Effect of intramuscular progesterone supplementation on clinical and ongoing pregnancy rates in patients with low serum progesterone levels on the day of embryo transfer in artificial frozen cycles / Abdelfatah Mohamed Kamel Eldesouky ; Supervised Fouad Abdelkader Abuhamila , Radwa Mohamed Fahmy , Ahmed Mohamed Elbakry

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Gynecology and Obstetrics

Aim: To investigate whether intramuscular progesterone supplementation will improve clinical pregnancy rates and ongoing pregnancy rates in patients with decreased serum progesterone levels on the day of embryo transfer in artificial frozen cycles. Methods: After obtaining informed consent and applying inclusion & exclusion criteria, patients undergoing frozen cycles following ICSI received artificial endometrial preparation starting from Day 2/3 of their cycle in the form of 2mg Estradiol Valerate pills three times daily (white pills of Cyclo-Progynova®, Bayer, Germany) which resumed for 7-10 days. After this time period a transvaginal 2D ultrasound was done using a Mindray DP-5 (50/60 Hz) model ultrasound and if an endometrial thickness greater than 7mm was noted, progesterone supplementation was initiated via Prontogest® 400mg vaginal pessaries twice daily (Prontogest®, Marcyrl, Egypt) for 5 complete days, ending with the day of embryo transfer.On the morning of embryo transfer, a blood sample was drawn from the patients and sent to the lab for serum progesterone measurement. After receiving the results, if the value was under 9.2 ng/ml, intramuscular progesterone supplementation with (Prontogest® 100mg, IBSA, Egypt) was initiated in twice-weekly doses (every 3 days) in addition to the twice-daily vaginal progesterone and continued until quantitative Ý-hcg was done 14 days after the date of embryo transfer. If positive, then an ultrasound was doneto confirm/exclude clinical pregnancies after 4 weeks from the day of embryo transfer (primary outcome). If clinical pregnancy was detected, luteal phase support was continued until 12 weeks of pregnancy to detect the ongoing pregnancy rate (secondary outcome), after which luteal phase support was discontinued owing to the dominance of placental steroidogenesis by this time. If serum progesterone on the day of embryo transfer was over 9.2ng/ml, only the traditional twice daily vaginal progesterone was resumed. In either case; if chemical or clinical pregnancy was not established, luteal phase support was discontinued. Results: In Group 1 (those with serum progesterone levels >9.2 ng/ml), the mean serum progesterone level on the day of ET was 13.43 ng/ml, with chemical, clinical and ongoing pregnancy rates of 68.9%, 61% and 56.5% respectively. Group 2 (those with serum progesterone levels <9.2 ng/ml), had a mean serum progesterone level of 4.62 ng/ml, with chemical, clinical and ongoing pregnancy rates of 63.8%, 58.8% and 53.1% respectively

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