Subcutaneous versus vaginal progesterone for vitrified–warmed blastocyst transfer in artificial cycles

Türkgeldi, Engin; Hanege, Burcu Yılmaz; Yıldız, Şule; Keleş, İpek; Ata, Barış

doi:10.1016/j.rbmo.2020.04.007

Cited by 17 publications

(9 citation statements)

References 20 publications

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“…Whether fPPOS, which provides higher endogenous gonadotropin levels and more oocytes than GnRH antagonist protocol in women with high ovarian reserve, also provides a higher oocyte yield than conventional PPOS remains to be seen. While we did not observe such a benefit of fPPOS in our retrospective study in women with decreased ovarian reserve ( 7 ), the limited potential of their ovaries could have prevented demonstration of a potential benefit. A comparison of the two PPOS protocols in women with high ovarian reserve is needed.…”

Section: Discussioncontrasting

confidence: 69%

“…Oocyte maturation was triggered with 0.2 mg triptorelin acetate, when the leading follicle size was greater than 17 mm with the majority of others >14 mm, followed by oocyte retrieval 36 h later. Embryology laboratory procedures including denudation, intracytoplasmic sperm injection, embryo culture, oocyte/embryo vitrification and thawing, luteal phase support, and endometrial preparation for frozen embryo transfers are described in our former publications ( 5 – 7 ).…”

Section: Methodsmentioning

confidence: 99%

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Outcomes of a GnRH Agonist Trigger Following a GnRH Antagonist or Flexible Progestin-Primed Ovarian Stimulation Cycle

et al. 2022

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A suggested explanation for the pituitary-suppressive effects of progestin-primed ovarian stimulation cycles (PPOS) is pituitary luteinizing hormone (LH) depletion with progestin exposure during the follicular phase. The GnRH agonist (GnRHa) trigger releases endogenous LH from the pituitary, and if the LH depletion theory is correct, the response to the agonist trigger would be dampened in PPOS cycles. In this study, we compared the performance of the GnRHa trigger after PPOS and GnRH antagonist ovarian stimulation cycles. All women who underwent ovarian stimulation with the GnRH antagonist or flexible PPOS (fPPOS) and received a GnRH agonist trigger were eligible for inclusion. Outcomes included number of metaphase-II (MII) oocytes retrieved per cycle, rates of empty follicle syndrome, maturation, fertilization, blastulation, and cumulative clinical pregnancy per stimulation cycle. During the screening period, there were 166 antagonists and 58 fPPOS cycles triggered with a GnRH agonist. Groups were matched for potential confounders using propensity score matching. Progestin-downregulated cycles had 19% high mature oocyte yield (median: 14 vs. 19 MII oocytes, P = 0.03). Cumulative ongoing pregnancy or live birth rates were estimated after matching for transferred embryo count, and rates were similar between GnRH antagonist and fPPOS group (57.0% vs. 62.1%, P = 0.68). However, the number of remaining blastocysts was higher in the fPPOS group (median: 5.0 vs. 6.0, P < 0.001). LH levels were higher in fPPOS cycles compared to GnRH antagonist cycles up to the trigger day (P < 0.001). After the GnRHa trigger, fPPOS cycles were associated with a steeper LH surge compared with antagonist cycles (P = 0.02). Higher endogenous gonadotropin levels through the stimulation period and an LH surge of higher magnitude following a GnRHa trigger suggest a milder pituitary suppression by fPPOS, which needs to be confirmed in larger samples. It appears that progestins do not deplete pituitary LH reserves and a GnRHa trigger is usable after PPOS in women with high ovarian reserve.

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Section: Discussioncontrasting

confidence: 69%

Section: Methodsmentioning

confidence: 99%

Outcomes of a GnRH Agonist Trigger Following a GnRH Antagonist or Flexible Progestin-Primed Ovarian Stimulation Cycle

et al. 2022

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“…Five studies explored the effects of subcutaneous Pg in a FET cycle ( 25 , 27 , 31 – 33 ). Specifically, a retrospective cohort study ( 31 ) involving 214 age-matched women compared 107 women who had undergone subcutaneous Pg (25 mg bid daily) with 107 women who had undergone vaginal Pg (90 mg 8% Pg vaginal gel bid daily). Only women <43-years-old and with <3 failed ART cycles were included ( 31 ).…”

