Comparative analysis of pregnancy outcomes after embryo transfer in a stimulated in vitro fertilisation cycle depending on the progestogen type used for post-transfer support
Khramtsova A.Yu., Bashmakova N.V., Semenov Yu.A., Karibaeva Sh.K., Melkozerova O.A.
Background: The choice of the optimal medication for post-transfer support in fresh embryo transfer in vitro fertilization (IVF) programs is an important issue in the choice of personalized therapy which is mainly aimed at improving perinatal outcomes.
Objective: To evaluate pregnancy outcomes after IVF programs with fresh embryo transfer depending on the type of progestogen used for the post-transfer support.
Materials and methods: This was a retrospective study conducted at the Urals Scientific Research Institute for Maternal and Child Care, Yekaterinburg in the period from February 2019 to December 2022. The study included 390 pregnant patients with a history of infertility who had stimulated IVF cycles with fresh embryo transfer. All women were divided into two groups: group 1 included 143 patients who received dydrogesterone 30 mg/day orally as luteal phase (LP) support after transvaginal puncture until 12–20 weeks gestation, and group 2 included 247 patients who received micronized vaginal progesterone (MVP) 600 mg/day vaginally as supportive therapy until 20 weeks gestation. The primary outcome measure was live birth rate, while the secondary outcome measure was the rate of early pregnancy termination (miscarriage), preterm and term labor, and pregnancy complications.
Results: Among gynecological diseases, polycystic ovary syndrome was statistically significantly more frequent in patients with LF dydrogesterone support than in patients with MVP support (20/143 (14%) and 18/247 (7.3%) respectively, p=0.020). Pregnancy outcomes were analyzed according to the type of progestogen used for the post-transfer support. The rate of term delivery was 84/143 (58.7%), the rate of pregnancy termination before 22 weeks was 34/143 (23.8%), and the rate of preterm delivery was 25/143 (17.5%) in the group of patients who took dydrogesterone. The rate of term delivery was 153/247 (61.9%), the rate of pregnancy termination was 50/247 (20.2%), and the rate of preterm delivery was 44/247 (17.8%) in the group of patients who received MVP. There were no statistically significant differences in the rate of pregnancy outcomes depending on the type of progesterone used for the post-transfer support (dydrogesterone or MVP) (p>0.05). Pregnancy-induced hypertension with or without proteinuria was statistically significantly more frequent in patients who took MVP for the post-transfer support, 24/247 (9.7%), compared to 6/143 (4.2%) in the dydrogesterone group (OR=2.457, 95% CI: 0.98-6.164, p=0.045).
Conclusion: The results of the analyses showed comparable effectiveness of progestogens used for the post-transfer support (dydrogesterone or MVP) on pregnancy outcomes in the IVF cycle; the data did not reach statistically significant differences. According to the results obtained in the study, it can be concluded that the use of dydrogesterone helped to reduce late pregnancy complications such as pre-eclampsia. It is necessary to conduct further studies to evaluate perinatal outcomes of pregnancies after IVF programs depending on the type of progestogen used for the post-transfer support.
Authors’ contributions: Bashmakova N.V. – developing the concept and design of the study; Khramtsova A.Yu. – collecting and processing the material; Khramtsova A.Yu., Karibaeva Sh.K. – statistical processing of the data; Khramtsova A.Yu., Bashmakova N.V. – writing the text; Semenov Y.A., Melkozerova O.A. – editing the article.
Conflicts of interes: The authors declare that there are no conflicts of interest.
Funding: The study was conducted without sponsorship.
Ethical Approval: The study was approved by the Ethical Review Board of the Urals Scientific Research Institute for Maternal and Child Care, Ministry of Health of Russia.
Patient Consent for Publication: The patients provided an informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Khramtsova A.Yu., Bashmakova N.V., Semenov Yu.A., Karibaeva Sh.K., Melkozerova O.A.
Comparative analysis of pregnancy outcomes after embryo transfer in a stimulated in vitro
fertilisation cycle depending on the progestogen type used for post-transfer support.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (10): 130-137 (in Russian)
https://dx.doi.org/10.18565/aig.2024.236
Keywords
assisted reproductive technologies
in vitro fertilization
dydrogesterone
micronized progesterone
pregnancy after ART
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Received 17.09.2024
Accepted 22.10.2024
About the Authors
Alexandra Yu. Khramtsova, PhD, obstetrician-gynecologist, Senior Researcher at the Department of ART, Urals Research Institute of Maternity and Child Care,Ministry of Health of Russia, 620028, Russia, Yekaterinburg, Repin str., 1, +7(912)68-26-726, aleksaxr@mail.ru, SPIN-code: 2467-5326, Scopus AuthorID: 57214320389,
https://orcid.org/0000-0002-4304-3516
Nadezda V. Bashmakova, Dr. Med. Sci., Professor, Honored Doctor of the Russian Federation, Chief Obstetrician-Gynecologist of the Ural Federal District, Head of the Department of ART, Chief Researcher, Urals Research Institute of Maternity and Child Care, Ministry of Health of Russia, 620028, Russia, Yekaterinburg, Repin str., 1, +7(343)371-87-68, BashmakovaNV@niiomm.ru, SPIN-code: 9604-0089, Scopus AuthorID: 270915
Yuri A. Semenov, Dr. Med. Sci., Director, Urals Research Institute of Maternity and Child Care, Ministry of Health of Russia, 620028, Russia, Yekaterinburg, Repin str., 1, +7(343)371-87-68, u-sirius@mail.ru, SPIN-code: 1461-0646, Scopus AuthorID: 928332
Sholpan K. Karibaeva, PhD, Director for Strategic Development, PERSONA International Clinical Center for Reproductive Medicine, Kazakhstan, Almaty,
sh.karibaeva@gmail.com, Scopus AuthorID: 57216159167, https://orcid.org/0000-0001-5691-8652
Oksana A. Melkozerova, Dr. Med. Sci., Associate Professor, Deputy Director for Scientific Work, Urals Research Institute of Maternity and Child Care,
Ministry of Health of Russia, 620028, Russia, Yekaterinburg, Repin str., 1, +7(343)-371-24-27, +7(922)219-45-06, abolmed1@mail.ru, https://orcid.org/0000-0002-4090-0578
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