Oral, vaginal or intramuscular progesterone in programmed frozen embryo transfer cycles: a pilot randomized controlled trial

Pabuçcu, Emre Göksan; Kovancı, Ertuğ; Israfilova, Guler; Tülek, Fırat; Demirel, Cem; Pabuçcu, Recai

doi:10.1016/j.rbmo.2022.06.027

Cited by 13 publications

(3 citation statements)

References 28 publications

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“…While the commercial gel containing PGT must be administrated twice a day (one dose containing 90 mg progesterone), the newly prepared hydrogels (P1) showed an optimal therapeutic effect, longer residence time, and would release more than 50% PGT in the first 60 min. Bourgain et al demonstrated that luteal endometrial maturation is sustained by administrating 300–600 mg PGT, which indicated that P1 hydrogel could contain approximately double the amount of a single dose of crinone gel [ 35 , 36 , 37 ]. Therefore, the prepared hydrogel showed comparable characteristics with others proposed in the literature and it can be considered that the hydrogel may be loaded to contain a higher or double amount of PGT to deliver the necessary amount of PGT or it can easily plan the exact amount knowing its loading and delivery characteristics.…”

Section: Resultsmentioning

confidence: 99%

Development of Vaginal Carriers Based on Chitosan-Grafted-PNIPAAm for Progesterone Administration

Afloarea

Cheaburu-Yılmaz²,

Vereştiuc

et al. 2022

Gels

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Chitosan-based hydrogels possess numerous advantages, such as biocompatibility and non-toxicity, and it is considered a proper material to be used in biomedical and pharmaceutical applications. Vaginal administration of progesterone represents a viable alternative for maintaining pregnancy and reducing the risk of miscarriage and in supporting the corpus luteum during fertilization cycles. This study aimed to develop new formulations for vaginal administration of progesterone (PGT). A previously synthesized responsive chitosan-grafted-poly (N-isopropylacrylamide) (CS-g-PNIPAAm) was formulated in various compositions with polyvinyl alcohol (PVA) as external crosslinking agent to obtain pH- and temperature-dependent hydrogels; the hydrogels had the capacity to withstand shear forces encountered in the vagina due to its mechanism of swelling once in contact with vaginal fluids. Three different hydrogels based on grafted chitosan were analyzed via Fourier-transform infrared spectroscopy (FTIR), swelling tests, in vitro drug release, and bioadhesion properties by TA.XTplus texture analysis. A higher amount of PVA decreased the swelling and the bioadhesion capacities of the hydrogel. All hydrogels showed sensitivity to temperature and pH in terms of swelling and in vitro delivery characteristics. By loading progesterone, the studied hydrogels seemed to possess even higher sensitivity than drug–free matrices. The release profile of the active substance and the bioadhesion characteristics recommended the CS-g-PNIPAAm/PVA 80/20 +PGT (P1) hydrogel as a proper constituent for the vaginal formulation for progesterone administration.

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Section: Resultsmentioning

confidence: 99%

Development of Vaginal Carriers Based on Chitosan-Grafted-PNIPAAm for Progesterone Administration

Afloarea

Cheaburu-Yılmaz²,

Vereştiuc

et al. 2022

Gels

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“…It seems to be more accepted by patients in terms of ease of use and lower cost [5]. Another pilot randomized controlled trial reported that treatment with 40 mg/d oral dydrogesterone, 180 mg/d progesterone vaginal gel or 100 mg/d intramuscular administration evealed similar reproductive outcomes in HRT-FET cycles [13]. In the above two studies, the daily dosage of dydrogesterone reached 40mg which exceeds the recommended dosage (30mg per day) of the drug prescribed for Chinese women and so was rarely applied in our center.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Oral Dydrogesterone versus Intravaginal Micronized Progesterone Gel in Clinical Outcome within the First HRT-FET Cycle: A Retrospective Analysis

