P-572 Hormonal Monitoring and Progesterone Adjustment in Frozen Embryo Transfer Cycles
Authors: Mansour Z , Ali H , Anis S , Orief Y 
Published: June 2022

Abstract

Study question
We investigated the effect of monitoring and follow-up of serum progesterone, estradiol & luteinizing hormone levels and progesterone supplement adjustments on pregnancy outcomes for FET in programmed HRT cycles.

Summary answer
Monitoring and follow-up of different hormones in patient’s serum in programmed frozen embryo transfer cycles didn’t have an impact on overall pregnancy rate.

What is known already
Frozen Embryo transfer treatment rapidly expanded in recent years. FET can effectively prevent IVF associated complications, such as ovarian hyperstimulation syndrome and multiple pregnancy. In addition, FET serves as a safe & cost-effective way to increase cumulative pregnancy rate.
Though progesterone levels on the day of transfer have not yet been studied extensively in humans, tailoring the time of transferring a frozen embryo based on serial P4 values rather than cycle day number alone results in higher pregnancy rates.The value of measuring the serum E2 levels on the day of embryo transfer as an indicator for clinical pregnancy is still doubtful.

Study design, size, duration
Six Hundred FETs were performed in a randomized prospective manner in an infertility center in Alexandria starting from 2019 till 2021.These were further subdivided based on computer randomization into Group I (Non-intervention) including300 patients with only ultrasound monitoring & Group II (intervention) including 300 patients with monitoring of serum level of progesterone, estrogen & luteinizing hormone as well as progesterone supplement adjustments.

Participants/materials, setting, methods
Group I (Non-intervention) including300 patients with only ultrasound monitoring & Group II (intervention) including 300 patients with monitoring of serum level of progesterone, estrogen & luteinizing hormone as well as progesterone supplement adjustments which are further subdivided into three groups depending on progesterone level in patient’s serum early in the morning prior to embryo transfer. Group II A: P4 levels &lt; 5ng/dl, Group II B: P4 levels 5-10ng/dl, Group II C: P4 levels &gt;10ng

Main results and the role of chance
Live birth and overall pregnancy rate showed no significant difference among group monitored with ultrasound only compared to the hormonal monitored group. However, on the day of embryo transfer, serum P4 &gt; 11.83 ng/ml represented a cut-off value above which there is marked increase in OPR/LBR and a sensitivity of 53.7% & specificity of 51.2% in predicting pregnancy. Also, serum E2 value more than 292 pg/ml at day 18 demonstrated an increase in OPR/LBR.In our study, the cut off value of LH level less than of 10.8 IU/L at day13 had a sensitivity of 58.3% & specificity of 50.4% in predicting pregnancy. Regarding pregnancy outcome, monitoring of LH levels didn’t generate useful data with no added prognostic value.Conclusion: Monitoring and follow-up of different hormones in patient’s serum in programmed frozen embryo transfer cycles didn’t have an impact on live birth, overall pregnancy & abortion rate when compared to ultrasound only in non-intervention group.

Limitations, reasons for caution
Patients in non-intervention group didn’t have a hormonal pre-transfer assessment so it’s not possible to determine if the progesterone levels are suboptimal or not when compared to intervention group.
Also, we didn’t have a post transfer hormonal assessment in case group to determine whether the progesterone dose reached desired levels.

Wider implications of the findings
Kofinas et al. proposed in his study that in order to optimize pregnancy and rate, P4 levels in FET cycles should be sustained between 10 and 20 ng/ml.
This was in accordance to our study where the cut off value of P4 on day of 11.83 ng/ml optimized pregnancy rates.

Trial registration number
NCT05189145