Section: Resultsmentioning

confidence: 99%

“…Specifically, a retrospective cohort study ( 31 ) involving 214 age-matched women compared 107 women who had undergone subcutaneous Pg (25 mg bid daily) with 107 women who had undergone vaginal Pg (90 mg 8% Pg vaginal gel bid daily). Only women <43-years-old and with <3 failed ART cycles were included ( 31 ). In both groups, only vitrified blastocysts reaching at least an expansion grade were transferred.…”

Section: Resultsmentioning

confidence: 99%

Luteal Phase Support Using Subcutaneous Progesterone: A Systematic Review

Conforti

Carbone

Iorio

et al. 2021

Front. Reprod. Health

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Luteal phase support (LPS) is crucial in assisted reproductive technology (ART) cycles when the luteal phase has been found to be defective. Such deficiency is most likely related to the supraphysiological steroid levels that usually occurr in stimulated cycles which, in turn, could severely affect luteinizing hormone (LH) secretion and function, thereby negatively influencing the luteal phase. A number of different medications and routes have been successfully used for LPS in ART. Although an optimal protocol has not yet been identified, the existing plethora of medications offer the opportunity to personalize LPS according to individual needs. Subcutaneous administration progesterone has been proposed for LPS and could represent an alternative to a vaginal and intramuscular route. The aim of the present systematic review is to summarize the evidence found in the literature concerning the application of subcutaneous progesterone in ARTs, highlighting the benefits and limits of this novel strategy. With this aim in mind, we carried out systematic research in the Medline, ISI Web of Knowledge, and Embase databases from their inception through to November 2020. Randomized controlled trials (RCTs) were preferred by the authors in the elaboration of this article, although case-control and cohort studies have also been considered. According to our findings, evidence exists which supports that, in women with a good prognosis undergoing a fresh in vitro fertilization (IVF) cycle, subcutaneous Pg is not inferior to vaginal products. In the Frozen-thawed embryo transfer (FET) cycle, data concerning efficacy is mixed with an increased miscarriage rate in women undergoing a subcutaneous route in oocyte donor recipients. Data concerning the acceptance of the subcutaneous route versus the vaginal route are encouraging despite the different scales and questionnaires which were used. In addition, a cost-effective analysis has not yet been conducted.

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“…The available routes for P administration in an HRT cycle are vaginal, intramuscular (im), subcutaneous (sc), oral and rectal. The vaginal administration, distinct form the other routes, has a first-pass uterine effect (20)(21)(22), and until now, there is paucity of data on the use of oral (dydrogesterone) (23) sc (24) and rectal (25) routes.…”

Section: Progesterone Administrationmentioning

confidence: 99%

Preparation of the Endometrium for Frozen Embryo Transfer: A Systematic Review

et al. 2021

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Despite the worldwide increase in frozen embryo transfer, the search for the best protocol to prime endometrium continues. Well-designed trials comparing various frozen embryo transfer protocols in terms of live birth rates, maternal, obstetric and neonatal outcome are urgently required. Currently, low-quality evidence indicates that, natural cycle, either true natural cycle or modified natural cycle, is superior to hormone replacement treatment protocol. Regarding warmed blastocyst transfer and frozen embryo transfer timing, the evidence suggests the 6th day of progesterone start, LH surge+6 day and hCG+7 day in hormone replacement treatment, true natural cycle and modified natural cycle protocols, respectively. Time corrections, due to inter-personal differences in the window of implantation or day of vitrification (day 5 or 6), should be explored further. Recently available evidence clearly indicates that, in hormone replacement treatment and natural cycles, there might be marked inter-personal variation in serum progesterone levels with an impact on reproductive outcomes, despite the use of the same dose and route of progesterone administration. The place of progesterone rescue protocols in patients with low serum progesterone levels one day prior to warmed blastocyst transfer in hormone replacement treatment and natural cycles is likely to be intensively explored in near future.

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Subcutaneous versus vaginal progesterone for vitrified–warmed blastocyst transfer in artificial cycles

Cited by 17 publications

References 20 publications

Outcomes of a GnRH Agonist Trigger Following a GnRH Antagonist or Flexible Progestin-Primed Ovarian Stimulation Cycle

Outcomes of a GnRH Agonist Trigger Following a GnRH Antagonist or Flexible Progestin-Primed Ovarian Stimulation Cycle

Luteal Phase Support Using Subcutaneous Progesterone: A Systematic Review

Preparation of the Endometrium for Frozen Embryo Transfer: A Systematic Review

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