A comparative study of the effects of two different treatment periods with estradiol in endometrial preparation on the pregnancy outcome of frozen embryos

Document Type : Original Article

Authors

1 Assistant professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Hamadan University of medical science, Hamadan, Iran.

2 Associate professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Hamadan University of medical science, Hamadan, Iran.

3 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Hamadan University of medical science, Hamadan, Iran.

4 Assistant professor, Department of Epidemiology, School of public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Abstract

Introduction: Currently, there is disagreement regarding the duration of treatment with estradiol in the cycle of frozen embryo transfer and its effect on pregnancy outcomes. The present study was performed with aim to compare the duration of treatment with estradiol in the endometrial preparation in the freezing embryo transfer cycle and its effect on pregnancy outcomes in infertile women.
Methods: This randomized controlled clinical trial study was performed in 2021 on 140 infertile women candidate for assisted reproductive technology by frozen embryo transfer. The subjects were randomly allocated into two groups: intervention (estradiol recipient, for 8 days) and control (recipient of estradiol as usual, 13 days). In the intervention group, progesterone was started from the eighth day of estradiol intake and in the control group from the thirteenth day of estradiol intake. In both groups, estradiol and progesterone levels were measured the day before progesterone onset and then the embryos were transferred in the morula or blastocyst stage. Data analysis was done using SPSS statistical software (version 26) and chi-square and t-test.  P<0.05 was considered statistically significant.
Results: In the intervention and control groups, the mean serum level of estradiol during embryo transfer was 285.7 ±287.1 and 443.5 ±354.3 (P = 0.028), the mean endometrial thickness at the time of progesterone onset was 9.3 ±1.4 and 8.8 ±0.9 mm (P = 0.008), frequency of chemical pregnancy occurrence was 31.4% and 17.1% (OR = 1.1, P = 0.049) and frequency of clinical pregnancy was 27.1% and 17.1% (OR = 1.4, P = 0.154) respectively.
Conclusions: In infertile women treated with IVF assisted reproductive technology, shorter duration of treatment with estradiol in endometrial preparation and frozen embryo transfer cycle are associated with better pregnancy outcomes.

