Abstract：
OBJECTIVE: Do women with endometriosis who achieve a live birth (LB) after HRT-frozen embryo transfer (HRT-FET) have different progesterone levels on the day of transfer compared to unaffected women?
CONCLUSIONS: In women achieving a LB after HRT-FET, serum progesterone levels on the day of the transfer did not differ between patients with endometriosis and unaffected patients.
BACKGROUND: In HRT-FET, several studies have highlighted the correlation between serum progesterone levels at the time of FET and LB rates. In the pathophysiology of endometriosis, progesterone resistance is typically described in the eutopic endometrium. This has led to the hypothesis that women with endometriosis may require higher progesterone levels to achieve a LB, especially in HRT-FET cycles without a corpus luteum.
METHODS: We conducted an observational cohort study at the university-based reproductive medicine center of our institution, focusing on women who underwent a single autologous frozen blastocyst transfer after HRT using exogenous estradiol and micronized vaginal progesterone for endometrial preparation between January 2019 and December 2021. Women were included only once during the study period. Serum progesterone levels were measured on the morning of the FET by a single laboratory.
METHODS: Patients were divided into groups based on whether they had endometriosis or not and whether they achieved a LB. The diagnosis of endometriosis was based on published imaging criteria (transvaginal sonography/magnetic resonance imaging) and/or confirmed histology. The primary outcome was progesterone levels on the day of the HRT-FET leading to a LB in patients with endometriosis compared to unaffected women. Subgroup analyses were performed based on the presence of deep infiltrating endometriosis or adenomyosis.
RESULTS: A total of 1784 patients were included. The mean age of the women was 35.1 ± 4.1 (SD) years. Five hundred and sixty women had endometriosis, while 1224 did not. About 179/560 (32.0%) with endometriosis and 381/1224 (31.2%) without endometriosis achieved a LB. Among women who achieved a LB after HRT-FET, there was no significant difference in the mean progesterone level on the day of the HRT-FET between those with endometriosis and those without (13.6 ± 4.3 ng/ml vs 13.2 ± 4.4 ng/ml, respectively; P = 0.302). In the subgroup of women with deep infiltrating endometriosis (n = 142) and adenomyosis (n = 100), the mean progesterone level was 13.1 ± 4.1 ng/ml and 12.6 ± 3.7 ng/ml, respectively, with no significant difference compared to endometriosis-free patients. After adjusting for BMI, parity, duration of infertility, tobacco use, and geographic origin, neither the presence of endometriosis (coefficient 0.38; 95% CI: -0.63 to 1.40; P = 0.457) nor the presence of adenomyosis (coefficient 0.97; 95% CI: -0.24 to 2.19; P = 0.114) was associated with the progesterone level on the day of HRT-FET. Among women who did not conceive, there was no significant difference in the mean progesterone level on the day of the HRT-FET between those with endometriosis and those without (P = 0.709).
CONCLUSIONS: The primary limitation of our study is associated with its observational design. Extrapolating our results to other laboratories or different routes and/or dosages of administering progesterone also requires validation.
CONCLUSIONS: This study shows that patients diagnosed with endometriosis do not require higher progesterone levels on the day of a frozen blastocyst transfer to achieve a LB in hormonal replacement therapy cycles.
BACKGROUND: None declared.
BACKGROUND: N/A.
CONCLUSIONS: In women achieving a LB after HRT-FET, serum progesterone levels on the day of the transfer did not differ between patients with endometriosis and unaffected patients.
BACKGROUND: In HRT-FET, several studies have highlighted the correlation between serum progesterone levels at the time of FET and LB rates. In the pathophysiology of endometriosis, progesterone resistance is typically described in the eutopic endometrium. This has led to the hypothesis that women with endometriosis may require higher progesterone levels to achieve a LB, especially in HRT-FET cycles without a corpus luteum.
METHODS: We conducted an observational cohort study at the university-based reproductive medicine center of our institution, focusing on women who underwent a single autologous frozen blastocyst transfer after HRT using exogenous estradiol and micronized vaginal progesterone for endometrial preparation between January 2019 and December 2021. Women were included only once during the study period. Serum progesterone levels were measured on the morning of the FET by a single laboratory.
