Measuring serum estradiol and progesterone one day prior to frozen embryo transfer improves live birth rates

Abstract

Background: Given no consensus in the literature, this study sought to determine if a protocol of measuring serum estradiol and progesterone the day prior to frozen embryo transfer (FET) improves likelihood of pregnancy and livebirth. Methods: This was a retrospective time-series study of women undergoing autologous vitrified-warmed blastocyst programmed FETs at an academic institution. Live birth rates were compared between a surveillance protocol, where serum estrogen and progesterone surveillance are performed the day prior to a programmed FET, and a standard protocol, whereby no hormonal lab evaluation is performed the day prior. Results: Three hundred seventy-nine standard FET and 524 surveillance FET cycles were performed. Patients in the surveillance protocol were significantly more likely to achieve live birth (51% vs. 39%; aOR 1.6, 95%CI [1.2, 2.2]). Obese women were noted to be more likely to have lower progesterone hormone levels on surveillance labs (OR 3.2, 95%CI [2.0, 5.3]). However those whose hormonal medication dose was modified because of pre-transfer labs were as likely to achieve live birth as those whose dose was not modified (47% vs. 53%; aOR 0.8, 95%CI [0.6, 1.2]). Conclusions: Cycles with the surveillance protocol were more likely to result in live birth. Patients with low levels of pre-transfer hormones, such as obese patients, likely have lower pregnancy rates. It is possible that when these levels were corrected after measurement, pregnancy rates improved to match those whose levels were not low enough to warrant intervention.

Low Luteal Serum Progesterone Levels Are Associated With Lower Ongoing Pregnancy and Live Birth Rates in ART: Systematic Review and Meta-Analyses

“…It could thus be relevant to test vaginal absorption in patients planned for an HRT embryo transfer in a preceding cycle (64), in order to adjust the progesterone administration. Lower luteal progesterone concentrations are observed in obese patients, both with the vaginal (41) and the intramuscular route (65). Increasing vaginal progesterone doses might be an option for some patients; however, vaginal absorption might reach saturation (66,67), which lessens the interest of such strategy for some patients (36).…”

“…Studies are lacking to define the optimal progesterone dose increase to reach an optimal progesterone level in HRT using the intramuscular progesterone: an insufficient dose increase might not efficiently correct progesterone concentrations and pregnancy outcomes as suggested by some authors (10). However, some authors reported restored live birth rates after increasing the intramuscular progesterone and/or oestradiol administration for patients whose progesterone concentration 1 day prior to embryo transfer was below 15 ng/ml and/or oestradiol concentration was below 150 pg/ml (65).…”