Abstract
BackgroundMore than 67% of all embryos transferred in the United States involve frozen-thawed embryos. Progesterone supplementation is necessary in medicated cycles to luteinize the endometrium and prepare it for implantation, but little data is available to show if this is beneficial in true natural cycles. We evaluated the use of luteal phase progesterone supplementation for cryopreserved/warmed blastocyst transfers in true natural cycles not using an ovulatory trigger.MethodsRetrospective cohort study in a single academic medical center. We studied the use of luteal phase progesterone supplementation in patients undergoing true natural cycle cryopreserved blastocyst embryo transfers. Our primary outcome measure was ongoing pregnancy rate, with other pregnancy outcomes being evaluated (i.e. implantation rate, miscarriage rate, ectopic rate, and multifetal gestation). Categorical data were analyzed utilizing Fisher’s exact test and all binary variables were analyzed using log-binomial regression to produce a risk ratio.ResultsTwo hundred twenty-nine patients were included in the analysis with 149 receiving luteal phase progesterone supplementation and 80 receiving no luteal phase support. Patient demographic and cycle characteristics, and embryo quality were similar between the two groups. No difference was seen in ongoing pregnancy rate (49.0% vs. 47.5%, p = 0.8738), clinical pregnancy rate (50.3% vs. 47.5%, p = 0.7483), positive HCG rate (62.4% vs. 57.5%, p = 0.5965), miscarriage/abortion rate (5.4% vs. 2.5%, p = 0.2622), ectopic pregnancy rate (0% vs. 1.3%, p = 0.3493), or multifetal gestations (7.4% vs. 3.8%, p = 0.3166).Conclusion(s)The addition of luteal phase progesterone support in true natural cycle cryopreserved blastocyst embryo transfers did not improve pregnancy outcomes and therefore the routine use in practice cannot be recommended based on this study, but the utilization should not be discouraged without further studies.CapsuleProgesterone supplementation as luteal phase support in true natural cycle cryopreserved blastocyst transfers does not improve ongoing pregnancies.
Highlights
As of 2017, more than two thirds of all embryo transfers in the United States involve frozen-thawed embryos with an increasing trend towards freeze-thaw cycles [1]
The cycle is referred to as a “true” natural cycle cryopreserved embryo transfer (CET) and the timing of ovulation is usually determined by Luteinizing Hormone (LH) assay
In the group receiving supplementation, no apparent differences were noted in the progesterone supplementation group compared with the control group for patient demographics as related to age, BMI, gravity, parity, infertility diagnosis, AMH, race/ethnicity, number of prior transfers at our institution, or lack of prior transfers (Table 1.)
Summary
As of 2017, more than two thirds of all embryo transfers in the United States involve frozen-thawed embryos with an increasing trend towards freeze-thaw cycles [1]. The natural cycle takes advantage of estrogen production by the dominant follicle in the follicular phase and a subsequent shift to progesterone production by the corpus luteum after ovulation to prepare a receptive endometrium for implantation. In this setting, the cycle is referred to as a “true” natural cycle cryopreserved embryo transfer (CET) and the timing of ovulation is usually determined by Luteinizing Hormone (LH) assay. A “modified” natural cycle CET, involves use of an exogenous ovulatory trigger, which facilitates the timing of ovulation and subsequent embryo transfer. We evaluated the use of luteal phase progesterone supplementation for cryopreserved/warmed blastocyst transfers in true natural cycles not using an ovulatory trigger
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