Abstract
Background: There is a paucity of data evaluating the efficacy of vaginal progesterone replacement in both fresh and frozen transfers of recipients of oocyte donors. Method: This was a multicenter, IRB approved, retrospective analysis from January 2009 through June 2013 of 255 cycles among women less than 55 years of age who were oocyte recipients in an anonymous donor program. Oocyte recipients from fresh and frozen cycles received vaginal progesterone gel (Crinone 8%) 90 mg twice daily and oral estradiol 2 mg 2–3 times daily in a step-up protocol. The comparative groups of fresh and frozen donor oocyte cycles took progesterone intramuscular 50 mg once a day, 5 days prior to transfer, Progesterone 200 mg vaginal capsule beginning the day of transfer and Estrogen 2 mg orally three times daily continuing until the tenth week of pregnancy. Subjects were monitored via transvaginal ultrasound, serum estradiol and progesterone levels, both on baseline and the week prior to transfer. A serum beta-hCG, estradiol, and progesterone were obtained 10 days after Blastocyst transfer. Hormone levels and pregnancy rates were summarized with descriptive statistics. Results: It was showed that the fertility interventions did not significantly differ with regard to number of positive pregnancy tests, χ²(3)=4.41, p=0.220. Results also showed that the fertility interventions did not significantly differ with regard to number of clinical pregnancies, χ²(3)=4.68, p=0.196. Conclusion: Preparing the endometrium with oral estradiol and vaginal progesterone gel among recipients treated in a contemporary donor oocyte program is highly effective.
Highlights
Women without ovarian function and those with poor oocyte quality can become pregnant through in vitro fertilization/ embryo transfer (IVF/ET) using oocytes donated by fertile women [1]
In oocyte recipients, progesterone replacement or supplementation during the luteal phase is needed to help prepare the endometrium for implantation and to improve fertility outcomes [1,3]
Findings from a study of 271 patients undergoing 285 cycles of IVF demonstrated that pregnancy rates were higher in patients who were treated with estrogen and progesterone compared with those treated with only progesterone during the luteal phase (33.8% vs. 23.4%) [4]
Summary
Women without ovarian function and those with poor oocyte quality can become pregnant through in vitro fertilization/ embryo transfer (IVF/ET) using oocytes donated by fertile women [1]. In oocyte recipients, progesterone replacement or supplementation during the luteal phase is needed to help prepare the endometrium for implantation and to improve fertility outcomes [1,3]. Women undergoing IVF/ET with donor oocytes are typically treated with estrogen in addition to progesterone to synchronize the cycle and help prime and prepare the endometrium before embryo transfer [2]. Estrogen stimulates the growth of the functional endometrium, priming the endometrium, and progesterone contributes to histological transition to a secretory endometrium, which is necessary preparation for implantation [2]. Findings from a study of 271 patients undergoing 285 cycles of IVF demonstrated that pregnancy rates were higher in patients who were treated with estrogen and progesterone compared with those treated with only progesterone during the luteal phase (33.8% vs 23.4%) [4]. There is a paucity of data evaluating the efficacy of vaginal progesterone replacement in both fresh and frozen transfers of recipients of oocyte donors
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