INDIVIDUALIZED PROGESTERONE TREATMENT PROTOCOLS FOR FROZEN THAWED EMBRYO TRANSFER PREPARATION

Abstract

Objective

Frozen-thawed embryo transfer (FET) is a technique commonly used in assisted reproductive technology (ART) to transfer previously frozen embryos into the uterus. Progesterone usage in luteal support is a critical component of creating an optimal hormonal environment for cycles [1]. It is typically administered in the form of intramuscular injections, vaginal suppositories, or oral medications. The day before ET, the progesterone levels may be more than 10 ng/mL and if it is lower some rescue protocols has been developed [2]. To date, there has been no ideal progesterone replacement therapy for FET and no study to compare to all the forms of progesterone. We hypothesize that in women within FET in IVF, progesterone levels in the day before ET is critical to implantation of the embryo and we analyze which rescue protocol is superior than others.

Material and Method

In this prospective randomized trial, the ethics committee approval was taken from 2022-27 Nigde University. Elective single blastocyst embryo transfer (eSET) strategy has been preferred in 200 patients with the diagnosis of unexplained infertility. After 10 days oral 6 mg/daily estradiol usage, we examined and accepted women with endometrial thickness more than 8 mm and progesterone levels lower than 1.5 ng/mL. Then 600 mg/daily vaginal progesterone was begun to all women. 6 day of progesterone administration, the best blastocyst embryo according to embryo scoring system was chosen to transfer. The day before ET, blood progesterone levels were examined and progesterone levels lower than 10 ng/mL were randomized to 5 group. These groups are Group 1 as a control group was 600 mg/daily vaginal micronized progesterone usage, group 2 800 mg/daily vaginal micronized progesterone usage, group 3 600 mg/daily micronized progesterone plus 50 mg/daily i.m. progesterone usage, group 4 600 mg/daily micronized progesterone plus 25 mg/daily s.c. progesterone usage, group 5 600 mg/daily micronized progesterone plus oral 30 mg/daily dydrogesterone usage, respectively.

Results

All women are under 35 years old and there has been no statistically significant difference between the groups. Also, all clinical characteristics were similar. The highest progesterone levels on the day of biochemical pregnancy day are in group 3 and 4. Although the group 3 and 4 has significantly increased clinical pregnancy rates, the other groups were similar pregnancy rates (Table 1). Early pregnancy loss rates are significantly lower in group 3 and 4. Also live birth rates of group 3 and 4 are higher than other groups.

Discussion and Conclusion

In this study, different progesterone administration methods were firstly compared and displayed the relation between these protocols to pregnancy rates, early pregnancy lost and live birth rates after frozen thawed eSET. Therefore, individualized luteal phase progesterone support and treatment modalities may be preferred to increase pregnancy rates in frozen thawed eSET.