凍胚植入  黃體素濃度與懷孕率無明顯相關

合併陰道黃體素+注射黃體素  vs.單用陰道黃體素

 合併黃體素濃度較高

https://doi.org/10.1016/j.fertnstert.2023.04.038

Elevated serum progesterone levels before frozen embryo transfer do not negatively impact reproductive outcomes: a large retrospective cohort study

Objective

To evaluate if patients with high serum progesterone levels before frozen embryo transfer (FET) under hormonal replacement therapy present worse reproductive outcomes.

Patient(s)

A total of 3183 FET cycles under hormonal replacement therapy between March 2009 and December 2020 were included. Luteal phase was covered with 200 mg/8h of vaginal micronized progesterone either alone or in combination with a daily subcutaneous injection of 25 mg of progesterone. A total of 1360 cycles corresponded to frozen homologous embryo transfer (ET) (hom-FET), 1024 were euploid ET (eu-FET) after preimplantation genetic testing for aneuploidies (PGT-A), and 799 cycles were frozen heterologous ET (het-FET). All patients presented adequate serum progesterone levels (≥10.6 ng/ml) before the procedure.

Results

Median [P25;P75] serum progesterone level before FET was 14.39 [12.43;17.49] ng/ml. Progesterone levels were significantly higher in the group under vaginal plus subcutaneous progesterone (15.96 [13.74;21.60] vs. 14.09 [12.19;16.95]; P<0.001). No differences in clinical pregnancy, miscarriage and LBR were found according to the use of vaginal or vaginal plus subcutaneous progesterone for each of the groups (hom-FET, eu-FET and het-FET). Live birth rates were comparable among patients in the highest centile of serum progesterone levels (≥p90, (22.33 ng/ml) and the rest of patients (p<90) (43.9 vs 41.3%; P=0.381). Patients with progesterone levels ≥p90 presented lower BMI compared to those in the lower centiles (<p90) (22.62±3.82 vs. 23.32±4.06; P=0.009). After dividing patients in deciles according to serum progesterone levels, no differences in LBR were observed among groups (P=0.938).

No association was observed using a generalized additive model (GAM) between progesterone levels and LBR. A multivariable logistic regression adjusted by oocyte age, type of treatment, BMI, type of luteal phase support and number of embryos transferred was applied for centile 90 and centile 95 of progesterone, and showed that serum progesterone in their highest levels did not negatively impact LBR.

Conclusions

Elevated serum progesterone levels before FET in artificially prepared cycles with vaginal or vaginal plus subcutaneous progesterone do not impair reproductive outcomes.