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Agonist IVF-ICSI-ET sikluslarında luteal faz desteği için verilen östradiol’ün gebelik oranlarına etkisi

Year 2021, Volume: 46 Issue: 2, 403 - 409, 30.06.2021
https://doi.org/10.17826/cumj.735887

Abstract

Amaç: Bu çalışmanın amacı agonist in-vitro fertilizasyon (IVF) / intrasitoplazmik sperm enjeksiyonu (ICSI) / embriyo transferi (ET) siklüslerinde, luteal faz desteği için progesterona ek olarak estrojen vermenin gebelik oranları üzerine etkisinin araştırılmasıdır.
Gereç ve Yöntem: Bu çalışmaya toplamda IVF / ICSI endikasyonu olan 142 hasta çalışmaya alındı. Hastalar, oosit toplama işleminden (OPU) sonra luteal destek için progesteron (kontrol grubu n = 71) ve ek olarak transdermal östrojen (çalışma grubu n = 71) verilmek üzere randomize edildi. Östrojen seviyeleri, embriyonun transfer gününde ve transfer sonrası 12. günde ölçüldü. Çalışmanın esas sonucu devam eden gebelik oranıdır. Her iki grup indüksiyon özellikleri, östrojen seviyeleri, β-hCG pozitifliği ve düşük oranları açısından da karşılaştırıldı.
Bulgular: Gruplar arasında yaş, infertilite süresi ve endikasyon açısından istatistiksel olarak anlamlı fark yoktu. Her iki grup indüksiyon özellikleri ve E2 düzeyleri açısından benzerdi. β-hCG pozitiflik oranı benzerdi ve devam eden gebelik oranı her iki grupta benzerdi. Biyokimyasal ve klinik abortus oranları açısından da her iki grup arasında anlamlı fark yoktu. 12. gün östrojen seviyesi gebelik elde edilen hastalarda, elde edilemeyenlere göre anlamlı düzeyde yüksekti.
Sonuç: Çalışmamız; luteal destek amacı ile progesterona ek olarak östrojen eklenmesinin β-hCG pozitifliği, devam eden gebelik ve düşük oranları üzerinde olumlu bir etkisi olmadığını göstermiştir.

