Highlights
- •Limited data exist comparing subcutaneous (sc) and vaginal progesterone (P) in HRT
- •No patient using sc P twice-daily needed additional P as a rescue protocol
- •15.8 % of patients using vaginal P gel twice-daily needed additional P as rescue
- •sc P alone and vaginal P with rescue yield comparable ongoing pregnancy rates in HRT
Abstract
Research Question
Does subcutaneous (sc) progesterone (P) administration support ongoing pregnancy rates
(OPRs) similar to vaginal P using a rescue protocol in hormone replacement therapy
(HRT) frozen embryo transfer (FET) cycles?
Design
Retrospective cohort study. Two sequential cohorts, vaginal P gel (December 2019-October
2021; n=474) and sc P (November 2021-November 2022; n=249) were compared. Following
estrogen priming, sc P 25 mg twice-daily or vaginal P gel 90 mg twice-daily were administered.
Serum progesterone (P4) was measured one day prior to warmed blastocyst transfer, i.e. day 5 of P administration.
In patients with serum P4 levels <8.75 ng/ml, additional sc P (rescue; 25 mg) was provided.
Results
In the vaginal P group, a total of 15.8 % had serum P4 <8.75 ng/ml and received rescue whereas no patient in the sc P group received rescue.
The OPRs were comparable between the sc P group without rescue and the vaginal P group
with rescue. After rescue, the route of P administration was not a significant predictor
of ongoing pregnancy. The impact of different serum P4 levels on reproductive outcomes was evaluated by percentiles (<10th, 10–49th, 50–90th and >90th percentiles), taking the >90th percentile as the reference subgroup. In the vaginal as well as the sc P group all
serum P4 percentile sub-groups had similar OPR`s.
Conclusions
Subcutaneous P 25 mg, twice-daily secures a serum P4 above 8.75 ng/ml whereas additional exogenous P (rescue) was needed in 15.8% of patients
receiving vaginal P. The sc and vaginal P routes, with rescue if needed, yield comparable
OPRs.
Key words
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Biography
Hakan Yarali is a specialist in reproductive endocrinology at Anatolia IVF, one of the busiest IVF centres in Turkey, and is also Professor at Hacettepe University, Ankara, Turkey. His special interests are in all clinical aspects of IVF. He has authored more than 130+ articles, eight book chapters and delivered over 50 lectures worldwide.
Article info
Publication history
Accepted:
May 10,
2023
Received in revised form:
May 7,
2023
Received:
January 12,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