METHODS: Patients were divided into groups based on whether they had endometriosis or not and whether they achieved a LB. The diagnosis of endometriosis was based on published imaging criteria (transvaginal sonography/magnetic resonance imaging) and/or confirmed histology. The primary outcome was progesterone levels on the day of the HRT-FET leading to a LB in patients with endometriosis compared to unaffected women. Subgroup analyses were performed based on the presence of deep infiltrating endometriosis or adenomyosis.
RESULTS: A total of 1784 patients were included. The mean age of the women was 35.1 ± 4.1 (SD) years. Five hundred and sixty women had endometriosis, while 1224 did not. About 179/560 (32.0%) with endometriosis and 381/1224 (31.2%) without endometriosis achieved a LB. Among women who achieved a LB after HRT-FET, there was no significant difference in the mean progesterone level on the day of the HRT-FET between those with endometriosis and those without (13.6 ± 4.3 ng/ml vs 13.2 ± 4.4 ng/ml, respectively; P = 0.302). In the subgroup of women with deep infiltrating endometriosis (n = 142) and adenomyosis (n = 100), the mean progesterone level was 13.1 ± 4.1 ng/ml and 12.6 ± 3.7 ng/ml, respectively, with no significant difference compared to endometriosis-free patients. After adjusting for BMI, parity, duration of infertility, tobacco use, and geographic origin, neither the presence of endometriosis (coefficient 0.38; 95% CI: -0.63 to 1.40; P = 0.457) nor the presence of adenomyosis (coefficient 0.97; 95% CI: -0.24 to 2.19; P = 0.114) was associated with the progesterone level on the day of HRT-FET. Among women who did not conceive, there was no significant difference in the mean progesterone level on the day of the HRT-FET between those with endometriosis and those without (P = 0.709).
CONCLUSIONS: The primary limitation of our study is associated with its observational design. Extrapolating our results to other laboratories or different routes and/or dosages of administering progesterone also requires validation.
CONCLUSIONS: This study shows that patients diagnosed with endometriosis do not require higher progesterone levels on the day of a frozen blastocyst transfer to achieve a LB in hormonal replacement therapy cycles.
BACKGROUND: None declared.
BACKGROUND: N/A.
