Heavy research: in vitro resuscitation transfer, just need to add this drug surrogate mother live birth rate increased by 42%!
With the resuscitation transplantation success rate increasing across the board, many surrogate mothers in IVF cycles prefer frozen embryo resuscitation transplantation, and in general for surrogate mothers who are able to ovulate on their own, doctors are more inclined to recommend the natural cycle.
The natural cycle is more in line with the human body’s natural state of pregnancy, with a short medication time and very low dosage of medication. This programme is also particularly suitable for our circle sisters, as the reduction in the use of oestrogen can significantly reduce the risk of hypercoagulability.
Improving the live birth rate has always been a pain point for our surrogate mothers, Circle Sisters turned to a heavyweight study in Human and Reproduction last year, where they added only one drug to increase the live birth rate of surrogate mothers by 42%.
I can’t wait to share it with you in hopes that it will help you who are entering your recovery cycle soon!
01 Luteal Support Boosts Live Birth Rate Randomised Controlled Study
It’s an already known fact that progesterone boosts live birth rates in surrogate mothers with early pregnancy preeclampsia, and progesterone is also required for frozen embryo transfers, but it’s generally used in artificial cycles.
Generally natural cycles mimic the natural process of pregnancy and progesterone is not usually given for IVF, will natural cycle use boost pregnancy rates? This is the question this article is trying to answer.
Between February 2013 and March 2018, a total of 500 subjects were randomly assigned to two 1:1 groups.
Randomisation was carried out using opaque sealed envelopes after transfer of frozen embryos in natural cycles.
The primary outcome was live birth rate; secondary outcomes were pregnancy, biochemical pregnancy, clinical pregnancy and miscarriage rates.
From the date of embryo transfer, half of the subjects received vaginal progesterone administration at 100 mg twice daily. The other half of the subjects did not receive any treatment.
On the day of embryo transfer, blood samples for serum progesterone measurements were collected from all subjects and, for the record, there were no differences in background characteristics between the study groups.
In the progesterone-supplemented group, 83 of 243 patients (34.2%) had live births, compared with 59 of 245 patients (24.1%) in the control group.
In terms of number of pregnancies, 104 out of 243 (42.8%) were in the progesterone group compared to 83 out of 245 (33.9%) in the control group.
The number of clinical pregnancies was 91 (37.4 per cent) of 243 in the progesterone group and 70 (28.6 per cent) of 245 in the control group.
In addition, there were no significant differences in biochemical pregnancy rates or miscarriage rates, and there was no correlation between these results and serum progesterone concentrations.
02 Luteal support may have a role in eventual live births
Previous studies have suggested that the timing of luteal support has an important impact on pregnancy and reproductive outcomes.
Early treatment before egg retrieval may lead to early closure of the implantation window, while late initiation of treatment 6 days after egg retrieval may also lead to reduced clinical pregnancy rates.
The timing of luteal support in this study began 3-6 days after a positive LH test and at the time of embryo transfer, which is similar to the timing of serum progesterone elevation during a normal menstrual cycle.
This is more favourable for embryo implantation, which is the consensus of previous studies.
The results of this study showed that although the statistical differences in biochemical and clinical pregnancy rates were not significant between the two groups, there was a significant difference in live birth rates.
It suggests that luteal support may have a further role in supporting ongoing pregnancy and ultimately live birth in addition to supporting embryo implantation.
Therefore, the duration of luteal support treatment needs to be considered in clinical practice, and the optimal duration of treatment in natural cycles has not been adequately studied.
These findings suggest that clinical luteal support therapy after embryo transfer has the potential to improve pregnancy outcomes, but the timing of initiation and duration of luteal support therapy needs to be carefully selected.
Also this study found that luteal support had a significant effect on improving live birth rate in day 3 day and day 5 embryos, while no significant difference was observed in day 2 and day 6 embryos.
We all know that day 3 and day 5 embryos, are of relatively higher quality compared to day 2 and day 6.
Therefore, there exists a possibility that luteal support may have a more significant effect on increasing the live birth rate when transferring better developed and high quality embryos.
This result further suggests the role of luteal support in supporting ongoing pregnancy, not just embryo implantation.
03 Progesterone levels do not predict pregnancy outcome
In this study, progesterone levels were monitored and 29 nmol/L was used as the threshold for progesterone levels on the day of embryo transfer;
Additional analyses of very low progesterone levels, with a threshold of 10 nmol/L, did not reveal any significant correlation between serum progesterone levels on the day of transfer and the final live birth rate.
These findings suggest that outcome prediction based on serum progesterone levels, as well as guiding the choice of luteal support therapy, may not be effective in the clinical setting.
In addition, serum progesterone levels may not fully reflect changes in progesterone levels in the local uterine environment during the implantation phase of the embryo, and therefore serum progesterone has limited efficacy in predicting pregnancy and live birth outcomes.
In addition many people struggle with the issue of the channel of luteal support and there is no consistency as to whether intramuscular or vaginal progesterone is better.
There is more agreement that progesterone administered vaginally can be rapidly absorbed locally and transported to high intrauterine concentrations compared to intramuscular administration.
It promotes histological changes in the endometrium of the surrogate mother’s uterus to improve the synchronisation of embryo implantation and can rapidly circulate to the ovaries to induce positive endocrine feedback for better maintenance of corpus luteum function.
In conclusion, resuscitation transfers, whether natural or artificial cycles, it seems from this study that luteal support is essential and a change of perspective may greatly enhance the surrogate mother’s live birth rate.
Also, I would like to say that there is no consistency in concluding whether to use intramuscular or vaginal administration, so you can decide on your own situation, which does not affect the final pregnancy outcome.