Advertisement
JOGC

Retrospective Review of Reproductive Outcomes Comparing Vaginal Progesterone to Intramuscular Progesterone as Luteal Support in Frozen Embryo Transfer Cycles

Published:April 04, 2022DOI:https://doi.org/10.1016/j.jogc.2022.03.009

      Abstract

      Objective

      Recent literature suggests that progesterone in oil (PIO) is superior to vaginal progesterone (VP; Prometrium) for endometrial preparation in frozen embryo transfer cycles (FET), improving the live birth rate and reducing the rate of miscarriage. PIO has disadvantages including cost, pain, and stress of administration. The objective of this study was to evaluate whether VP is non-inferior to PIO for medicated FET cycles.

      Methods

      We conducted a retrospective analysis comparing pregnancy, miscarriage, and live birth rates for PIO versus VP for medicated FET cycles, from 2017 to 2020 at a single fertility clinic. A total of 745 participants were included in the study; 438 received VP, and 307 received PIO. Univariate and multivariate binary and ordinal logistic regression analyses were performed to compare the rates of pregnancy, miscarriage, and live birth between VP and PIO.

      Results

      Our data demonstrated no difference between PIO and VP with respect to the rates of pregnancy (51% vs. 53%), miscarriage (20% vs. 18%), or live birth (31% vs. 34%) (all P > 0.05). For participants taking PIO, the odds of pregnancy were 0.93 [95% CI (0.70, 1.25), P = 0.65] that of participants on VP.

      Conclusion

      In our single-centre experience, VP was non-inferior to PIO for endometrial preparation in FET cycles.

      Résumé

      Objectif

      La littérature récente suggère que l’injection de progestérone (IP) est supérieure aux capsules vaginales de progestérone (CVP; Prometrium) pour la préparation de l’endomètre avant un cycle de transfert d’embryons congelés (TEC), qu’elle améliore le taux de naissances vivantes et qu’elle réduit le taux de fausses couches. L’IP présente des inconvénients, notamment le coût élevé ainsi que la douleur et le stress liés à l’administration. L’objectif de cette étude était d'évaluer si les CVP est non-inférieur à l'IP pour les cycles de TEC.

      Méthodologie

      Nous avons réalisé une analyse rétrospective pour comparer l’effet des IP et des CVP administrées pendant les cycles de TEC sur les taux de grossesse, d’avortement spontané et de naissances vivantes, pour la période de 2017 à 2020 dans une clinique de fertilité. Un total de 745 participantes ont été incluses dans l’étude; de ce nombre, 438 ont reçu des CVP et 307, des IP. Des analyses de régression logistique binaire et ordinale univariée et multivariée ont été effectuées pour comparer les taux de grossesse, d’avortement spontané et de naissances vivantes entre les groupes CVP et IP.

      Résultats

      Nos données ne montrent aucune différence entre les groupes IP et CVP relativement aux taux de grossesse (51 % p/r à 53 %), d’avortement spontané (20 % p/r à 18 %) et de naissances vivantes (31 % p/r à 34 %) (toutes les valeurs de p > 0,05). Pour le groupe IP, la probabilité de grossesse était de 0,93 [IC 95 % (0,70, 1,25), p = 0,65] par rapport au groupe CVP.

      Conclusion

      Selon notre analyse monocentrique, les CVP ne se sont pas révélées inférieures aux IP pour la préparation de l’endomètre aux cycles de TEC.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Obstetrics and Gynaecology Canada
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Csapo A.I.
        • Pulkkinen M.O.
        • Ruttner B.
        • et al.
        The significance of the human corpus luteum in pregnancy maintenance. I. Preliminary studies.
        Am J Obstet Gynecol. 1972; 112: 1061-1067
        • Fritz M.A.
        Clinical gynecologic endocrinology and infertility.
        Lippincott Williams & Wilkins, Philadelphia, PA2010
        • Casper R.F.
        • Yanushpolsky E.H.
        Optimal endometrial preparation for frozen embryo transfer cycles: window of implantation and progesterone support.
        Fertil Seril. 2016; 105: 867-872
        • Devine K.
        • Richter K.S.
        • Widra E.A.
        • et al.
        Vitrified blastocyst transfer cycles with the use of only vaginal progesterone replacement with Endometrin have inferior ongoing pregnancy rates: results from the planned interim analysis of a three-arm randomized controlled noninferiority trial.
        Fertil Steril. 2018; 109: 266-275
        • Wang Y.
        • He Y.
        • Zhao X.
        • et al.
        Crinone Gel for luteal phase support in frozen-thawed embryo transfer cycles: a prospective randomized clinical trial in the Chinese population.
        PLoS One. 2015; 10e0133027
        • Devine K.
        • Richter K.S.
        • Jahandideh S.
        • et al.
        Intramuscular progesterone optimizes live birth from programmed frozen embryo transfer: a randomized clinical trial.
        Fertil Steril. 2021; 116: 633-643
        • Phy J.L.
        • Weiss W.T.
        • Weiler C.R.
        • et al.
        Hypersensitivity to progesterone-in-oil after in vitro fertilization and embryo transfer.
        Fertil Steril. 2003; 80: 1272-1275
        • Huisman D.
        • Raymakers X.
        • Hoomans E.H.
        Understanding the burden of ovarian stimulation: fertility expert and patient perceptions.
        Reprod Biomed Online. 2009; 19: 5-10
        • Paulson R.J.
        • Collins M.G.
        • Yankov V.I.
        Progesterone pharmacokinetics and pharmacodynamics with 3 dosages and 2 regimens of an effervescent micronized progesterone vaginal insert.
        J Clin Endocrinol Metab. 2014; 99: 4241-4249
        • Blake E.
        • Norris P.
        • Dorfman S.
        • et al.
        Single and multidose pharmacokinetic study of vaginal micronized progesterone insert (Endometrin) compared with vaginal gel in healthy reproductive-aged female subjects.
        Fertil Steril. 2009; 94: 1296-1301
        • Labarta E.
        • Mariani G.
        • Holtmann N.
        • et al.
        Low serum progesterone on the day of embryo transfer is associated with a diminished ongoing pregnancy rate in oocyte donation cycles after artificial endometrial preparation: a prospective study.
        Hum Reprod. 2017; 32: 2437-2442
        • Labarta E.
        • Mariani G.
        • Rodriguez-Varela C.
        • et al.
        Individualized luteal phase support normalizes live birth rate in women with low progesterone levels on the day of embryo transfer in artificial endometrial preparation cycles.
        Fertil Steril. 2021; 117: 96-103
        • Ghobara T.
        • Gelbaya T.A.
        • Olugbenga Ayeleke R.
        Cycle regimens for frozen-thawed embryo transfer.
        Cochrane Database Syst Rev. 2017; 7: CD003414
        • Abdelhakim A.M.
        • Abd-ElGawad M.
        • Hussein R.S.
        • et al.
        Vaginal versus intramuscular progesterone for luteal phase support in assisted reproductive techniques: a systematic review and meta-analysis of randomized controlled trials.
        Gynecol Endocrinol. 2020; 36: 389-397
        • Liu Y.
        • Wu Y.
        Progesterone intramuscularly or vaginally administration may not change live birth rate or neonatal outcomes in artificial frozen-thawed embryo transfer cycles.
        Front Endocrinol. 2020; 11
        • Leonard P.H.
        • Hokenstad A.N.
        • Khan Z.
        • et al.
        Progesterone support for frozen embryo transfer: intramuscular versus vaginal suppository demonstrates no difference in a cohort.
        J Reprod Med. 2015; 60: 103-108