Keywords

References

  1. Abarikwu SO, Onuah CL, Singh SK. Plants in the management of male infertility. Andrologia 2020; 52(3):e13509.
  2. Starc A, Trampuš M, Pavan Jukić D, Grgas-Bile C, Jukić T, Polona Mivšek A. Infertility and sexual dysfunctions: a systematic literature review. Acta Clinica Croatica 2019; 58(3.):508-15.
  3. Kazemijaliseh H, Tehrani FR, Behboudi-Gandevani S, Hosseinpanah F, Khalili D, Azizi F. The prevalence and causes of primary infertility in Iran: a population-based study. Global journal of health science 2015; 7(6):226.
  4. Bellver J, Donnez J. Introduction: Infertility etiology and offspring health. Fertility and sterility 2019; 111(6):1033-5.
  5. Totev T, Tihomirova T, Tomov S, Gorchev G. Assisted Reproductive Technologies and Ovarian Cancerogenesis. Akusherstvo i Ginekologiia 2016; 55(2):42-4.
  6. Wise J. Assisted reproductive technology has low complication risk, US data show. BMJ: British Medical Journal (Online) 2015; 350.
  7. Bourdon M, Santulli P, Kefelian F, Vienet-Legue L, Maignien C, Pocate-Cheriet K, et al. Prolonged estrogen (E2) treatment prior to frozen-blastocyst transfer decreases the live birth rate. Human Reproduction 2018; 33(5):905-13.
  8. Sekhon L, Feuerstein J, Pan S, Overbey J, Lee JA, Briton-Jones C, et al. Endometrial preparation before the transfer of single, vitrified-warmed, euploid blastocysts: does the duration of estradiol treatment influence clinical outcome?. Fertility and Sterility 2019; 111(6):1177-85.
  9. Gruber I, Just A, Birner M, Lösch A. Serum estradiol/progesterone ratio on day of embryo transfer may predict reproductive outcome following controlled ovarian hyperstimulation and in vitro fertilization. Journal of Experimental & Clinical Assisted Reproduction 2007; 4(1):1-6.
  10. Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Human reproduction 2011; 26(7):1768-74.
  11. Fritz R, Jindal S, Feil H, Buyuk E. Elevated serum estradiol levels in artificial autologous frozen embryo transfer cycles negatively impact ongoing pregnancy and live birth rates. Journal of Assisted Reproduction and Genetics 2017; 34:1633-8.
  12. Ma WG, Song H, Das SK, Paria BC, Dey SK. Estrogen is a critical determinant that specifies the duration of the window of uterine receptivity for implantation. Proceedings of the National Academy of Sciences 2003; 100(5):2963-8.
  13. Forman R, Belaisch-Allart J, Fries N, Hazout A, Testart J, Frydman R. Evidence for an adverse effect of elevated serum estradiol concentrations on embryo implantation. Fertility and sterility 1988; 49(1):118-22.
  14. Arslan M, Bocca S, Arslan EO, Duran HE, Stadtmauer L, Oehninger S. Cumulative exposure to high estradiol levels during the follicular phase of IVF cycles negatively affects implantation. Journal of assisted reproduction and genetics 2007; 24:111-7.
  15. Imudia AN, Awonuga AO, Doyle JO, Kaimal AJ, Wright DL, Toth TL, et al. Peak serum estradiol level during controlled ovarian hyperstimulation is associated with increased risk of small for gestational age and preeclampsia in singleton pregnancies after in vitro fertilization. Fertility and sterility 2012; 97(6):1374-9.
  16. Pereira N, Elias RT, Christos PJ, Petrini AC, Hancock K, Lekovich JP, et al. Supraphysiologic estradiol is an independent predictor of low birth weight in full-term singletons born after fresh embryo transfer. Human reproduction 2017; 32(7):1410-7.
  17. Albrecht ED, Bonagura TW, Burleigh DW, Enders AC, Aberdeen GW, Pepe GJ. Suppression of extravillous trophoblast invasion of uterine spiral arteries by estrogen during early baboon pregnancy. Placenta 2006; 27(4-5):483-90.
  18. Hu XL, Feng C, Lin XH, Zhong ZX, Zhu YM, Lv PP, et al. High maternal serum estradiol environment in the first trimester is associated with the increased risk of small-for-gestational-age birth. The Journal of Clinical Endocrinology & Metabolism 2014; 99(6):2217-24.
  19. Niu Z, Feng Y, Sun Y, Zhang A, Zhang H. Estrogen level monitoring in artificial frozen-thawed embryo transfer cycles using step-up regime without pituitary suppression: is it necessary?. Journal of experimental & clinical assisted reproduction 2008; 5:1-5.
  20. Liu YF, Wang F, Huang GY, Mao XG. The relationship between the hormone levels before transplantation and the outcomes of hormone replacement therapy frozen embryo transfer. Minerva Endocrinologica 2017; 43(4):406-12.
  21. Hagshafiha M, Yecta Z, Taghavi A, Kiarang N, Oshnouei S. Evaluation of serum estradiol/progestrone ratio on day of embryo transfer and it's effect on intra cytoplasmic sperm induction outcome. Tehran University Medical Journal 2013; 71(4).
  22. Huang N, Situ B, Chen X, Liu J, Yan P, Kang X, et al. Meta-analysis of estradiol for luteal phase support in in vitro fertilization/intracytoplasmic sperm injection. Fertility and Sterility 2015; 103(2):367-73.
  23. Pinheiro LM, da Silva Cândido P, Moreto TC, Di Almeida WG, de Castro EC. Estradiol use in the luteal phase and its effects on pregnancy rates in IVF cycles with GnRH antagonist: a systematic review. JBRA assisted reproduction 2017; 21(3):247.
  24. Zhang XM, Lv F, Wang P, Huang XM, Liu KF, Pan Y, et al. Estrogen supplementation to progesterone as luteal phase support in patients undergoing in vitro fertilization: systematic review and meta-analysis. Medicine 2015; 94(8): e459.
  25. Aydin T, Kara M, Nurettin T. Relationship between endometrial thickness and in vitro fertilization-intracytoplasmic sperm injection outcome. International journal of fertility & sterility 2013; 7(1):29-34.
  26. Kasius A, Smit JG, Torrance HL, Eijkemans MJ, Mol BW, Opmeer BC, et al. Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis. Human reproduction update 2014; 20(4):530-41.
  27. Liao S, Wang R, Hu C, Pan W, Pan W, Yu D, et al. Analysis of endometrial thickness patterns and pregnancy outcomes considering 12,991 fresh IVF cycles. BMC Medical Informatics and Decision Making 2021; 21(1):1-3.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 26, Issue 3
May 2023
Pages 25-32

Files

Share

How to cite

Statistics