Modifiye Doğal Siklus Dondurulmuş Embriyo Transferlerinde Luteal Faz Desteği Için Progesteron Takviyesi Gerekli midir?

Year 2025, Volume: 6 Issue: 1, 45 - 49, 15.03.2025

Sevinç Özmen , Gönül Özer

Abstract

Giriş: Bu çalışmanın amacı, modifiye doğal siklusta dondurulmuş embriyo transferi yapılan otuz sekiz yaş altı kadınlarda luteal faz desteği olarak progesteron takviyesinin gebelik sonuçları üzerindeki etkisini değerlendirmektir.

Yöntemler: Şişli Memorial Hastanesi, Üremeye Yardımcı Teknoloji (ÜYTE) ve Üreme Genetiği Merkezinde 2011-2023 yılları arasında gerçekleştirilen 2216 modifiye doğal siklusta yapılmış dondurulmuş embriyo transfer siklusu retrospektif olarak analiz edildi. Çalışmaya, otuz sekiz yaşın altında, en iyi kalite veya iyi kalite olarak sınıflandırılan tek embriyo transferi yapılan kadınlar dahil edildi. Orta kaliteli veya düşük kaliteli embriyoları içeren sikluslar, çift embriyo transferleri ve anöploidi için preimplantasyon genetik testi yapılan sikluslar hariç tutuldu. Vakalar üç gruba ayrılarak incelendi. Luteal faz desteği almayan Grup A (n=493), günde iki kez 200 mg vajinal mikronize progesteron alan Grup B (n=1327) ve günde 200 mg vajinal mikronize progesteron artı 25 mg subkutan progesteron alan Grup C (n=396). İstatistiksel analiz SPSS 22 kullanılarak gerçekleştirilmiştir.

Bulgular: Demografik ve siklus özellikleri gruplar arasında benzerdi. Gebelik sonuçlarında istatistiksel olarak anlamlı bir fark yoktu: canlı doğum oranları %58,4 (A), %60,8 (B) ve %60,1 (C) (p=0,650); klinik gebelik oranları %65,9 (A), %69,1 (B) ve %68,2 (C) (p=0,432); biyokimyasal düşük oranları %4,5 (A), %6,6 (B) ve %5,3 (C) (p=0,186); ve klinik düşük oranları %6,3 (A), %6,7 (B) ve %5,3 (C) (p=0,828).

Sonuç: Modifiye edilmiş doğal siklusta dondurulmuş embriyo transferi yapılan 38 yaşın altındaki kadınlarda luteal faz desteği için progesteron kullanılmasına bakılmaksızın benzer gebelik sonuçları olduğu görülmüştür.

Keywords

Modifiye doğal siklusta dondurulmuş embriyo transferi, luteal faz desteği, progesteron takviyesi.

Is Progesterone Supplementation Necessary for Luteal Phase Support in Modified Natural Cycle Frozen Embryo Transfers?

Abstract

Introduction: This study aimed to evaluate the effect of progesterone supplementation as luteal phase support on pregnancy outcomes in women under thirty-eight years of age undergoing modified natural cycle frozen embryo transfer.

Methods: A retrospective analysis was conducted on 2216 modified natural cycle frozen embryo transfers performed at Sisli Memorial Hospital, Assisted Reproductive Technology (ART), and Reproductive Genetics Centre between 2011 and 2023. The study included women under thirty-eight who transferred a single embryo, classified as top quality or good quality. Cycles involving medium-quality or poor-quality embryos, double embryo transfers, and preimplantation genetic testing for aneuploidy were excluded. Participants were categorised into three groups: Group A (n=493) with no luteal phase support, Group B (n=1327) receiving 200 mg of vaginal micronised progesterone twice daily, and Group C (n=396) receiving 200 mg of vaginal micronised progesterone plus 25 mg of subcutaneous progestin daily. Statistical analysis was performed using SPSS 22.

Results: Demographic and fresh cycle characteristics were similar among groups. There were no statistically significant differences in pregnancy outcomes: live birth rates were 58.4% (A), 60.8% (B), and 60.1% (C) (p=0.650); clinical pregnancy rates were 65.9% (A), 69.1% (B), and 68.2% (C) (p=0.432); biochemical abortion rates were 4.5% (A), 6.6% (B), and 5.3% (C) (p=0.186); and clinical abortion rates were 6.3% (A), 6.7% (B), and 5.3% (C) (p=0.828).

Conclusions: Modified natural cycle frozen embryo transfers in women under 38 years of age showed similar pregnancy outcomes regardless of using progesterone for luteal phase support.