References

  • 1. Wilcox AJ, Baird DD, Weinberg CR. Time of implantation of the conceptus and loss of pregnancy. N. Engl J Med 1999; 340:1796-9. 2. Makrigiannakis A, Minas V. Mechanisms of implantation. Reprod Biomed Online 2007; 14:102-9 3. Pritts EA, Atwood AK. Luteal phase support in infertility treatment: a metaanalysis of the randomized trials. Human Reproduction. 2002; 17:2287.
  • 4. Tomic V, Kasum M, Vucic K. The role of luteal support during IVF: a qualitative systematic review. Gynecol Endocrinol. 2019;1-6. doi: 10.1080/09513590.2019.1603288. [Epub ahead of print]
  • 5. Pabuccu R1, Akar ME. Luteal phase support in assisted reproductive technology. Curr Opin Obstet Gynecol. 2005;17(3):277-81.
  • 6. Daya S. Gonadotropin-releasing hormone agonist protocols for pituitary desensitization in vitro fertilization and gamete intrafallopian transfer cycles. Cochrane Database Syst Rev 2000; CD001299.
  • 7. Elgindy EA, Sibai H, Mostafa MI, Gibreel A, Darwish E, Maghraby H E.A. Towards an optimal luteal support modality in agonist triggered cycles: a randomized clinical trial. Hum Reprod. 2018;33(6):1079-1086.
  • 8. Farhi J, Weissman A, Steinfeld Z, Shorer M, Nahum H, Levran D. Oestradiol supplementation during the luteal phase may improve the pregnancy rate in patients undergoing in vitro fertilization–embryo transfer cycles. Fertil Steril. 2000;73:761–766.
  • 9. Drakakis P, Loutradis D, Vomvolaki E, Stefanidis K, Kiapekou E, Anagnostou E, et al. Luteal oestrogen supplementation in stimulated cycles may improve the pregnancy rate in patients undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer. Gynecol Endocrinol. 2007;23:645–652.
  • 10. Lukaszuk K, Liss J, Lukaszuk M, Maj B. Optimization of oestradiol supplementation during the luteal phase improves the pregnancy rate in women undergoing in vitro fertilization–embryo transfer cycles. Fertil Steril. 2005;83:1372–1376.
  • 11. Engmann L, DiLuigi A, Schmidt D, Benadiva C, Maier D, Nulsen J.The effect of luteal phase vaginal estradiol supplementation on the success of in vitro fertilization treatment: a prospective randomized study. Fertil Steril. 2008; 89:554-561
  • 12. Serna J, Cholquevilque JL, Cela V, Salazar JM, Requena A, Velasco GV. Estradiol supplementation during the luteal phase of IVF-ICSI patients: a randomized, controlled trial. Fertil Steril 2008; 90:2190-2195.
  • 13. Ismail Madkour WA, Noah B, Abdel Hamid AM, Zaheer H, Al-Bahr A, Shaeer M, Moawad A. Luteal phase support with estradiol and progesterone versus progesterone alone in GnRH antagonist ICSI cycles: a randomized controlled study. Hum Fertil (Camb). 2016;19(2):142-9
  • 14. Haspels DA, Andriesse R. The effect of large doses of estrogens post coitum in 2000 women. Eur J Obstet Gynecol Repro Biol 1973; 3/4:113.
  • 15. Gorkemli H, Ak D, Akyurek C, Aktan M, Duman S. Comparison of pregnancy outcomes of progesterone or progesterone + estradiol for luteal phase support in ICSI-ET cycles. Gynecol Obstet Invest. 2004;58(3):140-4.
  • 16. Ozkaya E, Kutlu T, Abide Yayla C, Kayatas Eser S, Sanverdi I, et al. Area under the curve of temporal estrogen and progesterone measurements during assisted reproductive technology: which hormone is the main determinant of cycle outcome? J Obstet Gynaecol Res. 2018;44(2):263-269. 17. Makrigiannakis A, Minas V. Mechanisms of implantation. Reprod Biomed Online 2007;14:102–109.
  • 18. Valbuena D, Martin C, De Paplo JL, Ramohi J, Pellicer A, Simon C. Increasing levels of oestradiol are deleterious to embryonic implantation because they directly affect the embryo. Fertil Steril 2001; 76:962-968.
  • 19. Gelbaya TA, Kyrgiou M, Tsoumpou I, Nardo LG. Tarek A. The use of estradiol for luteal phase support in vitro fertilization/intracytoplasmic sperm injection cycles: a systematic review and meta-analysis. Fertil Steril. 2008;90(6):2116-25.
  • 20. Jee BC, Suh CS, Kim SH, Kim YB, Moon SY. Effects of oestradiol supplementation during the luteal phase of in vitro fertilization cycles: a meta-analysis. Fertil Steril. 2010;93:428–436.
  • 21. Huang N, Situ B, Chen X, Liu J, Yan P, Kang X, et al. Metaanalysis of oestradiol for luteal phase support in vitro fertilization/ intracytoplasmic sperm injection. Fertil Steril. 2015;103: 367–373.e5.
  • 22. van der Linden M, Buckingham K, Farquhar C, Kremer JAM, Metwally M. Luteal phase support for assisted reproduction cycles. The Cochrane Database of Systematic Reviews CD009154.
  • 23. Demir B, Dilbaz S, Cinar O, Ozdegirmenci O, Dede S, Dundar B, et al. Estradiol supplementation in intracytoplasmic sperm injection cycles with thin endometrium. Gynecol Endocrinol. 2013; 29(1): 42–45.
  • 24. Kasapoglu I, Düzok N, Şen E, Çakır C, Avcı B, Uncu G. Luteal oestradiol for patients with serum oestradiol levels lower than expected per oocyte. Hum Fertil (Camb). 2019;29:1-7.

