Progesterone concentrations and dosage with frozen embryo transfers – What's best?

Basnayake, S. K.; Volovsky, Michelle; Rombauts, Luk; Osianlis, Tiki; Vollenhoven, Beverley; Healey, Martin

doi:10.1111/ajo.12757

Cited by 33 publications

(31 citation statements)

References 14 publications

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“…Thus clinicians could optimize intramuscular progesterone supplementation according to the P monitoring. Our findings confirmed previous data that luteal progesterone level outside the range limits reduced clinical pregnancy rate (40)(41)(42). But we further explored newborn birthweight and gestational age in this intramuscular progesterone cohort and revealed that systemic P level higher than 41.82 pmol/L did not increase birthweight or prolong gestational weeks, but it increased the live birth rate.…”

Section: Interpretation Of Datasupporting

confidence: 91%

Progesterone Intramuscularly or Vaginally Administration May Not Change Live Birth Rate or Neonatal Outcomes in Artificial Frozen-Thawed Embryo Transfer Cycles

Liu

2020

Front. Endocrinol.

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BackgroundsPrevious studies suggested that singletons from frozen-thawed embryo transfer (FET) were associated with higher risk of large, post-date babies and adverse obstetrical outcomes compared to fresh transfer and natural pregnancy. No data available revealed whether the adverse perinatal outcomes were associated with aberrantly high progesterone level from different endometrium preparations in HRT-FET cycle. This study aimed to compare the impact of progesterone intramuscularly and vaginally regimens on neonatal outcomes in HRT-FET cycles.MethodsA total of 856 HRT-FET cycles from a fertility center from 2015 to 2018 were retrospectively analyzed. All patients had their first FET with two cleavage-staged embryos transferred. Endometrial preparation was performed with sequential administration of estrogen followed by progesterone intramuscularly 60 mg per day or vaginal gel Crinone 90 mg per day. Pregnancy outcomes including live birth rate, singleton birthweight, large for gestational age (LGA) rate, small for gestational age (SGA) rate, and preterm delivery rate were analyzed. Student’s t test, Mann-Whitney U-test, Chi square analysis, and multivariable logistic regression were used where appropriate. Differences were considered significant if p < 0.05.ResultsNo significant difference of live birth rate was found between different progesterone regimens (Adjusted OR 1.128, 95% CI 0.842, 1.511, p = 0.420). Neonatal outcomes like singleton birthweight (p = 0.744), preterm delivery rate (Adjusted OR 1.920, 95% CI 0.603, 6.11, p = 0.269), SGA (Adjusted OR 0.227, 95% CI 0.027, 1.934, p = 0.175), and LGA rate (Adjusted OR 0.862, 95% CI 0.425, 1.749, p=0.681) were not different between two progesterone regimens. Serum P level >41.82 pmol/L at 14 day post-FET was associated with higher live birth rate than serum P level ≤41.82 pmol/L in HRT-FET cycles when progesterone was intramuscularly delivered (Adjusted OR 1.690, 95% CI 1.002, 2.849, p = 0.049). But singleton birthweight, preterm delivery rate, SGA and LGA rate were not different between these two groups.ConclusionsRelatively higher serum progesterone level induced by intramuscular regimen did not change live birth rate or neonatal outcomes compared to vaginal regimen. Monitoring serum progesterone level and optimizing progesterone dose of intramuscular progesterone as needed in HRT-FET cycles has a role in improving live birth rate without impact on neonatal outcomes.

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Section: Interpretation Of Datasupporting

confidence: 91%

Progesterone Intramuscularly or Vaginally Administration May Not Change Live Birth Rate or Neonatal Outcomes in Artificial Frozen-Thawed Embryo Transfer Cycles

Liu

2020

Front. Endocrinol.

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“…However, which is the best scheme sitll unclear. In fact, the supraphysiological dose of hormones utilised in assisted reproductive technology (ART) procedures especially steroid hormone concentrations in the first trimester (oestradiol (E2), prolactin, progesterone (P)), and patient fertility-related problems may influence pregnancy, obstetric and neonatal outcomes [25][26][27][28]. Therefore, we aimed to determine whether AC-FET increases the risk of adverse pregnancy, obstetric and neonatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

Increased pregnancy complications following frozen-thawed embryo transfer during an artificial cycle

Jing

Zhang

et al. 2019

J Assist Reprod Genet

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Purpose This study aimed to clarify the risks of adverse pregnancy outcomes in patients and their offspring after frozen embryo transfer (FET) during an artificial cycle (AC). Methods We conducted a retrospective cohort study that included all FET cycles and subsequent deliveries in a single centre between August 2013 and March 2016. Pregnancy, obstetric and neonatal outcomes were compared among patients treated during an AC or a natural cycle with luteal phase support (NC-LPS). Multivariate logistic regression was performed to evaluate the relationship between endometrial preparation schemes and pregnancy, obstetric and neonatal outcomes. Results AC-FET was not a significant risk factor for clinical pregnancy rate, multiple birth rate or miscarriage rate after adjusting for potential confounders. However, AC-FET was a significant risk factor for ectopic pregnancy rate (adjusted odds ratio (AOR), 1.738; 95% confidence interval (CI), 1.086-2.781) and live birth rate (AOR, 0.709; 95% CI, 0.626-0.802). Regarding obstetric outcomes, AC-FET was found to be associated with an increased risk for hypertension disorder (

