scholarly journals P–595 Systematic dydrogesterone supplementation of artificial endometrial preparation cycles for frozen-thawed embryo transfer during Covid–19 pandemic: a good way to limit monitoring visits and optimize outcomes

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
I Cedri. . Durnerin ◽  
M Peigné ◽  
J Labrosse ◽  
M Guerout ◽  
C Vinolas ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Endometrial Thickness ◽  
Pregnancy Rates ◽  
Ongoing Pregnancy ◽  
Live Birth Rates ◽  
Endometrial Preparation ◽  
Time Periods ◽  
Frozen Thawed Embryo Transfer ◽  
Thawed Embryo Transfer

Abstract Study question Does systematic dydrogesterone supplementation in artificial cycles (AC) for frozen-thawed embryo transfer (FET) during Covid–19 pandemic modify outcomes compared to prior individualized supplementation adjusted on serum progesterone (P) levels ? Summary answer Systematic dydrogesterone supplementation in AC for FET is associated with similar outcomes compared to prior individualized supplementation in patients with low P levels. What is known already In AC for FET using vaginal P for endometrial preparation, low serum P levels following P administration have been associated with decreased pregnancy and live birth rates. This deleterious effect can be overcome by addition of other routes of P administration. We obtained effective results by adding dydrogesterone to vaginal P and postponing FET by one day in patients with low P levels. However, in order to limit patient monitoring visits and to schedule better FET activity during Covid–19 pandemic, we implemented a systematic dydrogesterone supplementation without luteal P measurement in artificial FET cycles. Study design, size, duration This retrospective study aimed to analyse outcomes of 394 FET after 2 different protocols of artificial endometrial preparation. From September 2019 to Covid–19 lockdown on 15th March 2020, patients had serum P level measured on D1 of vaginal P administration. When P levels were < 11 ng/ml, dydrogesterone supplementation was administered and FET was postponed by one day. From May to December 2020, no P measurement was performed and dydrogesterone supplementation was systematically used. Participants/materials, setting, methods In our university hospital, endometrial preparation was performed using sequential administration of vaginal estradiol until endometrial thickness reached >7 mm, followed by transdermal estradiol combined with 800 mg/day vaginal micronized P started in the evening (D0). Oral dydrogesterone supplementation (30 mg/day) was started concomitantly to vaginal P in all patients during Covid–19 pandemic and only after D1 P measurement followed by one day FET postponement in patients with P levels <11 ng/ml before the lockdown. Main results and the role of chance During the Covid–19 pandemic, 198 FET were performed on D2, D3 or D5 of P administration with dydrogesterone supplementation depending on embryo stage at cryopreservation. Concerning the 196 FET before lockdown, 124 (63%) were performed after dydrogesterone addition from D1 onwards and postponement by one day in patients with serum P levels <11 ng/ml at D1 while 72 were performed in phase following introduction of vaginal P without dydrogesterone supplementation in patients with P > 11 ng/ml. Characteristics of patients in the 2 time periods were similar for age (34.5 + 5 vs 34.1 + 4.8 years), endometrial thickness prior to P introduction (9.9 + 2.1 vs 9.9 + 2.2 mm), number of transferred embryos (1.3 + 0.5 vs 1.4 + 0.5) , embryo transfer stage (D2/D3/blastocyst: 8/16/76% vs 3/18/79%). No significant difference was observed between both time periods [nor between “dydrogesterone addition and postponement by 1 day” and “in phase” FET before lockdown] in terms of positive pregnancy test (39.4% vs 39.3% [44% vs 30.5%]), heartbeat activity at 8 weeks (29.3% vs 28% [29% vs 26.4%]) and ongoing pregnancy rates at 12 weeks (30.7% but truncated at end of October 2020 vs 25.5% [26.6% vs 23.6%]). Limitations, reasons for caution Full results of the Covid–19 period will be further provided concerning ongoing pregnancy rates as well as comparison of live birth rates and obstetrical and neonatal outcomes. Wider implications of the findings: These results suggest that systematic dydrogesterone supplementation is as effective as individualized supplementation according to serum P levels following administration of vaginal P. This strategy enabled us to schedule easier FET and limit patient visits for monitoring while maintaining optimal results for FET in AC during the Covid–19 pandemic. Trial registration number Not applicable

P–335 Endometrial compaction 5–10% is associated with the best live birth rate in artificial frozen-thawed embryo transfer cycles

