Abstract
To establish a relationship between serum progesterone values on the day of frozen blastocyst transfer in hormone-replaced cycles with the probability of pregnancy, miscarriage or delivery. This was an ambispective observational study including all frozen-thawed embryo transfer cycles performed at our department following in vitro fecundation from May 2018 to June 2019. The outcomes evaluated were β human chorionic gonadotropin (β-hCG)-positive pregnancy and delivery. Groups were compared according to the level of serum progesterone on the day of embryo transfer: the 1st quartile of progesterone was compared against the other quartiles and then the 2nd and 3rd quartiles against the 4th quartile. A total of 140 transfers were included in the analysis: 87 with β-HCG > 10 IU/L (62%), of which 50 (36%) delivered and 37 had a miscarriage (42%). Women with lower progesterone levels (< 10.7ng/mL) had a trend toward higher β-HCG-positive (72 versus 59%; p > 0.05), lower delivery (26 versus 39%; p > 0.05) and higher miscarriage rates (64 versus 33%; p < 0.01). Comparing the middle quartiles (P25-50) with those above percentiles 75, the rate of pregnancy was similar (60 versus 57%; p > 0.05), although there was a trend toward a higher number of deliveries (43 versus 31%; p > 0.05) and a lower number of miscarriages (28 versus 45%; p > 0.05). These differences were not statistically significant. There were no differences in pregnancy and delivery rates related with the progesterone level when measured in the transfer day. The miscarriage rate was higher in the 1st quartile group.
Highlights
Over the past decade, with the development of the vitrification technique and the consequent increase in embryo survival rate, frozen embryo transfers (FETs) have increased considerably.[1]
Verificou-se uma tendência para menor número de recém-nascidos nas transferências com níveis de progesterona no 1° quartil (< 10.7ng/mL) (26 versus 39%; p > 0.05) e um maior número de abortos (64 versus 33%; p < 0.01)
The latest data published by the European Society of Human Reproduction and Embryology (ESHRE) shows that > 248,000 frozen embryo transfers or endometrial preparation cycles for oocyte donation embryos have been performed across Europe.[2]
Summary
With the development of the vitrification technique and the consequent increase in embryo survival rate, frozen embryo transfers (FETs) have increased considerably.[1]. Endometrial preparation in FETs can be achieved in natural, modified, or artificial hormone substituted cycles, with no significant differences being reported to date in terms of clinical pregnancy and livebirth rates between the three preparation methods.[5,6] That said, the artificial hormone-substituted cycle has been most frequently used due to its ease in terms of scheduling and greater control of exogenous progesterone (P4) exposure, which is essential for achieving embryo-endometrial synchrony.[7,8]
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