The relationship between the hormone levels before transplantation and the outcomes of hormone replacement therapy frozen embryo transfer

Liu, Yaofang; Wang, Fang; Huang, Guiying; Mao, Xi-Guang

doi:10.23736/s0391-1977.17.02660-8

Cited by 8 publications

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“…The association between serum progesterone levels and outcomes in autologous FET using AC have also been described whether progesterone was administered using the vaginal route ( Yovich et al , 2015 ; Alsbjerg et al , 2018 ; Basnayake et al , 2018 ) or the intramuscular route ( Kofinas et al , 2015 ; Liu et al , 2018 ; Boynukalin et al , 2019 ). Moreover, a prospective study combining vaginal and rectal progesterone in AC cycles reported a non-linear relationship between serum progesterone levels and ongoing pregnancy rates, and that there might be an upper threshold above which pregnancy rates are decreased ( Alsbjerg et al , 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of endometrial preparation on early pregnancy loss and live birth rate after frozen embryo transfer: a large multicenter cohort study (14 421 frozen cycles)

Vinsonneau

Labrosse

Porcu-Buisson

et al. 2022

Human Reproduction Open

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Study question Does the endometrial preparation protocol (artificial cycle (AC) vs. natural cycle (NC) vs. stimulated cycle (SC)) impact the risk of early pregnancy loss and live birth rate after frozen/thawed embryo transfer (FET)? Summary answer In FET, artificial cycles were significantly associated with a higher pregnancy loss rate and a lower live birth rate compared with stimulated cycle or natural cycle. What is known already To date, there is no consensus on the optimal endometrial preparation in terms of outcomes. Although some studies have reported a higher pregnancy loss rate using AC compared with NC or SC, no significant difference was found concerning the pregnancy rate or live birth rate. Furthermore, no study has compared the three protocols in a large population. Study design, size, and duration A multicenter retrospective cohort study was conducted in nine reproductive health units in France using the same software to record medical files between January 1st, 2012 and December 31st, 2016. FET using endometrial preparation by AC, modified NC or SC were included. The primary outcome was the pregnancy loss rate at 10 weeks of gestation. The sample size required was calculated to detect an increase of 5% in the pregnancy loss rate (21 to 26%), with an alpha risk of 0.5 and a power of 0.8. We calculated that 1126 pregnancies were needed in each group, i.e., 3378 in total. Participants/materials, setting, methods Data were collected by automatic extraction using the same protocol. All consecutive autologous FET cycles were included: 14,421 cycles (AC: n = 8,139; NC: n = 3,126; SC: n = 3,156) corresponding to 3,844 pregnancies (hCG > 100 IU/L) (AC: n = 2,214; NC: n = 812; SC: n = 818). Each center completed an online questionnaire describing its routine practice for FET, particularly the reason for choosing one protocol over another. Main results and the role of chance AC represented 56.5% of FET cycles. Mean age of women was 33.5 (SD ± 4.3) years. The mean number of embryos transferred was 1.5 (±0.5). Groups were comparable, except for history of ovulation disorders (P = 0.01) and prior delivery (P = 0.03), which were significantly higher with AC. Overall, the early pregnancy loss rate was 31.5% (AC: 36.5%; NC: 25.6%; SC: 23.6%). Univariable analysis showed a significant association between early pregnancy loss rate and age > 38 years, history of early pregnancy loss, ovulation disorders, and duration of cryopreservation > 6 months. After adjustment (multivariable regression), the early pregnancy loss rate remained significantly higher in AC vs. NC (odds ratio (OR) 1.63 (95% CI) [1.35-1.97]; P < 0.0001) and in AC vs. SC (OR 1.87 [1.55-2.26]; P < 0.0001). The biochemical pregnancy rate (hCG > 10 and lower than 100 IU/L) was comparable between the three protocols: 10.7% per transfer. Limitations, reasons for caution This study is limited by its retrospective design that generates missing data. Routine practice within centers was heterogeneous. However, luteal phase support and timing of embryo transfer were similar in AC. Univariable analysis showed no difference between centers. Moreover, a large number of parameters were included in the analysis. Wider implications of the findings Our study shows a significant increase in early pregnancy loss when using AC for endometrial preparation before FET. These results suggest either a larger use of NC or SC, or an improvement of AC by individualizing hormone replacement therapy for patients in order to avoid an excess of pregnancy losses. Study funding/competing interests The authors declare no conflicts of interest in relation to this work. G. P.-B. declares consulting fees from Ferring, Gedeon-Richter, Merck KGaA, Theramex, Teva; Speaker’s fees or equivalent from Merck KGaA, Ferring, Gedeon-Richter, Theramex, Teva N.C. declares consulting fees from Ferring, Merck KGaA, Theramex, Teva; Speaker’s fees or equivalent from Merck KGaA, Ferring C.R. declares a research grant from Ferring, Gedeon-Richter; consulting fees from Gedeon-Richter, Merck KGaA; Speaker’s fees or equivalent from Merck KGaA, Ferring, Gedeon-Richter E.M.A. declares Speaker’s fees or equivalent from Merck KGaA, MSD, Ferring, Gedeon-Richter, Theramex, Teva I.C-D. declares Speaker’s fees or equivalent from Merck KGaA, MSD, Ferring, Gedeon-Richter, IBSA N.M. declares a research grant from Merck KGaA, MSD, IBSA; consulting fees from MSD, Ferring, Gedeon-Richter, Merck KGaA; Speaker’s fees or equivalent from Merck KGaA, MSD, Ferring, Gedeon-Richter, Teva, Goodlife, General Electrics Trial registration number Not applicable

