Estrogen in Luteal Phase Support: Effects on IVF-ICSI Antagonist Protocol Pregnancy Results

Year 2022, Volume: 12 Issue: 6, 978 - 983, 30.11.2022

Cemre Alan Hüseyin Görkemli

https://doi.org/10.16899/jcm.1125489

Abstract

Aim: This study aimed to investigate the effect of luteal phase support (LPS) with estradiol in addition to progesterone on pregnancy outcomes in patients who underwent ovulation induction with GnRH antagonist protocol in in vitro fertilization- intracytoplasmic sperm injection (IVF-ICSI).
Materials and Methods: This retrospective study was carried out at reproductive medicine center of Necmettin Erbakan University Meram Medical Faculty. The study enrolled 128 patients undergoing ICSI on an antagonist protocol for controlled ovarian hyperstimulation. Study group administered 7.8 mg transdermal estradiol (E2) daily in addition to progesterone for LPS (n=64). Control group administered only progesterone for LPS (n=64). All women received 200 mg progesterone 3x1 intravaginal daily and 50 mg progesterone intramuscular injection per two days for LPS. Blood samples were drawn 12 days after embryo transfer for β-hCG. If the result is negative, treatment was discontinued, if positive, estradiol was discontinued and progesterone support was continued until the 10th week of gestation. Pregnancy outcomes were the main endpoint.
Results: There was no difference between groups in terms of biochemical pregnancy, clinical pregnancy, abortus and ongoing pregnancy rates.
Conclusion: In our study, the use of estrogen for luteal phase support in GnRH antagonist protocol did not show any difference on pregnancy outcomes.

Keywords

Luteal phase support, estradiol, GnRH antagonist, ICSI

Luteal Faz Desteğinde Östrojen: IVF-ICSI Antagonist Protokolde Gebelik Sonuçları Üzerine Etkisi

Abstract

Giriş: Bu çalışma GnRH antagonist protokolle IVF-ICSI yapılan hastalarda luteal faz desteğinde (LFD) progesterone ek olarak östradiol verilmesinin gebelik sonuçlarına etkisini incelemeyi amaçlamaktadır.
Gereç ve Yöntem: Bu retrospektif çalışma Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Yardımla Üreme Teknikleri Merkezinde yapılmıştır. Çalışmaya GnRH antagonist protokolle kontrollü ovaryan stimülasyon uygulanacak 128 hasta katılmıştır. Çalışma grubuna LFD’de progesterona ek olarak günlük 7.8 mg transdermal estradiol (E2) uygulanmıştır (n=64). Kontrol grubu LFD için sadece progesteron kullanmıştır (n=64). Tüm kadınlara LFD’ de günlük 200 mg progesteron 3x1 intravajinal ve gün aşırı 50 mg progesteron intramuskuler uygulanmıştır. β-hCG için kan örnekleri embryo transferinden 12 gün sonra alınmıştır. Sonuç negatifse tedavi sonlandırılmış, pozitifse estradiol sonlandırılıp progesteron desteği gebeliğin 10. Haftasına kadar sürdürülmüştür. Gebelik sonuçları esas hedef olarak belirlenmiştir.
Bulgular: Gruplar arasında biyokimyasal gebelik, klinik gebelik, abortus ve devam eden gebelik oranları açısından fark bulunamadı.
Sonuç: Çalışmamızda GnRH antagonist protokol LFD’de östrojen kullanımı gebelik sonuçları üzerinde farklılık göstermedi.