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
E Yaprak ◽  
Y E Sukur ◽  
B Ozmen ◽  
M Sonmezer ◽  
B Berker ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Endometrial Thickness ◽  
Live Birth Rate ◽  
Follicular Phase ◽  
Endometrial Preparation ◽  
Frozen Thawed Embryo Transfer ◽  
Thawed Embryo Transfer

Abstract Study question What is the effect of endometrial compaction on live birth rate in frozen-thawed embryo transfer (FET) cycles? Summary answer In FET cycles with artificial endometrial preparation, the chance for live birth was significantly higher in cycles with endometrial compaction. What is known already Most studies conclude that thinner the endometrium poorer the pregnancy outcome. These studies mostly include measurements in the follicular phase. Since endometrial thickness indicates receptivity, one may expect the endometrial thickness measured on ET day to be more important to predict the outcome. However, few studies assessed endometrial thickness on ET day and unlike follicular phase studies conflicting results were obtained regarding pregnancy outcome. The change in endometrial thickness may be more valuable to predict the pregnancy outcome rather than a single measurement. Study design, size, duration Retrospective observational cohort study. 283 FET cycles in which all patients underwent artificial endometrial preparation were reviewed. Participants/materials, setting, methods: The inclusion criteria were artificial endometrial preparation, age between 20–38 years. The same protocol was applied to all patients for the endometrial preparation.The change of endometrial thickness between the end of estrogen phase and embryo transfer day was recorded. Any decrement is defined as endometrial compaction. The patients were grouped according to the changes of endometrial thicknesses as compaction and non-compaction. Main results and the role of chance Among 283 cycles, 89 had endometrial compaction and 194 did not have compaction. The clinical pregnancy, implantation and live birth rates were significantly higher in the compaction group when compared to non-compaction group (P values 0.007, 0.009, and 0.039, respectively). In order to evaluate the results according to the degree of compaction, we divided the patients into 5% compaction slices. The live birth rate was significantly higher in the 5–10% compaction group (P = 0.016). A multivariable logistic regression analysis was performed to examine the independent effects of different variables on live birth chance.In FET cycles with artificial endometrial preparation, the chance for live birth was significantly higher in cycles with endometrial compaction (OR: 2.352, 95% confidence interval {CI} 1.297–4.264, P = 0.005). A receiver operating characteristic (ROC) curve analysis was performed to evaluate whether there was a certain threshold of endometrial thickness at the end of estrogen phase for endometrial compaction to occur. The sensitivity and specificity of 9.25 mm at the end of estrogen phase calculated from the ROC curve were 76.4% and 58.8%, respectively (area under the curve: 0.701, 95% CI 0.640–0.763; P < 0.001). Limitations, reasons for caution The main limitations of the study were its retrospective nature, relatively small sample size and utilization of different ultrasound techniques at different measurements (using transvaginal ultrasound at the end of the estrogen phase and transabdominal ultrasound on ET day). Wider implications of the findings: Recently a cohort study they found that endometrial compaction results in better pregnancy outcomes, similar to our findings. But, this is the first study to suggest a threshold value (9.2) for endometrial thickness before the commencement of progesterone in regards to increase the chance of compaction. Trial registration number Not applicable

P–691 How predictive is endometrial thickness for live birth after fresh and frozen-thawed embryo transfer when no cut-off is employed?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
E Turkgeldi ◽  
B Shakerian ◽  
S Yildiz ◽  
I Keles ◽  
B Ata
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Endometrial Thickness ◽  
Treatment Success ◽  
University Hospital ◽  
Registration Number ◽  
Fresh Frozen ◽  
Frozen Thawed Embryo Transfer ◽  
Thawed Embryo Transfer