The effect of estradiol on pregnancy rates for luteal phase support in IVF-ICSI-ET agonist cycles

Year 2021, Volume: 46 Issue: 2, 403 - 409, 30.06.2021
https://doi.org/10.17826/cumj.735887

Abstract

Purpose: The aim of this study was to investigate the effect of transdermal estrogen on pregnancy rates in addition to progesterone for luteal phase support in agonist in-vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) / embriyo transfer (ET) cycles.
Material and Methods: This randomized controlled study (RCT) enrolled a total of 142 patients with an indication for IVF/ICSI. We randomized patients prospectively to administer either progesterone (control group n=71) and additionally transdermal estrogen patch (study group n=71) as luteal support after oocyte retrieval. The levels of estrogen was determined on the day of transfer of embryo and 12th day. The main outcome measure was the ongoing pregnancy rate. Both groups were also compared for the induction characteristics, estrogen levels, β-hCG positivity, and abortion rates.
Results: There were no significant differences between the groups according to age, infertility time, and indications. Both groups were similar for induction characteristics and E2 levels. β-hCG positivity rate was similar and the ongoing pregnancy rate was similar in both groups. Biochemical and clinical abortion rates were also similar in both groups. On the 12th day, estrogen levels increased significantly in those who became pregnant group.
Conclusion: Our study showed that adding supplementary estrogen to the progesterone has no positive effect on β-hCG positivity, ongoing pregnancy, and abortion rates.

