Effectiveness of progesterone rescue in women presenting low circulating progesterone levels around the day of embryo transfer: a systematic review and meta-analysis

Stavridis, Konstantinos; Kastora, Stavroula; Triantafyllidou, Olga; Mavrelos, D.; Vlahos, Nikolaos

doi:10.1016/j.fertnstert.2023.02.007

Cited by 12 publications

(8 citation statements)

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“…In a systematic review enrolling 2927 patients the salvage effect of rescue progesterone implementation was analyzed in patients with low serum progesterone. 10 There was no difference between patients with low serum progesterone receiving the rescue dose and those with adequate serum progesterone levels in terms of ongoing pregnancy (OR; 0.98), live birth and (OR; 0.92) and miscarriage rates (OR; 0.98). 10 In our cohort, luteal phase supplementation was not utilized in any of the patients, since serum progesterone on ET day was >10ng/ml in all patients.…”

Section: Resultsmentioning

confidence: 88%

“…10 There was no difference between patients with low serum progesterone receiving the rescue dose and those with adequate serum progesterone levels in terms of ongoing pregnancy (OR; 0.98), live birth and (OR; 0.92) and miscarriage rates (OR; 0.98). 10 In our cohort, luteal phase supplementation was not utilized in any of the patients, since serum progesterone on ET day was >10ng/ml in all patients. Although there is no consensus regarding the optimal luteal phase progesterone values in FET cycles, a range between 22 and 31 ng/ml has been proposed by some authors.…”

Section: Resultsmentioning

confidence: 88%

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The Success of True Natural Cycle in Patients Undergoing Frozen Thawed Embryo Transfers

SÖNMEZER

2023

TJRMS

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To analyze the success rate of true natural cycle in patients undergoing frozen thawed embryo transfers. Materials and Methods: This retrospective analysis included ovulatory 23 women undergoing natural frozen embryo transfer cycles between January 2022 and July 2023. In true natural frozen embryo transfer cycles hCG trigger and luteal phase supplementation were not utilized. The mean number of embryos transferred, the mean menstrual day of embryo transfer, mean peak estradiol level on the day of LH surge (>17iu/ml), and mean serum progesterone levels on embryo transfer day were recorded. The main outcome measures included implantation and clinical pregnancy rates. Results: Mean number of embryos transferred was 1.7, the mean implantation and clinical pregnancy rates were 55.8% and 69,5% respectively. Among the patients, single embryo transfer was performed in 12 and double embryo transfer was performed in 11 subjects. With regard to preimplantation genetic analysis, 8 patients received single euploid embryo transfer and 7/8 (87.5%) conceived. The mean menstrual day of transfer was 19,38±1.67 days (range; 17-23 days), mean peak estradiol level on the day of LH surge (>17ıu/ml) was 307,5±102,5 pg/ml (range; 178-492 pg/ml), and the mean serum progesterone on the day of ET was 24,33±16,4 ng/ml (range; 14.5-41). Conclusions: True natural cycle is a promising physiological alternative for patients undergoing frozen thawed embryo transfer cycles. Despite the numbers are low, the success rate seems to be higher in patients undergoing euploid embryo transfer.

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Section: Resultsmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 88%

The Success of True Natural Cycle in Patients Undergoing Frozen Thawed Embryo Transfers

SÖNMEZER

2023

TJRMS

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“…Stavridis et al., have recently presented another meta-analysis. The results of this meta-analysis suggested that rescue progesterone in patients with lower serum progesterone levels results in similar CPR, OPR and LBRs to patients with sufficient progesterone levels in artificial FET ( 18 ).…”

Section: Discussionmentioning

confidence: 91%

Initiating luteal phase support with sc progesterone based on low serum progesterone on the transfer day in true natural cycle frozen embryo transfers

Demirel,

Özcan,

Tülek

et al. 2023

Front. Endocrinol.

