Department of Obstetrics and Gynecology, Bezmialem University Faculty of Medicine Istanbul, Turkey.
Department of Obstetrics and Gynecology, Bezmialem University Faculty of Medicine Istanbul, Turkey.
Reprod Biomed Online. 2022 Oct;45(4):785-792. doi: 10.1016/j.rbmo.2022.05.023. Epub 2022 Jun 1.
What is the efficacy and possible positive effect of additional rescue subcutaneous (s.c.) progesterone therapy for restoration of progesterone concentration on embryo transfer day and pregnancy rates during programmed artificial frozen embryo transfer (FET) cycles with vaginal progesterone tablet plus i.m. progesterone?
Multicentre prospective cohort study (NCT04769401) including a total of 238 programmed artificial FET between February 2021 and September 2021. Patients were divided into ≥10 ng/ml and <10 ng/ml according to serum progesterone concentrations on embryo transfer day; 25 mg of s.c. progesterone was added to patients with <10 ng/ml; blood samples were taken 2 days later. The primary outcome was the ongoing pregnancy rate.
The proportion of patients having ≥10 ng/ml serum progesterone concentrations on embryo transfer day was 70.7%. There was no statistically significant difference with regard to cumulative pregnancy rate, ongoing pregnancy rate and miscarriage between the groups (55.4% versus 61.5%, P = 0.4; 78.2% versus 72.5% per pregnancy, P = 0.5; 21.8% versus 27.5%, P = 0.5, respectively, ≥10 ng/ml and <10 ng/ml). Eighty-three per cent of patients with low serum progesterone concentrations on embryo transfer day reached an adequate progesterone concentration with rescue s.c. progesterone treatment; 90% of pregnancy rates in patients with serum progesterone concentrations <10 ng/ml on embryo transfer day were in patients who reached adequate serum progesterone concentrations with daily rescue s.c. progesterone treatment.
The measurement of serum progesterone concentrations on embryo transfer day may create the opportunity for rescue progesterone administration on that day for patients who fail to reach adequate serum progesterone concentrations, achieving similar pregnancy rates without cancellation of the cycle.
在阴道孕酮片加肌内孕酮进行程序化人工冻融胚胎移植（FET）周期中，对于胚胎移植日孕酮浓度恢复和妊娠率，额外的皮下（s.c.）孕酮补救治疗是否具有疗效和可能的积极影响？
多中心前瞻性队列研究（NCT04769401），纳入 2021 年 2 月至 2021 年 9 月期间共 238 例程序化人工 FET。根据胚胎移植日血清孕酮浓度，患者分为≥10ng/ml 和<10ng/ml；<10ng/ml 的患者加用 25mg s.c.孕酮；2 天后采血。主要结局为持续妊娠率。
胚胎移植日血清孕酮浓度≥10ng/ml 的患者比例为 70.7%。两组间累积妊娠率、持续妊娠率和流产率无统计学差异（55.4%比 61.5%，P=0.4；每妊娠 78.2%比 72.5%，P=0.5；21.8%比 27.5%，P=0.5）。83%的胚胎移植日血清孕酮浓度低的患者经补救 s.c.孕酮治疗后达到足够的孕酮浓度；90%的胚胎移植日血清孕酮浓度<10ng/ml 的患者，经每日补救 s.c.孕酮治疗后达到足够的血清孕酮浓度，妊娠率为 90%。
在胚胎移植日测量血清孕酮浓度可能为当天未能达到足够血清孕酮浓度的患者提供补救孕酮治疗的机会，而无需取消周期，可获得相似的妊娠率。
