■关于当代体外受精(IVF)实践,冷冻胚胎移植(FET)周期的使用已经变得比新鲜移植更为普遍。自然循环(NC),程序化人工周期和轻度刺激周期是原发性子宫内膜准备周期。在FET周期中监测血清孕酮水平是当前研究的重点。胚胎移植当天的低孕酮水平被认为会对妊娠结局产生负面影响。而补充黄体酮可以提高妊娠率。我们试验的目的是评估在胚胎移植当天当tNC-FET中血清孕酮水平低于10ng/mL时开始皮下(SC)孕酮补充是否会导致与具有足够血清孕酮的患者相当的妊娠率。
■回顾性单中心研究于2022年8月至2023年4月进行,共进行了181个tNC-FET。根据胚胎移植(ET)日的血清孕酮浓度(≥10ng/mL和<10ng/mL)将患者分为两组。当血清孕酮<10ng/mL时,在ET当天给予S.c孕酮(25mg),一直持续到孕周。在ET后12天收集用于妊娠试验的血液样品。结果参数是怀孕率,临床妊娠率(CPR),流产率,多胎妊娠率,生化妊娠,和持续妊娠率(OPR)。
■大约一半(49.7%)在ET日具有足够的孕酮浓度(≥10ng/mL)。在妊娠试验阳性方面,两组之间没有显着差异,OPR,多胎妊娠,和流产率(57.8%对52.7%;34.4%对29.7%,1.1%对2.2%;7.8%对5.5%;对于ET日的孕酮浓度≥10ng/mL和<10ng/mL)。55.2%的转移导致临床妊娠,在生化妊娠和CPR方面出现了显着差异(3.3%vs12.1%,P=0.02;54.4%对40.7%,P=0.03,对于ET日≥10ng/mL和<10ng/mL孕酮浓度)。
■这项研究表明,由于孕酮低,将近一半的tNC-FET可能需要黄体期支持。然而,与正常孕酮组相比,25mcsc孕酮挽救了黄体支持,并产生了相似的OPR。需要进一步的研究来了解最佳孕酮水平,补充有效性,以及早期补充FET的潜在好处。
Concerning contemporary in-vitro fertilisation (IVF) practice, the use of frozen embryo transfer (FET) cycles has become more common than fresh transfers. Natural cycle (NC), programmed artificial cycle and mild stimulation cycle are primary endometrium preparation cycles. Monitoring serum progesterone levels in FET cycles are in the scope of current research focus. Low progesterone levels on the day of embryo transfer is presumed to negatively affect pregnancy outcomes, while progesterone supplementation may improve pregnancy rates. The purpose of our trial is to evaluate whether initiating subcutaneous (SC) progesterone supplementation on the day of embryo transfer when serum progesterone levels are below 10 ng/mL in tNC-FET will result in pregnancy rates comparable to those of patients with sufficient serum progesterone.
Retrospective single centre study was conducted between August 2022 and April 2023 with 181 tNC-FETs. Patients were separated into groups according to serum progesterone concentrations (≥10 ng/mL and <10 ng/mL) on embryo transfer (ET) day. S.c progesterone (25 mg) was given on the day of ET when serum progesterone was <10 ng/mL, continuing until the 10th gestational week. Blood samples for pregnancy tests were collected 12 days after ET. Outcome parameters were pregnancy rate, clinical pregnancy rate (CPR), miscarriage rate, multiple pregnancy rate, biochemical pregnancy, and ongoing pregnancy rate (OPR).
About half (49.7%) had adequate progesterone concentrations (≥10ng/mL) on ET day. There was no significant difference between the groups regarding positive pregnancy test, OPR, multiple pregnancies, and miscarriage rates (57.8% versus 52.7%; 34.4% versus 29.7%, 1.1% versus 2.2%; 7.8% versus 5.5%; respectively, for progesterone concentrations on ET day ≥10 ng/mL and <10 ng/mL). With 55.2% of transfers leading to clinical pregnancy, significant differences emerged in biochemical pregnancy and CPR (3.3% vs 12.1%, P=0.02; 54.4% vs 40.7%, P=0.03, for ≥10 ng/mL and <10 ng/mL progesterone concentrations on ET day).
This study indicates that nearly half of the tNC-FETs may need luteal phase support due to low progesterone. However, 25 mc sc progesterone rescued the luteal support and yielded similar OPR as compared to normal progesterone group. Further studies are needed for understanding optimal progesterone levels, supplementation effectiveness, and potential benefits of earlier supplementation in FETs.