References

  • 1. Wilcox AJ, Baird DD, Weinberg CR. Time of implantation of the conceptus and loss of pregnancy. N. Engl J Med 1999; 340:1796-9. 2. Makrigiannakis A, Minas V. Mechanisms of implantation. Reprod Biomed Online 2007; 14:102-9 3. Pritts EA, Atwood AK. Luteal phase support in infertility treatment: a metaanalysis of the randomized trials. Human Reproduction. 2002; 17:2287.
  • 4. Tomic V, Kasum M, Vucic K. The role of luteal support during IVF: a qualitative systematic review. Gynecol Endocrinol. 2019;1-6. doi: 10.1080/09513590.2019.1603288. [Epub ahead of print]
  • 5. Pabuccu R1, Akar ME. Luteal phase support in assisted reproductive technology. Curr Opin Obstet Gynecol. 2005;17(3):277-81.
  • 6. Daya S. Gonadotropin-releasing hormone agonist protocols for pituitary desensitization in vitro fertilization and gamete intrafallopian transfer cycles. Cochrane Database Syst Rev 2000; CD001299.
  • 7. Elgindy EA, Sibai H, Mostafa MI, Gibreel A, Darwish E, Maghraby H E.A. Towards an optimal luteal support modality in agonist triggered cycles: a randomized clinical trial. Hum Reprod. 2018;33(6):1079-1086.
  • 8. Farhi J, Weissman A, Steinfeld Z, Shorer M, Nahum H, Levran D. Oestradiol supplementation during the luteal phase may improve the pregnancy rate in patients undergoing in vitro fertilization–embryo transfer cycles. Fertil Steril. 2000;73:761–766.
  • 9. Drakakis P, Loutradis D, Vomvolaki E, Stefanidis K, Kiapekou E, Anagnostou E, et al. Luteal oestrogen supplementation in stimulated cycles may improve the pregnancy rate in patients undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer. Gynecol Endocrinol. 2007;23:645–652.
  • 10. Lukaszuk K, Liss J, Lukaszuk M, Maj B. Optimization of oestradiol supplementation during the luteal phase improves the pregnancy rate in women undergoing in vitro fertilization–embryo transfer cycles. Fertil Steril. 2005;83:1372–1376.
  • 11. Engmann L, DiLuigi A, Schmidt D, Benadiva C, Maier D, Nulsen J.The effect of luteal phase vaginal estradiol supplementation on the success of in vitro fertilization treatment: a prospective randomized study. Fertil Steril. 2008; 89:554-561
  • 12. Serna J, Cholquevilque JL, Cela V, Salazar JM, Requena A, Velasco GV. Estradiol supplementation during the luteal phase of IVF-ICSI patients: a randomized, controlled trial. Fertil Steril 2008; 90:2190-2195.
  • 13. Ismail Madkour WA, Noah B, Abdel Hamid AM, Zaheer H, Al-Bahr A, Shaeer M, Moawad A. Luteal phase support with estradiol and progesterone versus progesterone alone in GnRH antagonist ICSI cycles: a randomized controlled study. Hum Fertil (Camb). 2016;19(2):142-9
  • 14. Haspels DA, Andriesse R. The effect of large doses of estrogens post coitum in 2000 women. Eur J Obstet Gynecol Repro Biol 1973; 3/4:113.
  • 15. Gorkemli H, Ak D, Akyurek C, Aktan M, Duman S. Comparison of pregnancy outcomes of progesterone or progesterone + estradiol for luteal phase support in ICSI-ET cycles. Gynecol Obstet Invest. 2004;58(3):140-4.
  • 16. Ozkaya E, Kutlu T, Abide Yayla C, Kayatas Eser S, Sanverdi I, et al. Area under the curve of temporal estrogen and progesterone measurements during assisted reproductive technology: which hormone is the main determinant of cycle outcome? J Obstet Gynaecol Res. 2018;44(2):263-269. 17. Makrigiannakis A, Minas V. Mechanisms of implantation. Reprod Biomed Online 2007;14:102–109.
  • 18. Valbuena D, Martin C, De Paplo JL, Ramohi J, Pellicer A, Simon C. Increasing levels of oestradiol are deleterious to embryonic implantation because they directly affect the embryo. Fertil Steril 2001; 76:962-968.
  • 19. Gelbaya TA, Kyrgiou M, Tsoumpou I, Nardo LG. Tarek A. The use of estradiol for luteal phase support in vitro fertilization/intracytoplasmic sperm injection cycles: a systematic review and meta-analysis. Fertil Steril. 2008;90(6):2116-25.
  • 20. Jee BC, Suh CS, Kim SH, Kim YB, Moon SY. Effects of oestradiol supplementation during the luteal phase of in vitro fertilization cycles: a meta-analysis. Fertil Steril. 2010;93:428–436.
  • 21. Huang N, Situ B, Chen X, Liu J, Yan P, Kang X, et al. Metaanalysis of oestradiol for luteal phase support in vitro fertilization/ intracytoplasmic sperm injection. Fertil Steril. 2015;103: 367–373.e5.
  • 22. van der Linden M, Buckingham K, Farquhar C, Kremer JAM, Metwally M. Luteal phase support for assisted reproduction cycles. The Cochrane Database of Systematic Reviews CD009154.
  • 23. Demir B, Dilbaz S, Cinar O, Ozdegirmenci O, Dede S, Dundar B, et al. Estradiol supplementation in intracytoplasmic sperm injection cycles with thin endometrium. Gynecol Endocrinol. 2013; 29(1): 42–45.
  • 24. Kasapoglu I, Düzok N, Şen E, Çakır C, Avcı B, Uncu G. Luteal oestradiol for patients with serum oestradiol levels lower than expected per oocyte. Hum Fertil (Camb). 2019;29:1-7.
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Obstetrics and Gynaecology
Journal Section Research
Authors

Çiğdem Akcabay 0000-0003-2068-7412

İbrahim Ürünsak 0000-0002-4056-6434

Ümran Küçükgöz Güleç 0000-0003-3094-1381

Esra Cihan 0000-0002-3940-5959

Mete Sucu 0000-0002-6889-7147

Yılmaz Atay This is me 0000-0002-3298-3334

Publication Date June 30, 2021
Acceptance Date November 14, 2020
Published in Issue Year 2021 Volume: 46 Issue: 2

Cite

MLA Akcabay, Çiğdem et al. “Agonist IVF-ICSI-ET sikluslarında Luteal Faz desteği için Verilen östradiol’ün Gebelik oranlarına Etkisi”. Cukurova Medical Journal, vol. 46, no. 2, 2021, pp. 403-9, doi:10.17826/cumj.735887.