BACKGROUND Endometrial preparation with hormone replacement therapy (HRT) is the preferred regimen for clinicians due to the opportunity to schedule the day of embryo transfer and for patients due to the requirement of fewer visits for frozen-warmed embryo transfers (FET). The increasing number of FETs raises the question of the serum P levels required to optimize the pregnancy outcome on the embryo transfer day. METHODS This prospective cohort study includes patients who underwent single euploid FET. All patients received HRT with oestradiol valerate (EV) and 100 mg of intramuscular (IM) progesterone (P). FET was scheduled 117-120 h after the first IM administration of 100 mg P. The serum P level was analyzed 1 h before the embryo transfer (ET). In all cycles, only embryos that were biopsied on day 5 were utilized for FET. Next generation sequencing (NGS) was used for comprehensive chromosomal analysis. RESULTS Overall, the ongoing pregnancy rate (OPR) was 58.9% (99/168). Data were then categorized according to the presence (Group I; n = 99) or the absence (Group II; n = 69) of an ongoing pregnancy. No significant differences regarding, female age, body mass index (BMI), number of previous miscarriages, number of previous live birth, sperm concentration, number of oocytes retrieved, number of mature oocytes (MII), rate of fertilized oocytes with two pronuclei (2PN), trophectoderm score, inner cell mass (ICM) score, endometrial thickness (mm), oestrodiol (E2) and P levels prior to IM P administration were found between two groups. The P levels on the day of ET (ng/ml) were significantly higher in Group I (28 (5.6-76.4) vs 16.4 (7.4-60) p = 0.039). The P level on the day of ET was a predictor of a higher OPR (p < 0.001 OR: 1.033 95%CI [1.009-1.056]) after multivariate analysis. The ROC curve showed a significant predictive value of serum P levels on the day of ET for OPR, with an AUC (95%CI) = 0.716 (0.637-0.795). The optimal cut-off value for prediction of the OPR was a P level of 20.6 ng/ml (71.7% sensitivity, 56.5% specificity). CONCLUSIONS The present study suggests a minimum threshold of the serum P value on the day of ET that needs to be reached in HRT cycles to optimize the clinical outcome. Individualization of the P dosage should be evaluated in further studies.

中文翻译：

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在转移当天测量血清孕酮水平可以是增加单次整倍体冷冻囊胚转移正在进行妊娠的另一种工具。

背景技术由于有机会安排胚胎移植的一天的机会，子宫内膜的激素替代疗法（HRT）的制备是临床医生的首选方案，而对于冷冻温热的胚胎移植（FET）的访问次数较少，这种方案对于患者来说是首选的方案。FET数量的增加提出了在胚胎移植当天优化妊娠结局所需的血清P水平的问题。方法这项前瞻性队列研究包括接受单一整倍体FET的患者。所有患者均接受戊酸雌二醇（EV）和肌内孕酮（P）100 mg的HRT。首次IM 100 mg P给药后117-120 h安排FET。在胚胎移植（ET）1 h之前分析血清P水平。在所有周期中，仅将在第5天进行活检的胚胎用于FET。下一代测序（NGS）用于全面的染色体分析。结果总体而言，持续妊娠率（OPR）为58.9％（99/168）。然后根据持续妊娠的存在（I组； n = 99）或不存在（II组； n = 69）对数据进行分类。在女性年龄，体重指数（BMI），先前的流产次数，先前的活产次数，精子浓度，回收的卵母细胞数量，成熟的卵母细胞数量（MII），具有两个前核的受精卵母细胞的比率（（ 2PN），IMP给药前在两组之间发现了滋养外胚层得分，内细胞质量（ICM）得分，子宫内膜厚度（mm），雌二醇（E2）和P水平。第一组ET当天的P水平（ng / ml）显着更高（28（5.6-76.4）vs 16.4（7.4-60）p = 0.039）。多元分析后，ET当天的P水平是OPR较高的预测指标（p <0.001 OR：1.033 95％CI [1.009-1.056]）。ROC曲线显示了ET当天血清P水平对于OPR的显着预测价值，AUC（95％CI）= 0.716（0.637-0.795）。预测OPR的最佳临界值为P水平为20.6 ng / ml（灵敏度为71.7％，特异性为56.5％）。结论本研究建议在HRT周期中需要达到ET当天血清P值的最低阈值，以优化临床结果。P剂量的个体化应在进一步研究中进行评估。AUC（95％CI）= 0.716（0.637-0.795）。预测OPR的最佳临界值为P水平为20.6 ng / ml（灵敏度为71.7％，特异性为56.5％）。结论本研究建议在HRT周期中需要达到ET当天血清P值的最低阈值，以优化临床结果。P剂量的个体化应在进一步研究中进行评估。AUC（95％CI）= 0.716（0.637-0.795）。预测OPR的最佳临界值为P水平为20.6 ng / ml（灵敏度为71.7％，特异性为56.5％）。结论本研究建议在HRT周期中需要达到ET当天血清P值的最低阈值，以优化临床结果。P剂量的个体化应在进一步研究中进行评估。