational week ( 19 ), while a more recent study found that endogenous placental activity started on 5 th -6 th pregnancy week, differing significantly according to the pregnancy outcome ( 7 ).…”

“…Endogenous production of P during pregnancy might occur around week 6, when the uteroplacental shift occurs ( 7 ). Thus, levels of serum P in the mid-late luteal phase transition in artificial cycles could depend exclusively on the exogenous drug that is given to the patient.…”