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IntroductionConcerning contemporary in-vitro fertilisation (IVF) practice, the use of frozen embryo transfer (FET) cycles has become more common than fresh transfers. Natural cycle (NC), programmed artificial cycle and mild stimulation cycle are primary endometrium preparation cycles. Monitoring serum progesterone levels in FET cycles are in the scope of current research focus. Low progesterone levels on the day of embryo transfer is presumed to negatively affect pregnancy outcomes, while progesterone supplementation may improve pregnancy rates. The purpose of our trial is to evaluate whether initiating subcutaneous (SC) progesterone supplementation on the day of embryo transfer when serum progesterone levels are below 10 ng/mL in tNC-FET will result in pregnancy rates comparable to those of patients with sufficient serum progesterone.MethodsRetrospective single centre study was conducted between August 2022 and April 2023 with 181 tNC-FETs. Patients were separated into groups according to serum progesterone concentrations (≥10 ng/mL and <10 ng/mL) on embryo transfer (ET) day. S.c progesterone (25 mg) was given on the day of ET when serum progesterone was <10 ng/mL, continuing until the 10th gestational week. Blood samples for pregnancy tests were collected 12 days after ET. Outcome parameters were pregnancy rate, clinical pregnancy rate (CPR), miscarriage rate, multiple pregnancy rate, biochemical pregnancy, and ongoing pregnancy rate (OPR).ResultsAbout half (49.7%) had adequate progesterone concentrations (≥10ng/mL) on ET day. There was no significant difference between the groups regarding positive pregnancy test, OPR, multiple pregnancies, and miscarriage rates (57.8% versus 52.7%; 34.4% versus 29.7%, 1.1% versus 2.2%; 7.8% versus 5.5%; respectively, for progesterone concentrations on ET day ≥10 ng/mL and <10 ng/mL). With 55.2% of transfers leading to clinical pregnancy, significant differences emerged in biochemical pregnancy and CPR (3.3% vs 12.1%, P=0.02; 54.4% vs 40.7%, P=0.03, for ≥10 ng/mL and <10 ng/mL progesterone concentrations on ET day).DiscussionThis study indicates that nearly half of the tNC-FETs may need luteal phase support due to low progesterone. However, 25 mc sc progesterone rescued the luteal support and yielded similar OPR as compared to normal progesterone group. Further studies are needed for understanding optimal progesterone levels, supplementation effectiveness, and potential benefits of earlier supplementation in FETs.

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“…However, evidence show that a minimal serum progesterone level is necessary to ensure an optimal endocrine environment for embryo implantation and early pregnancy ( 35 ). Measuring progesterone levels, the day before embryo transfer also allows for individualizing luteal phase support, and several studies have demonstrated the effectiveness of progesterone rescue in women with low progesterone levels around the day of embryo transfer ( 36 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

Real-world practices of hormone monitoring during ovarian stimulation in assisted reproductive technology: a global online survey

Sachs-Guedj,

Hart,

Requena

et al. 2023

Front. Endocrinol.

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ObjectiveThe aim of this study is to understand the global practice of routine hormonal monitoring (HM) during ovarian stimulation (OS) in the context of assisted reproductive technique (ART) treatment.MethodsAn open-access questionnaire was available to 3,845 members of IVF-Worldwide.com from September 8 to October 13, 2021. The survey comprised 25 multiple-choice questions on when and how ultrasound (US) and hormone tests were conducted during ovarian stimulation OS. For most questions, respondents were required to select a single option. Some questions allowed the selection of multiple options.ResultsIn all, 528 (13.7%) members from 88 countries responded to the questionnaire. Most respondents (98.9%) reported using US to monitor OS cycles. HM was used by 79.5% of respondents during any of the cycle monitoring visits and was most commonly performed on the day of, or a day prior to final oocyte maturation. Overall, 87% of respondents claimed adjusting the dose of gonadotropin during OS, with 61.7% adjusting the dose based on hormonal levels. Oestradiol (E2) was the most frequently monitored hormone during all visits and was used by 74% of respondents for the prediction of ovarian hyperstimulation syndrome (OHSS). On or a day prior to ovulation triggering (OT), the number of respondents who measured progesterone increased from 34.3% in the second/third visit to 67.7%. Approximately one-third of respondents measured luteinizing hormone during all visits.ConclusionGlobally, most ART specialists (~80%) use HM, along with US, for monitoring OS, especially for the prevention of OHSS.

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Effectiveness of progesterone rescue in women presenting low circulating progesterone levels around the day of embryo transfer: a systematic review and meta-analysis

Cited by 12 publications

References 40 publications

The Success of True Natural Cycle in Patients Undergoing Frozen Thawed Embryo Transfers

The Success of True Natural Cycle in Patients Undergoing Frozen Thawed Embryo Transfers

Initiating luteal phase support with sc progesterone based on low serum progesterone on the transfer day in true natural cycle frozen embryo transfers

Real-world practices of hormone monitoring during ovarian stimulation in assisted reproductive technology: a global online survey

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