摘要：
目的：在HRT冷冻胚胎移植（HRT-FET）后达到活产（LB）的子宫内膜异位症妇女与未受影响的妇女相比，在移植当天的孕酮水平是否不同？
结论：在HRT-FET后达到LB的妇女中，子宫内膜异位症患者和未受影响的患者在转移当天的血清孕酮水平没有差异.
背景：在HRT-FET中，几项研究强调了FET时的血清孕酮水平与LB率之间的相关性。在子宫内膜异位症的病理生理学中，孕激素抵抗通常在在位子宫内膜中描述。这导致了这样的假设，即子宫内膜异位症女性可能需要更高的孕酮水平才能达到LB，特别是在没有黄体的HRT-FET周期中。
方法：我们在我们机构的大学生殖医学中心进行了一项观察性队列研究，重点关注在2019年1月至2021年12月期间使用外源性雌二醇和微粉化阴道孕酮进行子宫内膜准备的HRT后接受单次自体冷冻胚泡移植的女性.在研究期间，女性仅被纳入一次。由单个实验室在FET的早晨测量血清孕酮水平。
方法：患者根据是否患有子宫内膜异位症以及是否达到LB分为几组。子宫内膜异位症的诊断基于已公布的影像学标准（经阴道超声检查/磁共振成像）和/或证实的组织学。与未受影响的女性相比，主要结果是HRT-FET当天的孕酮水平导致子宫内膜异位症患者的LB。根据是否存在深部浸润子宫内膜异位症或子宫腺肌症进行亚组分析。
结果：共纳入1784例患者。妇女的平均年龄为35.1±4.1（SD）岁。五百六十个女人有子宫内膜异位症,1224没有。约179/560(32.0%)子宫内膜异位症患者和381/1224(31.2%)无子宫内膜异位症患者取得LB。在HRT-FET后获得LB的女性中，子宫内膜异位症患者和无子宫内膜异位症患者在HRT-FET当天的平均孕酮水平没有显着差异（13.6±4.3ng/mlvs13.2±4.4ng/ml，分别为；P=0.302）。在深部浸润性子宫内膜异位症（n=142）和子宫腺肌病（n=100）的妇女亚组中，平均孕酮水平为13.1±4.1ng/ml和12.6±3.7ng/ml，分别,与无子宫内膜异位症患者相比无显著差异。调整BMI后，奇偶校验，不孕的持续时间，烟草使用,和地理起源，子宫内膜异位症的存在(系数0.38;95%CI:-0.63~1.40;P=0.457)和子宫腺肌病的存在(系数0.97;95%CI:-0.24~2.19;P=0.114)均与HRT-FET当天的孕酮水平无关。在没有怀孕的女性中，子宫内膜异位症患者和无子宫内膜异位症患者在HRT-FET当天的平均孕酮水平没有显着差异（P=0.709）。
结论：我们研究的主要局限性与观察性设计有关。将我们的结果推断到其他实验室或施用孕酮的不同途径和/或剂量也需要验证。
结论：这项研究表明，诊断为子宫内膜异位症的患者在冷冻胚泡移植当天不需要更高的孕酮水平来达到激素替代疗法周期的LB。
背景：无声明。
背景：不适用。
结论：在HRT-FET后达到LB的妇女中，子宫内膜异位症患者和未受影响的患者在转移当天的血清孕酮水平没有差异.
背景：在HRT-FET中，几项研究强调了FET时的血清孕酮水平与LB率之间的相关性。在子宫内膜异位症的病理生理学中，孕激素抵抗通常在在位子宫内膜中描述。这导致了这样的假设，即子宫内膜异位症女性可能需要更高的孕酮水平才能达到LB，特别是在没有黄体的HRT-FET周期中。
方法：我们在我们机构的大学生殖医学中心进行了一项观察性队列研究，重点关注在2019年1月至2021年12月期间使用外源性雌二醇和微粉化阴道孕酮进行子宫内膜准备的HRT后接受单次自体冷冻胚泡移植的女性.在研究期间，女性仅被纳入一次。由单个实验室在FET的早晨测量血清孕酮水平。
方法：患者根据是否患有子宫内膜异位症以及是否达到LB分为几组。子宫内膜异位症的诊断基于已公布的影像学标准（经阴道超声检查/磁共振成像）和/或证实的组织学。与未受影响的女性相比，主要结果是HRT-FET当天的孕酮水平导致子宫内膜异位症患者的LB。根据是否存在深部浸润子宫内膜异位症或子宫腺肌症进行亚组分析。
结果：共纳入1784例患者。妇女的平均年龄为35.1±4.1（SD）岁。五百六十个女人有子宫内膜异位症,1224没有。约179/560(32.0%)子宫内膜异位症患者和381/1224(31.2%)无子宫内膜异位症患者取得LB。在HRT-FET后获得LB的女性中，子宫内膜异位症患者和无子宫内膜异位症患者在HRT-FET当天的平均孕酮水平没有显着差异（13.6±4.3ng/mlvs13.2±4.4ng/ml，分别为；P=0.302）。在深部浸润性子宫内膜异位症（n=142）和子宫腺肌病（n=100）的妇女亚组中，平均孕酮水平为13.1±4.1ng/ml和12.6±3.7ng/ml，分别,与无子宫内膜异位症患者相比无显著差异。调整BMI后，奇偶校验，不孕的持续时间，烟草使用,和地理起源，子宫内膜异位症的存在(系数0.38;95%CI:-0.63~1.40;P=0.457)和子宫腺肌病的存在(系数0.97;95%CI:-0.24~2.19;P=0.114)均与HRT-FET当天的孕酮水平无关。在没有怀孕的女性中，子宫内膜异位症患者和无子宫内膜异位症患者在HRT-FET当天的平均孕酮水平没有显着差异（P=0.709）。
结论：我们研究的主要局限性与观察性设计有关。将我们的结果推断到其他实验室或施用孕酮的不同途径和/或剂量也需要验证。
结论：这项研究表明，诊断为子宫内膜异位症的患者在冷冻胚泡移植当天不需要更高的孕酮水平来达到激素替代疗法周期的LB。
背景：无声明。
背景：不适用。
