In vitro fertilization and psychological stress: new insight about different routes of progesterone administration

Abstract

Infertility treatment is a stressful process and factors like anxiety and preoccupation could affect the success of In Vitro Fertilization (IVF) or other assisted reproductive techniques. Moreover, luteal phase support (LPS) in IVF cycles is recommended. Our aim was to analyze the effects of LPS with intramuscular and subcutaneous progesterone on stress hormones (cortisol and prolactin). We analyzed one hundred-thirty women undergoing their first IVF cycle and then randomized in two groups: group A (65 patients) received 33 mg/day of intramuscular in oil-progesterone from pick-up and 50mg/day from embryo transfer, group B (65 patients), instead, received 25 mg of subcutaneous water soluble-progesterone from pick-up. Cortisol and prolactin serum levels were obtained at day+7 from oocyte retrieval. Our results showed that the values of prolactin and cortisol were statistically significantly higher in group A compared to the group B. Subcutaneous progesterone treatment, in fact, is associated with lower cortisol and prolactin levels, suggesting new therapeutic opportunities in IVF cycles to reduce patients' distress and improve quality of life. SOMMARIOIl trattamento dell'infertilità è un processo stressante e fattori come l'ansia e la preoccupazione potrebbero influenzare il successo della fecondazione in vitro (IVF) o di altre tecniche di riproduzione assistita. Inoltre, il supporto alla fase luteale (LPS) è raccomandato nei cicli di IVF. Il nostro obiettivo è stato quello di analizzare gli effetti sugli ormoni dello stress (cortisolo e prolattina), della LPS con progesterone intramuscolare e sottocutaneo. Abbiamo analizzato centotrenta donne sottoposte al primo ciclo di IVF e le abbiamo randomizzate in due gruppi: il gruppo A (65 pazienti) ha ricevuto 33 mg/die di progesterone intramuscolare dal giorno del pick-up e 50 mg/die dal giorno del trasferimento dell'embrione, il gruppo B (65 pazienti), invece, ha ricevuto 25 mg di progesterone, solubile in acqua, per via sottocutanea dal giorno del pick-up. I livelli sierici di cortisolo e prolattina sono stati valutati dopo sette giorni dal pick-up. I nostri risultati hanno mostrato che i valori di prolattina e cortisolo erano statisticamente più alti nel gruppo A rispetto al gruppo B. Il trattamento sottocutaneo di progesterone, infatti, è associato a livelli più bassi di cortisolo e prolattina, suggerendo nuove opportunità terapeutiche nei cicli di IVF per ridurre lo stress dei pazienti e migliorare la qualità della vita.

Luteal Phase Support Using Subcutaneous Progesterone: A Systematic Review

“…A comparison between the intramuscular and subcutaneous routes was recently carried out by Mele et al in 2020 ( 30 ). In detail, 130 women undergoing a first IVF cycle were randomized to intramuscular Pg (33 mg/day from ovum pick up and 50 mg/day from embryo transfer) and subcutaneous Pg (25 mg/day).…”

“…Subcutaneous administration can be self-administered and is associated with lower injection site reactions, such as pain and irritation, compared with the intramuscular route ( 28 ). In addition, Mele et al reported a significantly reduced level of stress-related hormones, such as Prolactin and Cortisol ( 30 ).…”

“…This effect may be linked to the fact that the appropriate dosage in these populations is mainly unknown. So far, only one study compared intramuscular and subcutaneous Pg with no differences in terms of pregnancy rate between groups, but significantly lower prolactin and cortisol levels in the women who had received the subcutaneous route ( 30 ).…”

Laparoscopic management of a 13 weeks viable ectopic cesarean section Scar pregnancy: a case report

“…Points to be considered when determining a treatment plan include location, size and gestational age of the pregnancy, the hemodynamic stability and desire for future fertility [11]. Moreover, when dealing with fertility desire a careful consideration must be posed for possible psychological distress of the couple [15,16]. The various modalities for the management of CSP include conservative management, medical termination with methotrexate, uterine artery embolization (UAE) and surgical treatment.…”

Prediction of Oocyte Donation Intention using the Theory of Planned behavior among Women in Iran: cross-sectional study

“…There has been a shortage of donors in many countries [9] and the selection of a suitable donor has become a challenge for infertile couples due to the mismatch between supply and demand [10]. Sometimes the demand for donated oocytes exceeds the supply in many countries around the world [9][10][11].…”