Dashti Saeideh, Tabibnejad Nasim, Shamsi Farimah, Gandom Behnaz
Research and Clinical Centre for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Research and Clinical Centre for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Email:
Int J Fertil Steril. 2025 Mar 11;19(2):219-225. doi: 10.22074/ijfs.2024.2032890.1720.
Hormone replacement therapy (HRT) is the preferred protocol for endometrial preparation. Progesterone is important for successful implantation and the outcome of assisted reproductive techniques (ART). The impact of serum progesterone concentration on pregnancy outcomes has been extensively studied; however, there are conflicting results for dosage and route of administration. This study investigates the association between serum progesterone levels on embryo transfer day and assisted reproductive technique outcomes in frozen-thawed embryo transfer (FET).
This prospective cohort study was conducted on women who underwent FET. Participants received HRT with 6 mg of oestradiol valerate and 400 mg of micronized vaginal progesterone, along with 50 mg of intramuscular (IM) progesterone for endometrial preparation. Serum progesterone was assessed before embryo transfer. The primary outcome was live birth rate (LBR).
Overall, 190 infertile women underwent cleavage FET and were categorised according to the presence (group I: n=38) or absence (group II: n=152) of live birth. Group I women had significantly higher progesterone levels on the transfer day (34.48 ± 8.95 ng/ml) compared to group II women (29.83 ± 11.076 ng/ml, P=0.008). We divided the serum progesterone values into quartiles and observed significantly lower clinical pregnancy rates in the Q1 quartile (progesterone ≤23.84 ng/ml). Receiver operating characteristic (ROC) curve analysis indicated a significant threshold for progesterone level on the day of embryo transfer in terms of LBR, with an area under the curve (AUC) of 0.64 [95% confidence interval (CI): 0.54-0.73, P<0.001]. The estimated threshold was 26.95 ng/ml, with a sensitivity of 82% and a specificity of 43%.
The present study showed a significant positive association between serum progesterone levels on transfer day and LBR in FET cycles after patients received a combination of vaginal and IM progesterone supplements. Monitoring of serum progesterone in FET cycles are recommended.
激素替代疗法（HRT）是子宫内膜准备的首选方案。孕酮对于成功着床和辅助生殖技术（ART）的结局很重要。血清孕酮浓度对妊娠结局的影响已得到广泛研究；然而，关于剂量和给药途径的结果存在矛盾。本研究调查冻融胚胎移植（FET）中胚胎移植日血清孕酮水平与辅助生殖技术结局之间的关联。
本前瞻性队列研究针对接受FET的女性进行。参与者接受含6mg戊酸雌二醇和400mg微粉化阴道孕酮的HRT，以及50mg肌内注射（IM）孕酮用于子宫内膜准备。在胚胎移植前评估血清孕酮。主要结局是活产率（LBR）。
总体而言，190名不育女性接受了卵裂期FET，并根据活产情况（I组：n = 38）或未活产情况（II组：n = 152）进行分类。与II组女性（29.83±11.076ng/ml，P = 0.008）相比，I组女性在移植日的孕酮水平显著更高（34.48±8.95ng/ml）。我们将血清孕酮值分为四分位数，并观察到Q1四分位数（孕酮≤23.84ng/ml）的临床妊娠率显著更低。受试者工作特征（ROC）曲线分析表明，就LBR而言，胚胎移植日孕酮水平存在显著阈值，曲线下面积（AUC）为0.64 [95%置信区间（CI）：0.54 - 0.73，P < 0.001]。估计阈值为26.95ng/ml，敏感性为82%，特异性为43%。
本研究表明，在患者接受阴道和IM孕酮补充剂联合治疗后的FET周期中，移植日血清孕酮水平与LBR之间存在显著正相关。建议在FET周期中监测血清孕酮。
