Effect of elevated progesterone levels the day before ovulation on pregnancy outcomes in natural cycles of frozen thawed embryo transfer

Abstract

Objective

We aimed to analyze whether elevated progesterone levels on the day before ovulation affected pregnancy outcomes in natural cycles of frozen thawed embryo transfer (NC-FET).

Methods

A retrospective analysis was conducted in a public university hospital. Data on clinical pregnancy, live birth, ectopic pregnancy, and miscarriage rates were collected, along with other patient data. Patients were divided into two groups according to their progesterone levels the day before ovulation: the progesterone elevation (PE) group (progesterone level >1.0 ng/mL) and the normal progesterone (NP) group (progesterone level ≤1.0 ng/mL). We assessed the effect of elevated progesterone levels in NC-FET by performing multivariate logistic regression analysis.

Results

Overall 1159 women with tubal factor infertility who underwent NC-FET were enrolled, including 666 women who received cleavage-stage embryo transfers and 493 women who received blastocyst embryo transfers. When two cleavage-stage embryos were transferred, the clinical pregnancy rate was significantly higher in the PE than in the NP group following NC-FET (p < .05). After correcting for various confounders, we found that elevated progesterone levels (adjusted odds ratio [OR]: 1.672; 95% confidence interval [CI]: 1.089–2.566, p = .018) improved the clinical pregnancy rate following transfer of two cleavage-stage embryos but did not affect the pregnancy rate when blastocyst-stage embryos were transferred (adjusted OR: 0.856; 95% CI: 0.536–1.369; p = .517).

Conclusions

The results showed that in patients undergoing cleavage-stage NC-FET, progesterone levels >1.0 ng/mL improved the clinical pregnancy rates. However, the level of progesterone had no effect on the clinical pregnancy rate for patients undergoing blastocyst-stage NC-FET.

摘要

目的

本研究旨在分析排卵前一天孕酮水平升高是否影响冻融胚胎移植（NC-FET）自然周期中的妊娠结局。

方法

在一所公立大学医院进行回顾性分析。收集了临床妊娠、活产、异位妊娠和流产率的数据以及其他患者数据。患者根据排卵前一天的孕酮水平分为两组：孕酮升高（PE）组（孕酮水平>1.0ng/ml）和正常孕酮（NP）组（孕酮水平≤1.0ng/ml）。我们通过多变量逻辑回归分析评估了孕酮水平升高对NC-FET的影响。

结果

共纳入1159名接受NC-FET治疗的输卵管因素不孕患者, 其中666名接受卵裂期胚胎移植, 493名接受囊胚胚胎移植。当移植两个卵裂期胚胎时, NC-FET后PE组的临床妊娠率显著高于NP组（p<0.05）。在校正各种混杂因素之后研究发现, 孕酮水平升高（调整后比值比[OR]：1.672；95%置信区间[CI]:1.089-2.566, p=0.018）改善了植入两个卵裂期胚胎的临床妊娠率, 但不影响囊胚期胚胎移植时的妊娠率（调整后OR：0.856；95%CI：0.536-1.369；p=0.517）。

结论

结果表明, 在卵裂期NC-FET患者中, 孕酮水平>1.0ng/ml可提高临床妊娠率。然而, 孕酮水平对接受囊胚期NC-FET患者的临床妊娠率没有影响。

Keywords:

• Progesterone elevation
• frozen-thawed embryo transfer
• clinical pregnancy rate
• natural cycle
• endometrial decidualization

关键词:

• 孕酮升高
• 冻融胚胎移植
• 临床妊娠率
• 自然周期
• 子宫内膜蜕膜化

Data availability

Derived data supporting the findings of this study are available from the corresponding author on reasonable request. Data will be provided for ethical/privacy reasons.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 82071649) and the Key Scientific Research Projects of Higher Education Institutions in Henan Province (Grant No. 22A320025).