Endometrial preparation for frozen-thawed embryo transfer in an artificial cycle: transdermal versus vaginal estrogen

Abstract

The objective was to compare the endometrial thickness (ET) in a frozen embryo transfer (FET) cycle between transdermal and vaginal estrogen. Our secondary objectives were to compare the patient satisfaction and the pregnancy outcomes. Prospective monocentric cohort study between 01/2017 and 12/2017 at a single institution. Choice of administration was left to the patient. 119 cycles had transdermal estrogen (T-group) and 199 had vaginal estrogen (V-group). The ET at 10 ± 1 days of treatment was significantly higher in the T-group compared to the V-group (9.9 vs 9.3 mm, p = 0.03). In the T-group, the mean duration of treatment was shorter (13.6 vs 15.5 days, p < 0.001). The rate of cycle cancelation was comparable between the two groups (12.6% vs 8.5%, p = 0.24). Serum estradiol levels were significantly lower (268 vs 1332 pg/ml, p < 0.001), and serum LH levels were significantly higher (12.1 ± 16.5 vs 5 ± 7.5 mIU/ml, p < 0.001) in the T-group. Patient satisfaction was higher in the T-group (p = 0.04) and 85.7% (36/42) of women who had received both treatments preferred the transdermal over the vaginal route. Live birth rates were comparable between the two groups (18% vs 19%, p = 0.1). Transdermal estrogen in artificial FET cycles was associated with higher ET, shorter treatment duration and better tolerance.

Is there a critical LH level for hCG trigger after the detection of LH surge in modified natural frozen-thawed single blastocyst transfer cycles?

“…Artificial endometrial preparation with hormones and natural cycle are the most commonly used endometrial preparation techniques [ 15 ]. The most effective, practical, convenient and safe endometrial preparation protocol is still under debate.…”

Effect of transdermal estrogen dose regimen for endometrial preparation of frozen‐thawed embryo transfer on reproductive and obstetric outcomes

“…However, it should be noted that the report is a small study with 15 cases of live births in the two groups. In a study comparing patches and oral preparations 5 and a study comparing patches and vaginal tablets, 6 there was no difference in the ongoing pregnancy rate. In recent years, there have been few reports of using subcutaneous injection or intramuscular injection.…”

“…First, there are differences in the administration routes such as oral, transdermal, and vaginal. It has been reported that the live birth rate (LBR) did not differ depending on the administration route 4‐6 . Next, there are regimens that mimic changes in serum estradiol during the menstrual cycle to change the dose, and fixed‐dose regimens.…”

Is addition of GNRH agonist to HRT significant in improving the outcome in FTE transfer cycles? Randomized study.

“…Stimulated cycles are associated with higher cost, risk of side effects of the treatment. In spite of this discrepancy, the pregnancy and live birth rates were comparable in all methods [6] .…”