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Section: Discussionmentioning

confidence: 99%

Impact of endometrial preparation on early pregnancy loss and live birth rate after frozen embryo transfer: a large multicenter cohort study (14 421 frozen cycles)

Vinsonneau

Labrosse

Porcu-Buisson

et al. 2022

Human Reproduction Open

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“…Results are more controversial in studies using injected progesterone for which the threshold might be around 20 ng/ml: on the one hand, some authors report a minimal threshold to be reached (35,61); on the other hand, others define the optimal progesterone level below such threshold (60). However, in the latter, patients were excluded if their progesterone administration dosage was modified after progesterone level measurement on day 2 and progesterone level >10 ng/ml on the day of embryo transfer was required.…”

Section: No Corpus Luteummentioning

confidence: 99%

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

Ranisavljevic

Huberlant

Montagut³

et al. 2022

Front. Endocrinol.

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Progesterone plays a key role in implantation. Several studies reported that lower luteal progesterone levels might be related to decreased chances of pregnancy. This systematic review was conducted using appropriate key words, on MEDLINE, EMBASE, and the Cochrane Library, from 1990 up to March 2021 to assess if luteal serum progesterone levels are associated with ongoing pregnancy (OP) and live birth (LB) rates (primary outcomes) and miscarriage rate (secondary outcome), according to the number of corpora lutea (CLs). Overall 2,632 non-duplicate records were identified, of which 32 relevant studies were available for quantitative analysis. In artificial cycles with no CL, OP and LB rates were significantly decreased when the luteal progesterone level falls below a certain threshold (risk ratio [RR] 0.72; 95% confidence interval [CI] 0.62–0.84 and 0.73; 95% CI 0.59–0.90, respectively), while the miscarriage rate was increased (RR 1.48; 95% CI 1.17–1.86). In stimulated cycles with several CLs, the mean luteal progesterone level in the no OP and no LB groups was significantly lower than in the OP and LB groups [difference in means 68.8 (95% CI 45.6–92.0) and 272.4 (95% CI 10.8–533.9), ng/ml, respectively]. Monitoring luteal serum progesterone levels could help in individualizing progesterone administration to enhance OP and LB rates, especially in cycles without corpus luteum.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=139019, identifier 139019.

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Women utilizing oocyte donation have a decreased live birth rate if they displayed a low progesterone level in a previous hormonal replacement mock cycle

Labrosse

Peigné

Eustache

et al. 2021

J Assist Reprod Genet

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The relationship between the hormone levels before transplantation and the outcomes of hormone replacement therapy frozen embryo transfer

Cited by 8 publications

References 0 publications

Impact of endometrial preparation on early pregnancy loss and live birth rate after frozen embryo transfer: a large multicenter cohort study (14 421 frozen cycles)

Impact of endometrial preparation on early pregnancy loss and live birth rate after frozen embryo transfer: a large multicenter cohort study (14 421 frozen cycles)

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

Women utilizing oocyte donation have a decreased live birth rate if they displayed a low progesterone level in a previous hormonal replacement mock cycle

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