Does the Time of Starting Progesterone Luteal Support Affect Embryo Transfer in Long Agonist Protocol Downregulated ICSI
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REPRODUCTIVE ENDOCRINOLOGY: CLINICAL TRIALS
Does the Time of Starting Progesterone Luteal Support Affect Embryo Transfer in Long Agonist Protocol Downregulated ICSI Cycles? A Randomized Controlled Trial M. E. Ghanem 1 & M.H. Bedairy 1,2 & A. Shaaban 3 & Ibrahim A Albahlol 1,2,4 Received: 11 May 2020 / Accepted: 27 August 2020 # Society for Reproductive Investigation 2020
Abstract The aim of this study was to compare the effects of starting progesterone (P4) luteal support (LS) on day of egg retrieval (ER) or day of embryo transfer (ET) on the ratio of difficult ET and cycle outcome. This was a RCT (ClinicalTrials.gov Identifier: NCT03040830) carried out at Mansoura Integrated Fertility Center (MIFC), Mansoura, Egypt, from November 2015 to January 2017. A total of 171 eligible long agonist ICSI cases were randomly allocated on day of ER into group A (86) starting LS as daily IM 100 mg P4 on day of ER and group B (85) starting P4-LS on day of ET. Difficult ET was defined as blood on ET catheter and/ or sounding or dilating the cervix. Primary outcome was the overall ratio of difficult ET and ratios on day 3 and 5 ET. Secondary outcome was the ongoing pregnancy rate (OPR) and implantation rate (IR). The results are presented as % for groups A and B respectively: overall difficult ET (44.1, 24.7) (p = 0.009); day 3 difficult ET (23.2, 24.4) (p = 0.45); day 5 difficult ET (62.7, 25.6) (p = 0.001); overall OPR (38.3, 44.7) (p = 0.43); day 3 ET OPR (41.8, 33.3) (p = 0.51); day 5 ET OPR (34.8, 57.5) (p = 0.048); overall IR (20.0, 22.5) (p = 0.62); day 3 ET IR (17.8, 13.4) (p = 0.44); day 5 ET IR (22, 34.1) (p = 0.09). In conclusion, starting P4 luteal support on egg retrieval day is associated with significantly higher ratio of difficult embryo transfer and lower ongoing pregnancy rate and tendency to lower IR in day 5 ET, so starting P4-LS on day of ET is recommended. Keywords Progesterone . Luteal support . Embryo transfer
Introduction Embryo transfer procedure is considered the last and among the most critical steps of the IVF/ICSI cycles. Three-quarters of embryo transfer (ET) maneuvers pass easily and only varied degrees of difficulty are encountered in a quarter of patients [1, 2]. Difficult ET is defined on the bases of the presence of the following: advancement of ET loaded catheter through cervical canal is accompanied by resistance that necessitates cervical
* Ibrahim A Albahlol [email protected] 1
Mansoura Integrated Fertility Centre (MIFC), Mansoura, Egypt
2
Department of Obstetrics and Gynecology, College of Medicine, Mansoura University, Mansoura, Egypt
3
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
4
Department of Obstetrics and Gynecology, College of Medicine, Jouf University, Sakaka, Saudi Arabia
traction, with sounding or even cervical dilatation and results in blood on transfer catheter [3, 4]. It is well known that dysfunctional luteal phase results from pituitary downregulation by GnRH analogues in ART cycles. To combat such deficiency, administration of exogenous progeste
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