Abstract
Research question
Does serum progesterone concentration on the day of vitrified–warmed embryo transfer
affect live birth rate (LBR) with hormonal replacement therapy (HRT) cycles?
Design
Observational cohort study of patients (n = 915) undergoing single autologous vitrified–warmed blastocyst transfer under HRT
using vaginal micronized progesterone. Women were included once, between January 2019
and March 2020. Serum progesterone concentration was measured by a single laboratory
on the morning of embryo transfer. The primary end point was LBR. Univariate and multivariate
logistic regression models were used for statistical analyses.
Results
Median (25th–75th percentile) serum progesterone concentration on the day of embryo
transfer was 12.5 ng/ml (9.8–15.3). The LBR was 31.5% (288/915) in the overall population.
No significant differences were found in implantation rates (40.7% versus 44.9%);
LBR was significantly lower in women with a progesterone concentration ≤25th percentile
(≤9.8 ng/ml) (26.1% versus 33.2%, P = 0.045) versus women with a progesterone concentration
>25th percentile. This correlated with a significantly higher early miscarriage rate
(35.9% versus 21.6%, P = 0.005). After adjusting for potential confounding factors in multivariate analysis,
low serum progesterone levels (≤9.8 ng/ml) remained significantly associated with
lower LBR (OR 0.68 95% CI 0.48 to 0.97).
Conclusion
A minimum serum progesterone concentration is needed to optimize reproductive outcomes
in HRT cycles with single autologous vitrified–warmed blastocyst transfer. Whether
modifications of progesterone administration routes, dosage, or both, can improve
pregnancy rates needs further study so that treatment of patients undergoing HRT cycles
can be further individualized.
KEYWORDS
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Biography
Professor Pietro Santulli graduated from the University Paris Descartes. He was appointed Professor in 2018. He oversees the Reproductive Medicine Unit in the department headed by Professor Chapron, Cochin University Hospital, Paris. His main research activities focus on assessment and management of endometriosis and assisted reproductive technologies.
Key message
Serum progesterone levels below a critical threshold (≤9.8 ng/ml) on the day of vitrified–warmed blastocyst transfer led to lower live birth rates in artificial cycles. Further studies need to evaluate whether modification of progesterone administration (route, dosage, or both) can improve live birth rates in this subgroup of patients.
Article info
Publication history
Published online: November 17, 2021
Accepted:
November 10,
2021
Received in revised form:
November 1,
2021
Received:
June 29,
2021
Declaration: The authors report no financial or commercial conflicts of interest.Identification
Copyright
© 2021 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