Ye,

Luo,

Huang

et al. 2024

Preprint

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Objective The purpose of this study is to compare the clinical efficacy of oral dydrogesterone and intravaginal micronized progesterone gel during the first HRT-FET cycle. Methods A retrospective cohort study based on a total of 344 women undergoing their first HRT-FET cycles without Gonadotropin-Releasing Hormone agonist (GnRH-a) pretreatment was conducted. All the cycles were allocated to two groups in the reproductive medical center at the University of Hong Kong-Shenzhen Hospital. One group (n = 193) received oral dydrogesterone 30mg/d before embryo transfer, while the other group (n = 151) received intravaginal micronized progesterone gel 180mg/d. Results The demographics and baseline characteristics of two groups were comparable. We found no statistically significant difference in live birth rate (24.35% vs. 31.13%, P = 0.16), clinical pregnancy rate (34.72% vs. 36.42%, P = 0.74), embryo implantation rate (25.09% vs. 28.36%, P = 0.43), positive pregnancy rate (42.49% vs 38.41%, P = 0.45), or ectopic pregnancy rate (0.52% vs. 0.66%, P = 0.86) between the oral dydrogesterone group and micronized vaginal progesterone (MVP) gel group. In the multivariate logistic regression analysis for covariates, medication used for luteal support was not associated with live birth rate (OR = 0.74, 95% CI: 0.46–1.21, P = 0.23). And the different luteal support medication did not have a significant positive association with the live birth rate in the cycles with day 2 embryo transferred (OR = 0.73, 95% CI:0.34–1.54, P = 0.41) and blastocyst transferred (OR = 0.75, 95% CI:0.36–1.57, P = 0.45). Conclusion This study demonstrates that oral dydrogesterone is a viable alternative to intravaginal micronized progesterone gel in luteal phase support (LPS) during the first HRT-FET cycle.

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“…P treatment can be stopped at luteal placental shift (7 weeks gestational age); however, it commonly continues up to week 12 (by 'clinical routine'). From the patient perspective, a side effect free oral preparation is of advantage, and since the outcome is apparently comparable, this is an important point to consider [9].…”

Section: The Artificial ('Programmed') Frozen Embryo Transfer Cyclementioning

confidence: 99%

Ideal frozen embryo transfer regime

Castillo,

Kol

2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review This review aims to compare evidence on four criteria (embryo implantation, obstetric outcomes, patient convenience, and IVF-unit efficiency) by analyzing published research on different endometrial preparation methods for frozen embryo transfer (FET). Recent findings While the artificial-FET cycle provides advantages in scheduling and implantation, it falls short in ensuring optimal obstetric outcomes. In contrast, natural-FET ensures embryo implantation conditions if ovulation is correctly identified. Supplementing with exogenous progesterone shields against low corpus luteum progesterone secretion, crucial for positive obstetric outcomes. In mNC-FET, ovulation is hCG-triggered, closely resembling natural cycles and reducing monitoring visits for enhanced patient convenience. Letrozole is a recommended option for anovulatory patients, preserving endometrial thickness. It is cost-effective, less likely to induce multifollicular development than gonadotropins, and better tolerated. In a novel approach, the natural-proliferative-phase-FET initiates progesterone in an unmediated ovulatory cycle at 7 mm endometrial thickness, combining the benefits of a natural proliferative endometrium with the convenience of scheduled artificial cycles. Summary The artificial cycle offers scheduling advantages, but may compromise obstetric outcomes. Natural FET relies on accurate ovulation timing for successful implantation. mNC-FET simplifies the process using hCG induction, minimizing clinic visits for improved convenience. Letrozole is highlighted as a cost-effective and well tolerated option in anovulatory patients. A recent innovative approach combines elements of natural and artificial cycles, showing promise for FET procedures.

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Oral, vaginal or intramuscular progesterone in programmed frozen embryo transfer cycles: a pilot randomized controlled trial

Cited by 13 publications

References 28 publications

Development of Vaginal Carriers Based on Chitosan-Grafted-PNIPAAm for Progesterone Administration

Development of Vaginal Carriers Based on Chitosan-Grafted-PNIPAAm for Progesterone Administration

Comparison Between Oral Dydrogesterone versus Intravaginal Micronized Progesterone Gel in Clinical Outcome within the First HRT-FET Cycle: A Retrospective Analysis

Ideal frozen embryo transfer regime

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