Dikbaş Levent, Dahan Michael H
Reyap Hospital IVF Center, Tekirdağ, Türkiye.
Department of Obstetrics and Gynecology, McGill University, Québec, Canada.
J Turk Ger Gynecol Assoc. 2025 Sep 3;26(3):157-166. doi: 10.4274/jtgga.galenos.2025.2025-1-13. Epub 2025 Aug 13.
To investigate the potential influence of serum estradiol (E) and progesterone (P) levels, measured one day before artificially prepared frozen embryo transfer (FET), on pregnancy rates in women who received combined vaginal and injectable P.
This retrospective cohort study analyzed the association between serum E and P levels on the day before FET in 167 cases prepared with hormone replacement therapy between February 2022 and October 2023. The primary outcomes assessed were the pregnancy and live birth rates. We modeled a cut-off serum value based on luteal support for pregnancy. Luteal support was through a combination of vaginal suppositories and subcutaneous injections. Multivariate logistic regression was used to test relationships between pregnancy outcomes and independent variables. Cut-off values were evaluated using receiver operating characteristic (ROC) analysis and percentile analysis.
No significant relationships were found between serum E or P levels on the day before FET and pregnancy rates. The mean E level was 169.0±51.9 pg/mL for individuals who achieved conception and 177.7±56.9 pg/mL for individuals who did not conceive (p=0.45). The corresponding values for P were 28.1±18.4 ng/mL and 31.2±25.4 ng/mL, respectively (p=0.73). No differences were observed in body mass index (BMI) or endometrial thickness between the groups. Cut-off values for predicting pregnancy using E and P could not be determined using ROCs. However, no one in the lowest 10 percentile of serum P levels conceived (range 10.0-15.6 ng/mL). When multivariate logistic regression was used, this finding lost significance suggesting that low serum levels are related to age, BMI, and/or other factors.
In artificially prepared FET cycles, the serum E and P levels one day before embryo transfer do not significantly affect pregnancy rates in women with serum E levels between 150-300 pg/mL and P between 10-40 ng/mL when ROC was used for evaluation. However, percentile analysis suggests that serum P levels should be more than 15.6 ng/mL when combined injectable and vaginal P is used for programmed FET. Although this finding may be due to the confounding effects of age, BMI, and other factors affecting steroid metabolism, when controlled for in the multivariate logistic regression.
探讨在人工准备的冷冻胚胎移植（FET）前一天测得的血清雌二醇（E）和孕酮（P）水平对接受阴道和注射用P联合治疗的女性妊娠率的潜在影响。
这项回顾性队列研究分析了2022年2月至2023年10月间167例接受激素替代疗法准备的FET前一天血清E和P水平之间的关联。评估的主要结局是妊娠率和活产率。我们基于黄体支持妊娠建立了血清临界值模型。黄体支持通过阴道栓剂和皮下注射联合进行。采用多因素逻辑回归分析来检验妊娠结局与自变量之间的关系。使用受试者工作特征（ROC）分析和百分位数分析来评估临界值。
FET前一天的血清E或P水平与妊娠率之间未发现显著关系。受孕者的平均E水平为169.0±51.9 pg/mL，未受孕者为177.7±56.9 pg/mL（p = 0.45）。P的相应值分别为28.1±18.4 ng/mL和31.2±25.4 ng/mL（p = 0.73）。两组间体重指数（BMI）或子宫内膜厚度无差异。使用ROC无法确定用E和P预测妊娠的临界值。然而，血清P水平处于最低10百分位数（范围10.0 - 15.6 ng/mL）的患者中无人受孕。当使用多因素逻辑回归分析时，这一发现失去显著性，表明低血清水平与年龄、BMI和/或其他因素有关。
在人工准备的FET周期中，当使用ROC进行评估时，胚胎移植前一天的血清E和P水平对血清E水平在150 - 300 pg/mL且P在10 - 40 ng/mL之间的女性妊娠率无显著影响。然而，百分位数分析表明，在程序化FET中使用注射用和阴道用P联合治疗时，血清P水平应高于15.6 ng/mL。尽管这一发现可能是由于年龄、BMI和其他影响类固醇代谢的因素的混杂效应所致，但在多因素逻辑回归分析中进行了控制。
