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Lower Pregnancy and Live Birth Rates with Vaginal Endometrin Plus Intramuscular Progesterone Every Third Day Versus
Luke Y Ying1, Bradley S Hurst2, Michelle Matthews2
1Women's Care Florida, Safety Harbor, Florida, USA.
Reproductive Sciences (Thousand Oaks, Calif.)
|June 4, 2024
Summary
Vaginal Endometrin plus intramuscular progesterone (VIM) resulted in lower pregnancy and live birth rates during frozen embryo transfer (FET) compared to daily intramuscular progesterone alone. Daily intramuscular progesterone may be a preferred method for programmed FET cycles.
Area of Science:
- Reproductive Endocrinology
- Infertility Treatment
- Embryo Transfer Technologies
Background:
- Progesterone support is crucial for successful frozen embryo transfer (FET) cycles.
- Different progesterone administration routes and combinations are used in programmed FET protocols.
- The efficacy of combined vaginal Endometrin and intramuscular progesterone (VIM) versus daily intramuscular progesterone (IM) alone in programmed FET requires investigation.
Purpose of the Study:
- To compare pregnancy and live birth rates between VIM and IM progesterone protocols in programmed FET.
- To determine if the VIM regimen is associated with inferior outcomes in programmed FET.
- To provide evidence-based recommendations for progesterone supplementation in programmed FET.
Main Methods:
- Retrospective analysis of 903 programmed frozen embryo transfers (FETs) from November 2018 to December 2021.
- Comparison of outcomes between women receiving daily IM progesterone (control) and those receiving vaginal Endometrin twice daily plus IM progesterone every third day (VIM).
- Inclusion criteria focused on single day 5 or 6 embryo transfers, with no significant baseline demographic or clinical differences between groups.
Main Results:
- The VIM group showed significantly lower positive hCG rates (60.2% vs 72.0%) and clinical pregnancy rates (40.6% vs 56.7%) compared to the IM group (P < 0.001).
- Live birth rates were significantly lower in the VIM group (36.1%) compared to the IM group (49.4%) (P < 0.0001).
- These findings persisted even after excluding FETs involving donor eggs.
Conclusions:
- The VIM regimen is associated with significantly lower pregnancy and live birth rates in programmed FET cycles compared to daily IM progesterone alone.
- Daily intramuscular progesterone monotherapy appears to be a more effective strategy for programmed frozen embryo transfers.
- Clinical practice may benefit from prioritizing daily IM progesterone over combined VIM for programmed FET.