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“…Our findings confirmed previous data that serum higher progesterone level during mid-luteal phase got higher successful rate than the lower P level counterparts in HRT-FET cycles. Luteal progesterone level outside the range limits reduced clinical pregnancy rate [24][25][26]. We further explored newborn birthweight and gestational age in intramuscular progesterone cohort.…”

Section: Discussionmentioning

confidence: 99%

Progesterone regimen impact on live birth rate and neonatal outcomes in artificial frozen-thawed embryo transfer cycles: a retrospective cohort study

Liu¹,

Wu²

2020

Preprint

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Background: Previous studies have demonstrated that singletons from frozen embryo transfer (FET) are heavier and longer-gestational-days at delivery than those from fresh embryo transfer. The amounts and routes of progesterone used in FET vary tremendously among different ART centers.Does different serum progesterone level induced by different progesterone regimens determine live birth rate and neonatal outcomes in hormone replacement therapy frozen-thawed embryo transfer (HRT-FET) cycles?Design: A cohort study of 856 HRT-FET cycles from a Chinese public fertility center. Data from patients undergoing their first FET cycles from 2015-2018 were extracted from the database. All patients had their first FET with two day2 or day3 embryos transferred. Endometrial preparation was performed with sequential administration of estrogen followed by progesterone 60mg per day intramuscularly or Crinone 90mg per day vaginally. Live birth was the primary outcome. Secondary outcome included clinical pregnancy rate, singleton birthweight, large for gestational age (LGA) rate, SGA rate and preterm delivery rate. Student's t test, Mann-Whitney U-test, Chi square analysis and multivariable logistic regression were used where appropriate. Differences were considered significant if p<0.05.Results: No significant difference of live birth rate was found between different progesterone regimens (Adjusted OR 1.128, 95%CI 0.842, 1.511, p=0.420). Neonatal outcomes like birthweight, preterm delivery rate, SGA and LGA rate were not different between two progesterone regimens.Serum P level >41.82 pmol/L at 14 day post-FET was associated with higher live birth rate than serum P level ≤41.82pmolL in HRT-FET cycles when progesterone was intramuscularly delivered (Adjusted OR 1.690, 95%CI 1.002, 2.849, p=0.049). Birthweight and gestational weeks were not different between these two different P level groups. Conclusions: Progesterone vaginally or intramuscularly didn't impact live birth rate and neonatal outcomes in artificial FET cycles. Relatively higher serum progesterone level induced by intramuscular regimen did not increase newborn birthweight or prolong gestational weeks compared to vaginal regimen. Intramuscular progesterone supplementation during HRT-FET cycles was associated with development in cows. Theriogenology 2011, 76:1594-1601. 17. Nogueira MF, Melo DS, Carvalho LM, Fuck EJ, Trinca LA, Barros CM: Do high progesterone concentrations decrease pregnancy rates in embryo recipients synchronized with PGF2alpha and eCG? Theriogenology 2004, 61:1283-1290. 18. Mitwally MF, Diamond MP, Abuzeid M: Vaginal micronized progesterone versus intramuscular progesterone for luteal support in women undergoing in vitro fertilization-embryo transfer. Fertil Steril 2010, 93:554-569. 19. Zarei A, Sohail P, Parsanezhad ME, Alborzi S, Samsami A, Azizi M: Comparison of four protocols for luteal phase support in frozen-thawed Embryo transfer progesterone on the day of embryo transfer is associated with a diminished ongoing pregnancy rate in oocyte donation ...

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Progesterone concentrations and dosage with frozen embryo transfers – What's best?

Abstract: Improved pregnancy outcomes are seen with day 16 serum progesterone concentrations >50 nmol/L. There is a statistically significant correlation between live births, number of progesterone doses per day and day 16 serum progesterone concentrations in this study.

Cited by 33 publications

References 14 publications

Progesterone Intramuscularly or Vaginally Administration May Not Change Live Birth Rate or Neonatal Outcomes in Artificial Frozen-Thawed Embryo Transfer Cycles

Progesterone Intramuscularly or Vaginally Administration May Not Change Live Birth Rate or Neonatal Outcomes in Artificial Frozen-Thawed Embryo Transfer Cycles

Increased pregnancy complications following frozen-thawed embryo transfer during an artificial cycle

Progesterone regimen impact on live birth rate and neonatal outcomes in artificial frozen-thawed embryo transfer cycles: a retrospective cohort study

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