Research question

Does subcutaneous progesterone provide similar live birth or ongoing pregnancy rates as vaginal progesterone in frozen embryo transfer (FET) cycles?

Design

Retrospective cohort study (n = 214 women), consisting of 107 women who received subcutaneous progesterone for FET in artificial cycles and 107 women receiving vaginal progesterone who were matched for age and treatment cycle rank acted as controls. All embryos were transferred in an artificial cycle with 6 mg per day oral oestradiol valerate starting on the second or third day of the menstrual cycle. Patients underwent transvaginal ultrasound on the 10th day of priming, and subcutaneous progesterone (50 mg/day) or vaginal progesterone (180 mg/day) was started if the endometrium had a trilinear pattern regardless of its thickness. Embryo transfer was carried out on the sixth day of progesterone administration. Oestradiol and progesterone were continued until a negative pregnancy test, 10 days after the transfer, or until the completion of 10th gestational week. Main outcome measures were live birth or ongoing pregnancy rates.

Results

Baseline characteristics were similar between the groups. Positive pregnancy test rates (64.5% versus 58.9%; P = 0.40; RR 1.1; 95% CI 0.89 to 1.35), live birth or ongoing pregnancy rates (39.3% versus 35.5%; P = 0.57; RR 1.11; 95% CI 0.78 to 1.56) and miscarriage rates (29% versus 25.5%; P = 0.68; RR 1.08; 95% CI 0.76 to 1.55) were similar in the subcutaneous progesterone and vaginal progesterone groups, respectively.

Conclusions

Subcutaneous progesterone seems to be an effective alternative to vaginal progesterone in patients undergoing FET. Randomized controlled trials comparing it with different progesterone preparations, routes and protocols are needed to better define its role.

中文翻译：

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皮下与阴道黄体酮在人工周期中进行玻璃化温育的囊胚转移。

研究问题

在冷冻胚胎移植（FET）周期中，皮下孕酮是否提供与阴道孕酮相似的活产或持续妊娠率？

设计

回顾性队列研究（ñ = 214名妇女），由107名在人工周期中接受皮下孕激素治疗FET的妇女和107名接受年龄和治疗周期等级相匹配的阴道孕激素的妇女作为对照。从月经周期的第二天或第三天开始，以人工周期转移所有胚胎，每天口服6 mg戊酸雌二醇酯。在启动的第10天对患者进行经阴道超声检查，如果子宫内膜不论其厚度如何均呈三线性模式，则开始皮下孕酮（50 mg /天）或阴道孕酮（180 mg /天）。在孕激素给药的第六天进行胚胎移植。雌二醇和孕酮一直持续到妊娠试验阴性，转移后10天或直到第10个孕周为止。

结果

两组之间的基线特征相似。妊娠试验阳性率（64.5％对58.9％; P  = 0.40; RR 1.1; 95％CI 0.89至1.35），活产或持续妊娠率（39.3％对35.5％; P  = 0.57; RR 1.11; 95％CI 0.78 皮下孕酮组和流产孕酮组的流产率（分别为29％和25.5％; P = 0.68; RR 1.08; 95％CI 0.76至1.55）相似。

结论

在接受FET的患者中，皮下孕酮似乎是阴道孕酮的有效替代品。需要将其与不同的孕酮制剂，途径和方案进行比较的随机对照试验，以更好地定义其作用。