Waldman Ian N, Racowsky Catherine, Disler Emily R, Thomas Ann, Lanes Andrea, Hornstein Mark D
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
Fertil Res Pract. 2021 Feb 9;7(1):4. doi: 10.1186/s40738-021-00096-5.
More 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.
Retrospective 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.
Two 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.
Progesterone supplementation as luteal phase support in true natural cycle cryopreserved blastocyst transfers does not improve ongoing pregnancies.
在美国，超过67%的胚胎移植涉及冻融胚胎。在药物治疗周期中，补充孕酮以使子宫内膜黄体化并为着床做准备是必要的，但几乎没有数据表明这在真正的自然周期中是否有益。我们评估了在不使用排卵触发剂的真正自然周期中，黄体期补充孕酮用于冷冻保存/解冻囊胚移植的情况。
在一个单一的学术医学中心进行回顾性队列研究。我们研究了在接受真正自然周期冷冻保存囊胚胚胎移植的患者中黄体期补充孕酮的使用情况。我们的主要结局指标是持续妊娠率，同时评估其他妊娠结局（即着床率、流产率、异位妊娠率和多胎妊娠）。分类数据采用Fisher精确检验进行分析，所有二元变量采用对数二项回归进行分析以得出风险比。
229例患者纳入分析，其中149例接受黄体期孕酮补充，80例未接受黄体期支持。两组患者的人口统计学和周期特征以及胚胎质量相似。持续妊娠率（49.0%对47.5%，p = 0.8738）、临床妊娠率（50.3%对47.5%，p = 0.7483）、HCG阳性率（62.4%对57.5%，p = 0.5965）、流产/堕胎率（5.4%对2.5%，p = 0.2622）、异位妊娠率（0%对1.3%，p = 0.3493）或多胎妊娠（7.4%对3.8%，p = 0.3166）均无差异。
在真正自然周期冷冻保存囊胚胚胎移植中添加黄体期孕酮支持并不能改善妊娠结局，因此基于本研究不建议在实践中常规使用，但在没有进一步研究的情况下也不应阻止使用。
在真正自然周期冷冻保存囊胚移植中作为黄体期支持补充孕酮并不能提高持续妊娠率。