Keywords

Luteal faz desteği, estradiol, GnRH antagonist, ICSI

References

• 1. Ubaldi F, Bourgain C, Tournaye H, Smitz J, Van Steirteghem A, Devroey P. Endometrial evaluation by aspiration biopsy on the day of oocyte retrieval in the embryo transfer cycles in patients with serum progesterone rise during the follicular phase. Fertil Steril 1997;67(3):521-6.
• 2. Pados G, Devroey P. Luteal phase support. Assist Reprod Rev 1992;2:148.
• 3. Fatemi HM, Camus M, Kolibianakis EM et al. The luteal phase of recombinant follicle stimulating hormone/ gonadotropin releasing hormone antagonist in vitro fertilization cycles during supplementation with progesterone or progesterone and estradiol. Fertil Steril 2006;87(3):504-8.
• 4. Chang EM, Han JE, Won HJ, Kim YS, Yoon TK, Lee WS. Effect of estrogen priming through luteal phase and stimulation phase in poor responders in in-vitro fertilization. J Assist Reprod Genet 2012;29(3):225-30.
• 5. Fanchin R, CunhaFilho JS, Schonauer LM, Kadoch IJ, CohenBacri P, Frydman R. Coordination of early antral follicles by luteal estradiol administration provides a basis for alternative controlled ovarian hyperstimulation regimens. Fertil Steril 2003;79(2):316-21.
• 6. Fanchin R, Salomon L, CasteloBranco A, Olivennes F, Frydman N, Frydman R. Luteal estradiol pretreatment coordinates follicular growth during controlled ovarian hyperstimulation with GnRH antagonists. Hum Reprod 2003;18(12):2698-703.
• 7. Ireland JJ, Richards JS. Acute effects of estradiol and folliclestimulating hormone on specific binding of human [125I] iodofolliclestimulating hormone to rat ovarian granulosa cells in vivo and in vitro. Endocrinol 1978;102:876–83.
• 8. Hutchinson-Williams K, Lunenfeld B, Diamond M, Lagy G, Boyers S, De Cherney A. Human chorionic gonadotropin, estradiol, and progesterone profiles in conception and non-conception cycles in an in vitro fertilization program. Fertil Steril 1989;52:441-445.
• 9. Pritts EA, Atwood AK. Luteal phase support in infertility treatment: a meta-analysis of the randomized trials. Hum Reprod 2002;17(9):2287-99.
• 10. Tavaniotou A, Devroey P. Luteal hormonal profile of oocyte donors stimulated with a GnRH antagonist compared with natural cycles. Reprod Biomed Online 2006;13(3):326-30.
• 11. Serna J, Cholquevilque JL, Cela V, Martínez-Salazar J, Requena A, Garcia-Velasco JA. Estradiol supplementation during the luteal phase of IVF-ICSI patients: a randomized, controlled trial. Fertil Steril 2008;90(6):2190-5.
• 12. 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(3):554-61.
• 13. Farhi J, Weissman A, Steinfeld Z, Shorer M, Nahum H, Levran D. Estradiol supplementation during the luteal phase may improve the pregnancy rate in patients undergoing in vitro fertilization-embryo transfer cycles. Fertil Steril 2000;73(4):761-6.
• 14. Jung, H, Roh HK. The effects of E2 supplementation from the early proliferative phase to the late secretory phase of the endometrium in hMG-stimulated IVF-ET. J Assist Reprod Genet 2000;17: 28-33.
• 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. Gelbaya TA, Kyrgiou M, Tsoumpou I, Nardo LG. The use of estradiol for luteal phase support in in vitro fertilization/intracytoplasmic sperm injection cycles: a systematic review and meta-analysis. Fertil Steril 2008;90(6):2116-25.
• 17. Kolibianakis EM, Venetis CA, Papanikolaou EG, Diedrich K, Tarlatzis BC, Griesinger G. Estrogen addition to progesterone for luteal phase support in cycles stimulated with GnRH analogues and gonadotrophins for IVF: a systematic review and meta-analysis. Hum Reprod. Jun 2008;23(6):1346-54.
• 18. Jee BC, Suh CS, Kim SH, Kim YB, Moon SY. Effects of estradiol supplementation during the luteal phase of in vitro fertilization cycles: a meta-analysis. Fertil Steril 2010;93(2):428-36.
• 19. van der Linden M, Buckingham K, Farquhar C, et al. Luteal phase support for assisted reproduction cycles. Cochrane Database Syst Rev CD009154 2011.
• 20. Friedler S, Gilboa S, Schachter M, Raziel A, Strassburger D, Ron ER. Luteal phase characteristics following GnRH antagonist or agonist treatment - a comparative study. Reprod Biomed Online 2006;12(1):27-32.
• 21. Ismail Madkour WA, Noah B, Abdel Hamid AM et al. 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.
• 22. Pinheiro LMA, Cândido PDS, Moreto TC, Almeida WGD, Castro EC. Estradiol use in the luteal phase and its effects on pregnancy rates in IVF cycles with GnRH antagonist: a systematic review. JBRA Assist Reprod 2017;21(3):247-50.
• 23. Kwon SK, Kim CH, Lee KH et al. Luteal estradiol supplementation in gonadotropin-releasing hormone antagonist cycles for infertile patients in vitro fertilization. Clin Exp Reprod Med 2013;40(3):131-4.
• 24. Huang N, Situ B, Chen X et al. Meta-analysis of estradiol for luteal phase support in in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril 2015;103(2):367-73.
• 25. Scheffer JB, Scheffer BB, Carvalho RF et al. A comparison of the effects of three luteal phase support protocols with estrogen on in vitro fertilization-embryo transfer outcomes in patients on a GnRH antagonist protocol. JBRA Assist Reprod 2019;23(3):239-245.