Successful outcomes of fresh and frozen donor ovum cycles among recipients using oral estradiol and vaginal progesterone GEL vs intramuscular and vaginal progesterone

Abstract

There is a paucity of data evaluating the efficacy of vaginal progesterone replacement in fresh and frozen IVF transfers of recipients undergoing oocyte donation. The purpose of this investigation is to detect any differences in pregnancy rates between vaginal progesterone as compared to Intramuscular (IM) and vaginal progesterone among fresh and frozen donor oocyte cycles among 2 separate practitioners in a large regional ART center. This is a single center, IRB-approved, retrospective analysis from 1/2009 through 6/2013 of 255 cycles from subjects less than 55 years of age who were oocyte recipients in a anonymous donor program. Recipients in this data base included gestational surrogates and cycles with preimplantation genetic screening. Oocyte recipients from fresh and frozen cycles received oral estradiol 2 mg 2–3 times daily in a step-up protocol followed by vaginal progesterone gel (Crinone 8%) 90 mg twice daily for 5 days for blastocyst transfer. The comparative groups of fresh and frozen donor oocyte cycles took oral estradiol in a similar fashion followed by progesterone IM 50 mg once a day for 5 days prior to transfer and subsequently a Progesterone 200 mg vaginal capsule in addition beginning the day of transfer 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. Serum beta-hCG, estradiol and progesterone were obtained 10 days after blastocyst transfer. Table 1 demonstrates that the women who prepared the endometrium with vaginal or IM progesterone during fresh and frozen cycles did not significantly differ with regard to number of positive pregnancy tests, χ2 = 4.41, p = .220. Similar outcomes were observed with respect to clinical pregnancy rates, χ2 = 4.68, p = .196.Tabled 1Positive Pregnancy Rate and Clinical Pregnancy RatePregnancy RateClinical Pregnancy RateFresh cycles with vaginal progesterone only80/109 (73.3%)75/109 (68.8%)Frozen cycles with vaginal progesterone only40/52 (77.0%)34/52 (65.3%)Fresh cycles with vaginal and IM progesterone45/57 (79.0%)43/57 (75.4%)Frozen cycles with vaginal and IM progesterone27/37 (73.0%)27/37 (73.0%) Open table in a new tab Preparing the endometrium with oral estradiol and vaginal progesterone gel among recipients treated in a contemporary donor oocyte program is highly effective and not significantly different from utilizing oral estradiol with IM and vaginal progesterone in fresh and frozen embryo transfers.