A comparison of luteal phase support in graduated estradiol/progesterone replacement cycles using intramuscular progesterone alone vs. combination with vaginal suppositories on outcome following frozen embryo transfer

Abstract

Background: One method to prepare the endometrium for frozen embryo transfer (ET) is to use a graduated estradiol regimen followed by luteal phase support with progesterone (P). The majority of patients at our IVF center are supported with both progesterone vaginal suppositories (PVS) and IM P during frozen ET cycles. Some women, however, either because of previous side effects of PVS receive only the IM P.Objective: To compare pregnancy outcome following frozen ET in women treated with a combination of PVS and IM P vs. those treated with IM P alone.Materials and Methods: The outcome of a woman’s first frozen ET in our facility in all patients up to age 45 during a 5 year period was evaluated according to whether they took the P regimen of 200mg twice daily PVS with 100mg IM P (50mg the first day) vs. those who only used IM P (same dosage). Implantation rate, clinical pregnancy rate (PR), and live delivery rate were compared using the chi-squared analysis.Results: The clinical and live delivered PRs for the combined group of IM and PVS (n=713) was 43.7% and 35.6%, respectively vs. 57.6% and 45.9% for the IM P only group (n=111) (p=.006, and .036, respectively). The respective implantation rates were 19.5% (453/2322) and 22.6% (93/410) for the two groups (p=.138). There were no obvious confounding variables found that would skew the results.Conclusions: These data show that despite the absence of corpora lutea, the use of higher dosages of P, provided by adding PVS therapy to IM P, does not improve outcome. There is even a suggestion that too much P may be somewhat detrimental. This retrospective study stimulates interest in performing a prospective comparison of PVS vs. IM P and possibly eliminating the higher dosages obtained by combining both treatments. Background: One method to prepare the endometrium for frozen embryo transfer (ET) is to use a graduated estradiol regimen followed by luteal phase support with progesterone (P). The majority of patients at our IVF center are supported with both progesterone vaginal suppositories (PVS) and IM P during frozen ET cycles. Some women, however, either because of previous side effects of PVS receive only the IM P. Objective: To compare pregnancy outcome following frozen ET in women treated with a combination of PVS and IM P vs. those treated with IM P alone. Materials and Methods: The outcome of a woman’s first frozen ET in our facility in all patients up to age 45 during a 5 year period was evaluated according to whether they took the P regimen of 200mg twice daily PVS with 100mg IM P (50mg the first day) vs. those who only used IM P (same dosage). Implantation rate, clinical pregnancy rate (PR), and live delivery rate were compared using the chi-squared analysis. Results: The clinical and live delivered PRs for the combined group of IM and PVS (n=713) was 43.7% and 35.6%, respectively vs. 57.6% and 45.9% for the IM P only group (n=111) (p=.006, and .036, respectively). The respective implantation rates were 19.5% (453/2322) and 22.6% (93/410) for the two groups (p=.138). There were no obvious confounding variables found that would skew the results. Conclusions: These data show that despite the absence of corpora lutea, the use of higher dosages of P, provided by adding PVS therapy to IM P, does not improve outcome. There is even a suggestion that too much P may be somewhat detrimental. This retrospective study stimulates interest in performing a prospective comparison of PVS vs. IM P and possibly eliminating the higher dosages obtained by combining both treatments.