Abstract Study question Does endometrial thickness (EMT) predict live birth (LB) after fresh and frozen-thawed embryo transfer (ET) and is there a lower EMT cut-off for ET? Summary answer Once intracavitary pathology and inadvertent progesterone exposure is excluded, EMT is not predictive for LB. EMT is not linearly associated with probability of LB. What is known already EMT is commonly used as a marker of endometrial receptivity and in turn, assisted reproductive technology treatment success. ET is often cancelled or postponed if EMT is below an arbitrary cut-off. However, the available evidence on the relationship between EMT and LB rates is conflicting and too dubious to hold such strong stance. An overwhelming majority of the studies on the subject are retrospective, they use different arbitrary cut off values ranging between 6 to 9 mm with heterogeneous stimulation and transfer protocols. Study design, size, duration Records of all women who underwent fresh or frozen-thawed ET in Koc University Hospital Assisted Reproduction Unit between October 2016 - August 2019 were retrospectively screened. All women who underwent fresh or frozen-thawed blastocyst transfer during the study period were included. Every woman contributed to the study with only one transfer cycle for each category, i.e., fresh ET and frozen-thawed ET. Participants/materials, setting, methods After ruling out endometrial pathology, EMT was measured on the day of ovulation trigger for fresh ET cycles, and on the day of progesterone commencement for frozen-thawed ET. ET was carried out, regardless of EMT, if there was no suspicion of inadvertent progesterone exposure, i.e., due to follicular phase progesterone elevation in fresh or premature ovulation in frozen ET cycles. Main results and the role of chance 560 ET cycles, 273 fresh and 287 frozen-thawed, were analyzed. EMT varied from 4mm to 18mm. EMT were similar between women who achieved a LB and who did not after fresh ET [10.5 (9.2 – 12.2) mm and 9 (8 – 11) mm, respectively, p = 0.11]. Ovarian stimulation characteristics and proportion of women who received a single embryo were similar (69% vs 68.3%, respectively, p = 0.91). Women who achieved a LB was significantly younger than those who did not [35 (32–38) and 37 (33–41), respectively, p < 0.01]. Women who had a LB and who did not after frozen-thawed ET had similar EMT of 8.4 (7.4 – 9.7) mm and 9 (8 – 10) mm, respectively (p = 0.38). Women who achieved a LB were significantly younger than those who did not [32 (29–35) vs 34 (30–38) years, p = 0.04]. The proportion of women who received a single ET was similar between women who achieved a LB and who did not after a FET [86/95 (90.5%) vs 181/192 (94.3%), respectively, p = 0.26]. Area under curve values of EMT for predicting LB in fresh, frozen-thawed and all ET were 0.56, 0.47 and 0.52, respectively. EMT and LB rate were not linearly correlated in fresh or frozen-thawed ET cycles. Limitations, reasons for caution Although our study is retrospective, no women was denied ET due to EMT in our center. Only patients undergoing ET were included in the analysis, which may introduce bias due to the selection of couples who were competent enough to produce at least one blastocyst fit for transfer. Wider implications of the findings: Since women with thin endometrium had reasonable chance for LB even in the absence of a cut-off for EMT in this unique dataset, delaying or denying ET for any given EMT value alone does not seem justified. Further studies in which ET is carried out regardless of EMT are needed. Trial registration number Not applicable

scholarly journals Serum Progesterone Level at the Day Prior to Frozen Thawed Embryo Transfer and Pregnancy Rate

2021 ◽  
pp. 221-231
Author(s):  
Merihan Mohamed Elewa ◽  
Ayman Abdelaziz Eldorf ◽  
Shahinaz Hamdy Elshorbagy ◽  
Manal Mostafa Abdallah
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Endometrial Thickness ◽  
Pregnancy Rates ◽  
Observational Research ◽  
Embryo Survival ◽  
Serum Progesterone ◽  
Laboratory Methods ◽  
Frozen Thawed Embryo Transfer ◽  
Thawed Embryo Transfer

Background: Cryopreservation's success rate varies depending on woman age, as low as 14.8% (if eggs were extracted from 40-year-old women), and as high as 31.5% with 25-year-old women. The goal of the research is to improve laboratory methods for freezing-thawing embryos, leading to elevated embryo survival rate. Yet, in hormonal replacement therapy frozen-thawed embryo transfer (HRT-FET) cycles, effective endometrial preparation before embryo transfer attracted less focus. The present research’s aim is to see whether there's a link between blood progesterone levels and pregnancy rates the day before frozen-thawed embryo transfer. Methods: This prospective observational research has investigated 120 patients of frozen-thawed embryo transfer cycle treatment, only 100 individuals subdivided to 2 groups for serum level of progesterone one day before frozen-thawed embryo transfer. The subjects visited both the Obstetrical and Gynecological Department of Tanta University as well as private centers between May 2020 and January 2021. Results: We discovered no correlation between maternal age with pregnancy test results. Yet, our study discovered highly significant variation among both groups regarding endometrial thickness one day preceding embryo transfer, and regarding pregnancy rate (p<0.05). Conclusion: The serum progesterone hormone preceding frozen embryo transfer has significant and direct relation and impact upon pregnancy rates. The present research detected low serum progesterone less than 10 nanograms/ml in the day before frozen-thawed embryo transfer in HRT-FET cycles significantly decreased probability of ongoing pregnancy post frozen-thawed embryo transfer.

Live birth after frozen–thawed embryo transfer: which endometrial preparation protocol is better?

