Abstract
BackgroundLow serum progesterone on the day of frozen embryo transfer (FET) is associated with diminished pregnancy rates in artificial endometrium preparation cycles, but there is no consensus on whether strengthened luteal phase support (LPS) benefits patients with low progesterone on the FET day in artificial cycles. This single-centre, large-sample retrospective trial was designed to investigate the contribution of strengthened LPS to pregnancy outcomes for groups with low progesterone levels on the FET day in artificial endometrium preparation cycles.MethodsWomen who had undergone the first artificial endometrium preparation cycle after a freeze-all protocol in our clinic from 2016 to 2018 were classified into two groups depending on their serum progesterone levels on the FET day. Routine LPS was administered to group B (P ≥ 10.0 ng/ml on the FET day, n = 1261), and strengthened LPS (routine LPS+ im P 40 mg daily) was administered to group A (P < 10.0 ng/ml on the FET day, n = 1295). The primary endpoint was the live birth rate, and the secondary endpoints were clinical pregnancy, miscarriage and neonatal outcomes.ResultsThe results showed that the clinical pregnancy rate was significantly lower in group A than in group B (48.4% vs 53.2%, adjusted risk ratio (aRR) 0.81, 95% confidence interval (CI) 0.68, 0.96), whereas miscarriage rates were similar between the two groups (16.0% vs 14.7%, aRR 1.09, 95% CI 0.77, 1.54). The live birth rate was slightly lower in group A than in group B (39.5% vs 43.3%, aRR 0.84, 95% CI 0.70, 1.0). Birthweights and other neonatal outcomes were similar between the two groups (P > 0.05).ConclusionsThe results indicated that the serum progesterone level on the FET day was one of the risk factors predicting the chances of pregnancy in artificial endometrium preparation cycles, and strengthened LPS in patients with low progesterone on the FET day might help to provide a reasonable pregnancy outcome in artificial cycles, although further prospective evidence is needed to confirm this possibility.
Highlights
5 million babies resulting from assisted conception (in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)) have been delivered, and the demand for these fertility treatments is increasing
The results indicated that the serum progesterone level on the frozen embryo transfer (FET) day was one of the risk factors predicting the chances of pregnancy in artificial endometrium preparation cycles, and strengthened luteal phase support (LPS) in patients with low progesterone on the FET day might help to provide a reasonable pregnancy outcome in artificial cycles, further prospective evidence is needed to confirm this possibility
Low serum progesterone levels on the FET day in artificial cycles using vaginal progesterone have been reported to be associated with compromised reproductive outcomes [5,6,7]; there is no consensus on whether strengthened LPS is beneficial for patients with low progesterone levels in artificial cycles [8, 9]
Summary
5 million babies resulting from assisted conception (in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)) have been delivered, and the demand for these fertility treatments is increasing. Artificial endometrial preparation for a frozen embryo transfer (FET) cycle is different from a stimulated IVF cycle in that there is no endogenous progesterone production; instead of luteal phase supplementation, there is a need for luteal phase “creation” or replacement [2]. In this context, artificial cycles provide us with a chance to explore the optimal dose and route of progesterone supplementation to support embryo implantation without the interferences of endogenous production in stimulation cycles [3]. Low serum progesterone on the day of frozen embryo transfer (FET) is associated with diminished pregnancy rates in artificial endometrium preparation cycles, but there is no consensus on whether strengthened luteal phase support (LPS) benefits patients with low progesterone on the FET day in artificial cycles. This singlecentre, large-sample retrospective trial was designed to investigate the contribution of strengthened LPS to pregnancy outcomes for groups with low progesterone levels on the FET day in artificial endometrium preparation cycles
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