IVIRMA Valencia, Valencia, Spain; IVI Foundation, Valencia, Spain.
IVIRMA Valencia, Valencia, Spain; IVIRMA Roma, Roma, Italy.
Fertil Steril. 2022 Jan;117(1):96-103. doi: 10.1016/j.fertnstert.2021.08.040. Epub 2021 Sep 20.
To analyze the impact on live birth rates (LBRs) of the individualized luteal phase support (termed iLPS) in patients with low serum progesterone (P) levels compared with patients without iLPS.
Retrospective cohort study, December 1, 2018, to May 30, 2019.
Private medical center.
PATIENT(S): A total of 2,275 patients checked for serum P on the day of blastocyst transfer were analyzed. During the study period, 1,299 patients showed serum P levels of ≥9.2 ng/mL, whereas 550 showed serum P levels of <9.2 ng/mL and received iLPS. Additionally, a historical group of 426 patients with serum P levels of <9.2 ng/mL but no iLPS were used for comparison. Eligible patients were aged ≤50 years with adequate endometrium morphology after receiving estrogens. Luteal phase support was provided with micronized vaginal P (MVP) to all women. Patients with personalized initiation of exogenous P according to the endometrial receptivity assay test, polyps, fibroids distorting the cavity, or hydrosalpinx were not included in the analysis.
INTERVENTION(S): As routine practice since December 2018, patients with low serum P levels received an iLPS with a daily injection of 25 mg of subcutaneous P from the day of embryo transfer (ET) in addition to standard LPS (400 mg of MVP twice a day).
MAIN OUTCOME MEASURE(S): Live birth rate.
RESULT(S): The LBR was 44.9% in the iLPS cases vs. 45.0% in patients with normal serum P levels (crude odds ratio [OR], 1.0; 95% confidence interval [CI], 0.82-1.22). By regression analysis, low serum P levels did not affect the LBR after adjusting for possible confounders (age, oocyte origin, fresh vs. frozen, day of ET, embryo quality, number of embryos transferred) (adjusted OR, 0.99; 95% CI, 0.79-1.25). Similarly, no differences were observed in other pregnancy outcomes between groups. The LBR was significantly higher in the group of patients who received additional subcutaneous P (iLPS) compared with the historical group with low serum P levels and no iLPS (44.9% vs. 37.3%; OR, 1.37; 95% CI, 1.06-1.78). In the overall population, patients showing P levels of <9.2 ng/mL on the day of ET were slightly younger and had higher body mass index and lower estradiol and P levels during the proliferative phase compared with patients with P levels of ≥9.2 ng/mL. No differences were observed with regard to the time in between the last dose of MVP and the serum P determination. After a multivariable logistic regression analysis, only body mass index and estradiol levels in the proliferative phase reminded statistically significant. Significant differences in the LBR were observed between patients with serum P levels of <9.2 ng/mL without iLPS and patients with serum P levels of ≥9.2 ng/mL when using either own or donated oocytes.
CONCLUSION(S): Individualized LPS for patients with low serum P levels produces LBRs similar to those of patients with adequate serum P levels.
分析与未行黄体期支持（iLPS）的患者相比，血清孕激素（P）水平低的患者行个体化黄体期支持（iLPS）对活产率（LBR）的影响。
回顾性队列研究，2018 年 12 月 1 日至 2019 年 5 月 30 日。
私人医疗中心。
分析了 2275 名在囊胚移植日检查血清 P 的患者。在研究期间，1299 例患者血清 P 水平≥9.2ng/mL，550 例患者血清 P 水平<9.2ng/mL 并接受 iLPS。此外，还使用了 426 例血清 P 水平<9.2ng/mL 但未行 iLPS 的历史组进行比较。合格患者年龄≤50 岁，接受雌激素治疗后子宫内膜形态良好。所有女性均接受微粒化阴道 P（MVP）进行黄体期支持。未将根据子宫内膜容受性检测试验、息肉、扭曲宫腔的肌瘤或输卵管积水而个体化起始外源性 P 的患者纳入分析。
自 2018 年 12 月以来，作为常规治疗，血清 P 水平低的患者在胚胎移植（ET）日开始除标准 LPS（400mg 每日两次 MVP）外，每日接受 25mg 皮下 P 的 iLPS。
活产率。
iLPS 组的 LBR 为 44.9%，血清 P 水平正常组为 45.0%（粗比值比[OR]，1.0；95%置信区间[CI]，0.82-1.22）。通过回归分析，在调整了可能的混杂因素（年龄、卵母细胞来源、新鲜 vs. 冷冻、ET 日、胚胎质量、移植胚胎数）后，低血清 P 水平并不影响 LBR（调整 OR，0.99；95%CI，0.79-1.25）。同样，两组之间其他妊娠结局也无差异。与血清 P 水平低且未行 iLPS 的历史组相比，接受额外皮下 P（iLPS）的患者的 LBR 显著更高（44.9% vs. 37.3%；OR，1.37；95%CI，1.06-1.78）。在总体人群中，与 P 水平≥9.2ng/mL 的患者相比，ET 日 P 水平<9.2ng/mL 的患者年龄稍小，且增殖期的体质量指数、雌二醇和 P 水平更高。在 MVP 末次剂量与血清 P 测定之间的时间无差异。多变量逻辑回归分析后，仅发现体质量指数和增殖期雌二醇水平有统计学意义。当使用自身或捐赠卵母细胞时，血清 P 水平<9.2ng/mL 且未行 iLPS 的患者与血清 P 水平≥9.2ng/mL 的患者的 LBR 存在显著差异。
对于血清 P 水平低的患者行个体化 LPS 可产生与血清 P 水平正常的患者相似的 LBR。
