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

Romain Corroenne,Guillaume Legendre,Hady El Hachem,Caroline Verhaeghe,Philippe Descamps,Pascale May-Panloup,Pierre-Emmanuel Bouet,Pauline Jeanneteau,Cecile Dreux

doi:10.1038/s41598-020-57730-3

Romain Corroenne, Guillaume Legendre + Show 7 more

Open Access

https://doi.org/10.1038/s41598-020-57730-3

Copy DOI

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.

Highlights

The objective was to compare the endometrial thickness (ET) in a frozen embryo transfer (FET) cycle between transdermal and vaginal estrogen
Our study has showed that transdermal estrogen was associated with higher endometrial thickness, shorter treatment duration, fewer side effects and higher patient satisfaction, but a higher cycle cancelation rate, compared to the vaginal route for endometrial preparation in artificial FET cycles
Several studies have assessed its impact on cycle outcomes, and the threshold used to consider an endometrial thickness as acceptable varies between 7, 8 or 9 mm according to studies

Summary

Introduction

The objective was to compare the endometrial thickness (ET) in a frozen embryo transfer (FET) cycle between transdermal and vaginal estrogen. Transdermal estrogen in artificial FET cycles was associated with higher ET, shorter treatment duration and better tolerance. A FET can be performed in a natural cycle, a modified natural cycle (with ovulation triggering), an artificial cycle using treatment with exogenous estrogen and progesterone, and a stimulated cycle using exogenous gonadotrophins[5,6,7] Each of these methods has its advantages and drawbacks. Natural cycles allow the patients to have a treatment-free transfer, but could be problematic in terms of scheduling the activity in an IVF unit since the transfer date is dictated by the patient’s ovulation, and cannot be offered to women with irregular cycles These two problems can be resolved with the use of an artificial cycle, the most commonly used FET protocol worldwide. Our secondary objectives were to compare the global patient satisfaction and the undesirable side effects between the two protocols, as well as the pregnancy outcomes and the cancelation rates

Objectives

Methods

Results

Conclusion