Frontiers in Endocrinology (Jun 2024)

Individualized luteal phase support in frozen-thawed embryo transfer after intramuscular progesterone administration might rectify live birth rate

  • Fazilet Kübra Boynukalin,
  • Fazilet Kübra Boynukalin,
  • Yusuf Aytac Tohma,
  • Yusuf Aytac Tohma,
  • Zalihe Yarkıner,
  • Meral Gultomruk,
  • Gürkan Bozdag,
  • Sinan Ozkavukcu,
  • Mustafa Bahçeci,
  • Berfu Demir

DOI
https://doi.org/10.3389/fendo.2024.1412185
Journal volume & issue
Vol. 15

Abstract

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BackgroundThe serum P concentrations are suggested to have an impact on pregnancy outcome. However there is no consensus about the optimal progesterone cut-off during the luteal phase. Few studies evaluated the effectiveness of a “rescue protocol” for low serum P concentrations and most of these studies used vaginal progesterone administration. There is paucity of data on the effectiveness of rescue protocol using intramuscular progesterone (IM-P) in frozen-thawed embryo transfer (FET).MethodsThis study is a retrospective cohort study included 637 single or double blastocyst FETs with artificially prepared endometrium receiving 100 mg IM progesterone (P) after incremental estrogen treatment. Serum P concentrations were evaluated using blood samples obtained 117-119 hours after the first IM-P administration and 21 ± 2 hours after the last IM-P administration. Patients with serum P concentrations <20.6 ng/ml on the ET day were administrated 400 mg vaginal progesterone for rescue.ResultsDemographic and cycle characteristics were similar between patients receiving rescue vaginal P (embryo transfer (ET)-day P concentration < 20.6 ng/ml) and patients who did not need rescue vaginal P (ET-day P concentration ≥ 20.6 ng/ml). Clinical pregnancy, miscarriage, and live birth rates were similar between two groups: 52.9%(45/85) vs 59.6%(326/552), p=0.287; 11.1%(5/45) vs 14.1%(46/326), p=0.583; and 47.1%(40/85) vs 50.7%(280/552), p=0.526, respectively. Logistic regression analysis revealed that the female age (p = 0.008, OR=0.942, 95% CI = 0.902–0.984) and embryo quality (ref: good quality for moderate: p=0.02, OR=0.469, 95% CI =0.269–0.760; for poor: p=0.013, OR= 0.269, 95% CI = 0.092–0.757) were independent variables for live birth. Following rescue protocol implementation, ET-day P concentration was not a significant predictor of live birth.ConclusionsRescue vaginal P administration for low ET day serum P concentrations following IM-P yields comparable live birth rates.

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