Universal warming protocol” for vitrified human embryos: a retrospective study on combination of 3 different vitrification/warming kits

Abstract

for confounders, logistic and Poisson regression models, adjusted a priori for oocyte age, donor egg, and serum P measurement on day 3, were used to estimate the odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI) of live birth. RESULTS: Mean serum P at transfer on day 5 was 28.4AE10.5 ng/mL. Compared to patients with P>20 ng/mL, patients with P<20 ng/mL on day 3 or 5 had a significantly higher implantation failure rate (negative hCG, 30.8% vs 22.3%, OR 1.54, 95% CI 1.07-2.22), lower CPR (57.9% vs 67.8%, OR 0.66, 95% CI 0.47-0.91) and lower LBR (45.1 vs 58.1%, OR 0.60, 95% CI 0.43-0.83), even after increasing P dose (Table). LBRs were stable from serum P 20 to 60 ng/mL (assay upper limit); there was no upper limit of P above which the LBR declined. Among obese patients (BMI>30 kg/m2, n¼129), P<20 ng/mL was more common than in non-obese patients (n¼672) (52.7% vs 18.9%, OR 4.76, 95% CI 3.2-7.1). Among patients with P>20 ng/mL, the LBR was significantly lower in obese vs. non-obese patients (44.6 vs 57.7%, OR 0.60, 95% CI 0.38-0.96). CONCLUSIONS: Serum P>20 ng/mL was associated with increased CPR and LBR following blastocyst transfer into a prepared uterus. LBRs were not rescued by increasing P doses for serum levels <20 ng/mL. Obese recipients may require higher initial doses of IM P for luteal support. Future research is needed to define the optimal serum P at transfer, and to determine whether this varies according to patient characteristics, such as BMI.