BACKGRAUND
One of the advantages of ovarian stimulation using protocol with GnRH antagonists in patients with risk of ovarian hyperstimulation syndrome (OHSS) is the opportunity to use GnRH agonist for final oocyte maturation. There is a luteal phase deficiency while usage of such treatment, which can lead to lower clinical pregnancy rate (CPR). Possible method to compensate this negative effect is «American» approach for luteal phase support (combination of high doses of progesterone and estrogens).
OBJECTIVE
Evaluation of efficacy of fresh embryo transfers in ART (assisted reproductive technologies) cycles with substitution of trigger and usage of «American» approach for luteal phase support.
MATERIAL AND METHODS
Patients undergoing ART cycles during 2018 in International Centre for Reproductive Medicine were included into the study. We carried out retrospective analysis of efficacy of fresh embryo transfers in the cycles of ovarian stimulation with GnRH antagonist protocol and GnRH agonist for final oocyte maturation and «American» approach for luteal phase support. The outcomes of the study were clinical pregnancy rate (CPR) (determined as gestational sac can be seen through ultrasound examination 3 weeks later after embryo transfer), ongoing pregnancy rate (embryonic heartbeat can be seen 5 weeks after embryo transfer), live birth rate.
RESULTS
We analyzed medical records of 111 patients at the age between 18 and 40 years old. We used recombinant or highly purified urinary gonadotrophins for ovarian stimulation, triptorelin 0.2 mg s.c. for final oocyte maturation. For luteal phase support we used micronized progesterone 600 mg in combination with dydrogesterone 60 mg per day or oleal solution of progesterone 1% 2.0 i.m. Estrogens (estradiol valerate) were prescribed in accordance of endometrium thickness at the day of triggering at the dose from 2 and up to 6 mg per day. Embryo transfers were performed at the blastocyst stage in 77.4% and at morula stage in 22.6% of cases. An average number of transferred embryos was 1.5±0.05. There were no one case of OHSS. CPR was 40.5%, ongoing pregnancy rate was 31.5%, live birth rate was 76.9% (per clinical pregnancy).
CONCLUSIONS
Fresh embryo transfer after substitution of trigger for final oocyte maturation while usage of «American» approach for luteal phase support can be effective for main ART outcomes. It can be used in some cases (in cases of impossibility of cycle segmentation), but further prospective studies are needs for widely recommendations.
