The effectiveness of various options for preparing the endometrium against the background of hormone replacement therapy for a thawed embryo transfer program
AbstractBackground. The article presents the results of a comparative analysis of thawed embryo transfer protocols against the background of various hormone replacement therapy regimens. The paper provides new information on the efficacy and safety of various options for preparing the endometrium for thawed embryo transfer.
The aim of the study was to compare the efficacy and safety of thawed embryo transfer protocols against the background of various hormone replacement therapy regimens.
Material and methods. A prospective cohort study was conducted, which included 87 patients in IVF programs with thawed embryo transfer (PRE). The patients were divided into three groups: group 1 (n=35) received oral estradiol 6 mg + dydrogesterone 30 mg, group 2 (n=33) received transdermal estradiol 4.5 g + dydrogesterone 30 mg, group 3 (n=19) received transdermal estradiol 4,5 g + micronized vaginal progesterone 600 mg. As methods for monitoring the effectiveness of the therapy, the following methods were used: assessment of the condition of the urogenital tract by PCR, ultrasound of the pelvic organs on the 5th–7th and 19th–21st days of the menstrual cycle, determination of the hormonal background on the 2nd–3rd day of the menstrual cycle (FSH, LH, AMH, TSH, PRL, T4sv), general clinical tests (examination in accordance with Order No. 803n).
Results. In a comparative assessment of groups of patients with different endometrial preparation regimens for the HRT RE program, the mean age was 34±4 years, and 86.2% had a history of repeated IVF program attempts. In the groups 1 and 3, the tubal factor of infertility prevailed (31.4% in the group 1, 31.5% in the group 3), in the group 2 the unclear factor of infertility prevailed and accounted for 36.4%. The thickness of the endometrium on the day of transfer was 10.1 mm in group 1, 9.8 mm and 9.5 mm in group 2 and group 3, respectively. The pregnancy rate was significantly higher when preparing the endometrium with the use of dydrogesterone – in the group 1 the rate was 54.3%, in the group 2 – 57.6%, but the data did not reach statistical significance (p>0.05). Complications of the post-transfer period in the form of bloody discharge from the genital tract of varying intensity, but not requiring hospitalization, amounted to 25,7% (n=9) in group 1, 18,2% in group 2 (n=6) and 5,3% (n=1) in group 3. The incidence of continued pregnancy up to 12 weeks in group 1 of the study was 28,6% in 10 patients, 18,2% (n=6) and 21,1% (n=4) in group 2 and group 3, respectively. The highest rate of live births was among group 1 of patients – 28,6% (n=10). In the group 1, patients noted better tolerability and convenience of using the oral form of therapy.
Conclusion. With the introduction of new technologies in reproduction, there is a need to increase the number of cryotransfers within the framework of ART programs. Choosing a PRE protocol scheme is sometimes a difficult task. When comparing the effectiveness and safety of thawed embryo transfer protocols against the backdrop of various hormone replacement therapy regimens, it was shown that the pregnancy rate was significantly higher in the preparation of endometrium with dirogesterone – in the group 1 the indicator was 54,3%, in the group 2 – 57.6%, and the rate of live births was the highest in the group 1 and was 28.6%. The oral method of application of therapy is noted as the most convenient for doctors and has a high degree of detail among patients.
Keywords:перенос размороженных эмбрионов; заместительная гормональная терапия; эстрадиол; дидрогестерон; микронизированный прогестерон
Финансирование. Исследование не имело спонсорской поддержки.
Конфликт интересов. Автор заявляет об отсутствии конфликта интересов.
Для цитирования: Сабирова В.Л., Миннуллина Ф.Ф., Курбатина М.М. Эффективность различных вариантов подготовки эндометрия на фоне заместительной гормональной терапии к программе переноса размороженного эмбриона // Акушерство и гинекология: новости, мнения, обучение. 2024. Т. 12, № 2. С. 59–64. DOI: https://doi.org/10.33029/2303-9698-2024-12-2-59-64
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