2020 ◽  
Vol 49 (8) ◽  
pp. 101782
Author(s):  
Gulnaz Sahin ◽  
Ferruh Acet ◽  
Nilufer Calimlioglu ◽  
Reci Meseri ◽  
Ege Nazan Tavmergen Goker ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Endometrial Preparation ◽  
Frozen Thawed Embryo Transfer ◽  
Thawed Embryo Transfer

scholarly journals Co-administration of GnRH agonists with vaginal progesterone compared to vaginal progesterone in luteal phase support of the frozen-thawed embryo transfer cycle: An RCT

2021 ◽  
pp. 863-872
Author(s):  
Afsoon Zareii ◽  
Sara Davoodi ◽  
Mahshid Alborzi ◽  
Marzieh Eslami Moghadam ◽  
Elham Askary
Keyword(s):  
Embryo Transfer ◽  
Spontaneous Abortion ◽  
Luteal Phase ◽  
Pregnancy Rates ◽  
Gnrh Agonists ◽  
Ongoing Pregnancy ◽  
Luteal Phase Support ◽  
Vaginal Progesterone ◽  
Frozen Thawed Embryo Transfer ◽  
Thawed Embryo Transfer

Background: Since progesterone alone does not seem to be enough for luteal phase support (LPS), especially in frozen embryo transfer (FET) cycles, so gonadotropin-releasing hormone agonist (GnRH-a) is suggested as an adjuvant therapy in combination with progesterone for LPS. Objective: To evaluate the effects of the administration of GnRH agonists with vaginal progesterone compared to vaginal progesterone alone in luteal phase support of the frozen-thawed embryo transfer cycles. Materials and Methods: In this randomized controlled clinical trial, 240 infertile women who were candidates for FET were evaluated into two groups (n = 120/each). Group I received 400 mg vaginal progesterone twice a day from the time of transfer. The second group received vaginal progesterone and also 0.1 mg diphereline on days 0, 3, and 6 of FET for LPS. Finally, the clinical and ongoing pregnancy rates, and the implantation, and spontaneous abortion rates were compared in two groups. Results: Results showed that there was no significant difference between the mean age of women and the duration of infertility (p = 0.78, p = 0.58, respectively). There were no significant differences between groups in the terms of implantation and spontaneous abortion rates (p = 0.19, p = 0.31, respectively). However, in terms of clinical and ongoing pregnancy rates, the significant differences were seen between groups (p = 0.008 and p = 0.005, respectively). Conclusion: Co-administration of GnRH-a and vaginal progesterone in LPS may be superior to vaginal progesterone alone in women who underwent a frozen-selected embryo transfer cycle. Key words: Luteal phase, Fertilization in vitro, Embryo transfer.

scholarly journals Effect of autologous platelet rich plasma on thin endometrium in frozen thawed embryo transfer

2020 ◽  
Vol 9 (3) ◽  
pp. 1079
Author(s):  
Adaboina Anitha ◽  
Burri Sandhya Rani
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Endometrial Thickness ◽  
Platelet Rich Plasma ◽  
Study Data ◽  
Thin Endometrium ◽  
History Of ◽  
Autologous Platelet Rich Plasma ◽  
Frozen Thawed Embryo Transfer ◽  
Thawed Embryo Transfer

Background: Endometrium is one of the main factors in implantation and pregnancy. Some of the assisted reproductive technology treatment (ART) cycles get cancelled due to inadequate endometrial growth. This study was conducted to evaluate the effectiveness of PRP (platelet rich plasma) in the treatment of thin endometrium and its outcome on pregnancy and live birth rates.Methods: This study was a prospective cohort which was conducted from January 2018 to December 2018 at Laxmi Narasimha Hospital, Warangal, Telangana State. 30 patients with history of inadequate endometrial growth in frozen thawed embryo transfer cycles were recruited into the study. Intrauterine infusion of PRP was performed. Endometrial thickness was assessed.Results: 30 women were recruited in the study data of the 24 women were collected. Live birth was seen in 5 patients in the week range of 37±to 37±5 and average EMT in mm was 7.8, abortion was seen in 3 patients in the week range of 6 to 8±2 and average EMT in mm was 7.4 , chemical pregnancy was seen in 2 patients in the week range of 6 and average EMT in mm was 7.2 and number of women who were not pregnant were 14 and average EMT in mm was 7.0. Live birth was observed in 21% of the patients, abortion was observed in 13%, chemical pregnancy was seen in 9% and women who were not pregnant were 58%.Conclusions: Ability of autologous PRP to restore the endometrial receptivity of damaged endometrium has some aspects other than increasing the EMT.

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