Keywords

Modified natural cycle frozen embryo transfer (mNC-FET), Luteal phase support, Progesterone supplementation

Ethical Statement

Ethical approval: The Ethics Committee at Istanbul Memorial Sisli Hospital, located in Istanbul, Turkey, accepted this study. (Approval number: 28.06.2024/003).

References

• Czyżyk A, Podfigurna A, Genazzani AR, Męczekalski B. The role of progesterone therapy in early pregnancy: from physiological role to therapeutic utility. Gynecol Endocrinol 2017:421-4.
• Yakin K, Hela F, Oktem O. Progesterone signaling in the regulation of luteal steroidogenesis. Mol Hum Reprod 2023;29:34-42.
• Melo P, Chung Y, Pickering O, et al. Serum luteal phase progesterone in women undergoing frozen embryo transfer in assisted conception: a systematic review and meta-analysis. Fertil Steril 2021;6:1534-56.
• Bjuresten K, Landgren BM, Hovatta O, Stavreus-Evers A. Luteal phase progesterone increases live birth rate after frozen embryo transfer. Fertil Steril 2011;2:534-7.
• Coomarasamy A, Devall AJ, Brosens JJ, et al. Micronized vaginal progesterone to prevent miscarriage: a critical evaluation of randomized evidence. Am J Obstet Gynecol 2020;2:167-76.
• Horowitz E, Mizrachi Y, Finkelstein M, et al. A randomized controlled trial of vaginal progesterone for luteal phase support in modified natural cycle – frozen embryo transfer. Gynecol Endocrinol 2020:792-7.
• Kyrou D, Fatemi HM, Popovic-Todorovic B, Van den Abbeel E, Camus M, Devroey P. Vaginal progesterone supplementation has no effect on ongoing pregnancy rate in hCG-induced natural frozen–thawed embryo transfer cycles. European Journal of Obstetrics & Gynecology and Reproductive Biology 2010;2:175-9.
• Waldman I, Racowsky C, Disler E, Thomas A, Andrea L, Hornstein M. Luteal Phase Progesterone Support Does Not Improve Ongoing Pregnancies in True Natural Cycle Cryopreserved Blastocyst Stage Embryo Transfers. Fertil Steril 2020;112:456-62.
• Zhang W, Ren B, Wu S, Zhang W, Guan Y, Du X. Does the addition of luteal function support drug benefit pregnancy and perinatal outcome in modified natural cycle frozen thawed embryo transfer in women under the age of 35-year-old? Fertil Steril 2022;117:891-99.
• Jiang Y, Wang L, Shen H, et al. The effect of progesterone supplementation for luteal phase support in natural cycle frozen embryo transfer: a systematic review and meta-analysis based on randomized controlled trials. Fertil Steril 2023;4:597-605.
• Schwartz E, Bernard L, Ohl J, et al. Luteal phase progesterone supplementation following induced natural cycle frozen embryo transfer: A retrospective cohort study. J Gynecol Obstet Hum Reprod 2019;2:95-98.
• Özer G, Özkara G. Effects of embryo characteristics in frozen-thawed single euploid blastocyst transfers on pregnancy outcomes: a retrospective cohort study. The European Research Journal 2023;5:1215-23.
• Lee VC, Li RH, Ng EH, Yeung WS, Ho PC. Luteal phase support does not improve the clinical pregnancy rate of natural cycle frozen-thawed embryo transfer: a retrospective analysis. Eur J Obstet Gynecol Reprod Biol 2013;1:50-3.
• Waldman IN, Racowsky C, Disler ER, Thomas A, Lanes A, Hornstein MD. The clinical relevance of luteal phase progesterone support in true natural cycle cryopreserved blastocyst stage embryo transfers: a retrospective cohort study. Fertil Res Pract 2021;1:4.
• Ai J, Jin L, Zheng Y, Yang P, Huang B, Dong X. The morphology of inner cell mass is the strongest predictor of live birth after a frozen-thawed single embryo transfer. Front Endocrinol (Lausanne) 2021:621221.
• Nazem TG, Sekhon L, Lee JA, et al. The correlation between morphology and implantation of euploid human blastocysts. Reprod Biomed Online 2019;2:169-76.
• Wånggren K, Dahlgren Granbom M, Iliadis SI, Gudmundsson J, Stavreus-Evers A. Progesterone supplementation in natural cycles improves live birth rates after embryo transfer of frozen-thawed embryos—a randomized controlled trial. Hum Reprod 2022;10:2366-74.
• Mumusoglu S, Polat M, Ozbek IY, et al. Preparation of the Endometrium for Frozen Embryo Transfer: A Systematic Review. Front Endocrinol (Lausanne) 2021:688237.
• Practice Committees of the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility. Diagnosis and treatment of luteal phase deficiency: a committee opinion. Fertil Steril 2021;115:1416-23.