1. Overweight and obesity affect the efficacy of vaginal vs. intramuscular progesterone for luteal-phase support in vitrified-warmed blastocyst transfer
- Author
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Jinlin, Xie, Na, Li, Haiyan, Bai, Juanzi, Shi, and He, Cai
- Subjects
Reproductive Medicine ,Obstetrics and Gynecology - Abstract
To compare the difference in live birth rates (LBRs) between vaginal and intramuscular progesterone as luteal support in programmed vitrified-warmed blastocyst transfer cycles and to determine whether the association was moderated by overweight/obesity.Retrospective cohort study.Tertiary reproductive medicine center.Patients undergoing transfer of single vitrified-warmed blastocyst in a programmed cycle between January 2018 and June 2021.Vaginal progesterone or intramuscular progesterone as luteal support. Analysis was performed using the generalized estimating equations (GEE) framework and multivariate regression models. Interaction testing was used to determine whether overweight/obesity (body mass index of 25 or higher) moderated the association between progesterone replacement and LBRs.The primary outcome was live birth. The secondary outcomes were biochemical pregnancy, clinical pregnancy, miscarriage and total pregnancy loss.A total of 6905 programmed cycles (4616 with vaginal progesterone and 2289 with intramuscular progesterone) were included in the analysis. In the general cohort undergoing cryopreserved blastocyst transfer, the LBRs were 46.23% in vaginal progesterone group versus 48.62% in intramuscular progesterone group, respectively (OR 0.91, 95%CI 0.82-1.01; aOR 0.89, 95%CI 0.81-0.98), with a significantly increased rate of pregnancy losses in vaginal progesterone group compared with intramuscular progesterone group (22.22% versus 18.90%; OR 1.23, 95% CI 1.08-1.39; aOR 1.23, 95% CI 1.08-1.40). Among normal weight women, the LBRs among vaginal progesterone group were lower than that among intramuscular progesterone group (aOR 0.84, 95% CI 0.75-0.95). Whereas, among women with overweight/obesity, the LBRs were similar between the two groups of progesterone replacement (aOR 1.06, 95% CI 0.86-1.33). Interaction testing of routes of progesterone administration and overweight/obesity was significant (P=0.03).Luteal support with vaginal progesterone was associated with reduced LBRs compared with intramuscular progesterone for vitrified-warmed blastocyst transfer and the association was modified by maternal overweight/obesity. Further research is needed to better understand the mechanisms behind the association.
- Published
- 2023